Text of US HB 6637 (2020)

I 116TH CONGRESS 2D SESSION H. R. 6637 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2020 Mr. GARCI´A of Illinois (for himself, Ms. PRESSLEY, Ms. JUDY CHU of Cali- fornia, Mr. RICHMOND, Mr. ESPAILLAT, Mr. VELA, Mr. VARGAS, Ms. BARRAGA´N, Ms. ROYBAL-ALLARD, Mr. SOTO, Ms. TLAIB, Mr. HIGGINS of New York, Mr. HUFFMAN, Mr. GREEN of Texas, Ms. NORTON, Ms. GARCIA of Texas, Mr. TAKANO, Mr. SERRANO, Ms. JACKSON LEE, Mrs. BEATTY, Mr. BISHOP of Georgia, Mr. THOMPSON of Mississippi, Mr. LEWIS, Ms. WILSON of Florida, Ms. SEWELL of Alabama, Mr. GOMEZ, Ms. MOORE, Mr. CARSON of Indiana, Ms. LEE of California, Mrs. DAVIS of California, Mr. SABLAN, Mrs. HAYES, Mrs. NAPOLITANO, Ms. BONAMICI, Ms. CLARKE of New York, Ms. KELLY of Illinois, Mrs. WAT- SON COLEMAN, Mr. DOGGETT, Ms. OMAR, Ms. BLUNT ROCHESTER, Mrs. TRAHAN, Ms. OCASIO-CORTEZ, Ms. SA´NCHEZ, Ms. ESCOBAR, Mr. CARBAJAL, Mr. CASTRO of Texas, Mr. CA´RDENAS, Mr. GRIJALVA, Ms. CASTOR of Florida, Mr. MCNERNEY, Mr. CORREA, Ms. MENG, Mr. RUSH, Ms. VELA´ZQUEZ, Ms. JAYAPAL, Mr. EVANS, Mr. CASTEN of Illi- nois, Mr. GALLEGO, Mr. SARBANES, Mr. MEEKS, Ms. JOHNSON of Texas, Mr. BROWN of Maryland, Ms. LOFGREN, Mr. BUTTERFIELD, Mr. NAD- LER, Mr. ENGEL, Mr. KENNEDY, Mr. MCGOVERN, Mr. HASTINGS, Mrs. CAROLYN B. MALONEY of New York, Mr. MCEACHIN, Mr. SIRES, Mr. PAYNE, Mr. SCHIFF, Mr. JOHNSON of Georgia, Mr. KHANNA, Mr. HORSFORD, Mr. SAN NICOLAS, Ms. BASS, and Mr. DANNY K. DAVIS of Illinois) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Agriculture, Oversight and Reform, Ways and Means, Education and Labor, the Judiciary, the Budget, Veterans’ Affairs, Natural Resources, Armed Services, and Homeland Security, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 6637 IH A BILL To improve the health of minority individuals, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Accountability Act of 2020’’. 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 data for the Medicare program. 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, gender identity, and so- cioeconomic status in collection of health data. Sec. 109. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 110. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 111. Clarification of simplified administrative reporting requirement. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH CARE Sec. 201. Definitions; findings. Sec. 202. Improving access to services for individuals with limited English pro- ficiency. Sec. 203. Ensuring standards for culturally and linguistically appropriate serv- ices in health care. Sec. 204. Culturally and linguistically appropriate health care in the Public Health Service Act. Sec. 205. Pilot program for improvement and development of State medical in- terpreting services. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 6637 IH Sec. 206. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. Sec. 207. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 208. Increasing understanding of and improving health literacy. Sec. 209. Requirements for health programs or activities receiving Federal funds. Sec. 210. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 211. English for speakers of other languages. Sec. 212. Implementation. Sec. 213. Language access services. Sec. 214. Medically underserved populations. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving institutions, historically Black colleges and univer- sities, Asian American and Native American Pacific Islander- serving institutions, Tribal Colleges, regional community-based organizations, and national minority medical associations. 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. Sec. 314. Study and report on strategies for increasing diversity. Sec. 315. Conrad State 30 and physician retention. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Subtitle A—Improvement of Coverage Sec. 401. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. 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. Indian defined in title I of the Patient Protection and Affordable Care Act. Sec. 407. Removing Medicare barrier to health care. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 6637 IH 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. Sec. 410. Medicaid coverage for citizens of freely associated states. Sec. 411. At-risk youth Medicaid protection. Subtitle B—Expansion of Access Sec. 412. Amendment to the Public Health Service Act. Sec. 413. Protecting sensitive locations. Sec. 414. Grants for racial and ethnic approaches to community health. Sec. 415. Border health grants. Sec. 416. Critical access hospital improvements. Sec. 417. Establishment of Rural Community Hospital (RCH) Program. Sec. 418. Medicare remote monitoring pilot projects. Sec. 419. Rural Health Quality Advisory Commission and demonstration projects. Sec. 420. Rural health care services. Sec. 421. Community health center collaborative access expansion. Sec. 422. Facilitating the provision of telehealth services across State lines. Sec. 423. Scoring of preventive health savings. Sec. 424. Sense of Congress on maintenance of effort provisions regarding chil- dren’s health. Sec. 425. Protection of the HHS Offices of Minority Health. Sec. 426. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 427. Study of DSH payments to ensure hospital access for low-income pa- tients. Sec. 428. Assistant Secretary of the Indian Health Service. Sec. 429. Reauthorization of the Native Hawaiian Health Care Improvement Act. Sec. 430. Availability of non-English language speaking providers. Sec. 431. Access to essential community providers. Sec. 432. Provider network adequacy in communities of color. Sec. 433. Improving access to dental care. Sec. 434. Providing for a special enrollment period for pregnant individuals. Sec. 435. Coverage of maternity care for dependent children. Sec. 436. Federal employee health benefit plans. Sec. 437. Continuation of Medicaid income eligibility standard for pregnant in- dividuals and infants. Subtitle C—Advancing Health Equity Through Payment and Delivery Reform Sec. 441. Sense of Congress. Sec. 442. Centers for Medicare & Medicaid Services reporting and value-based programs. Sec. 443. Development and testing of disparity reducing delivery and payment models. Sec. 444. Diversity in Centers for Medicare & Medicaid consultation. Sec. 445. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle D—Health Empowerment Zones VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 6637 IH 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 of Secretary. Sec. 457. Authorization of appropriations. 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. MOMMA’s Act. Sec. 506. Rural maternal and obstetric modernization of services. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing unintended teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. 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. Expansion of CDC prevention research centers program to include centers on optimal maternity outcomes. Sec. 519. Expanding models allowed to be tested by Center for Medicare & Medicaid Innovation to include maternity care models. Sec. 520. Development of interprofessional maternity care educational models and tools. Sec. 521. Including services furnished by certain students, interns, and resi- dents supervised by certified nurse midwives within inpatient hospital services under Medicare. Sec. 522. Grants to professional organizations to increase diversity in maternal, reproductive, and sexual health professionals. Sec. 523. Interagency update to the quality family planning guidelines. Sec. 524. 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. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 6637 IH 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 mental health disparities research gaps. Sec. 605. Health professions competencies to address racial and ethnic mental health disparities. Sec. 606. Geoaccess study. Sec. 607. Asian American, Native Hawaiian, Pacific Islander, and Hispanic and Latino behavioral and mental health outreach and education strategies. Sec. 608. Mental health in schools. Sec. 609. Building an effective workforce in mental health. Sec. 610. Mental health at the border. 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. Prostate research, imaging, and men’s education (PRIME). Sec. 704. Prostate cancer detection research and education. Sec. 705. National Prostate Cancer Council. Sec. 706. Improved Medicaid coverage for certain breast and cervical cancer pa- tients in the territories. Sec. 707. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 708. Reducing cancer disparities within Medicare. Sec. 709. Cancer clinical trials. 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, Obesity, 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. Sec. 737. Guide on evidence-based strategies for public health department obe- sity prevention programs. Subtitle E—HIV/AIDS Sec. 741. Statement of policy. Sec. 742. Findings. Sec. 743. Additional funding for AIDS drug assistance program treatments. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 6637 IH 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. 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 HIV in prison. Sec. 759. Support data system review and indicators for monitoring HIV care. Sec. 760. Transfer of funds for implementation of ending the HIV epidemic: a plan for America. Subtitle F—Diabetes Sec. 771. Research, treatment, and education. Sec. 772. Research, education, and other activities. Sec. 773. Research, education, and other activities. Sec. 774. Research, education, and other activities. Sec. 775. Updated report on health disparities. Subtitle G—Lung Disease Sec. 776. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 777. Asthma-related activities of the Centers for Disease Control and Pre- vention. Sec. 778. Influenza and pneumonia vaccination campaign. Sec. 779. Chronic obstructive pulmonary disease action plan. Subtitle H—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. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 6637 IH 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—Kidney Disease Research, Surveillance, Prevention, and Treatment Sec. 797. Kidney disease, research, surveillance, prevention, and treatment. Sec. 798. Kidney disease research in minority populations. Sec. 799. Kidney disease action plan. Sec. 799A. Home dialysis and increasing end-stage renal disease treatment mo- dalities in minority communities action plan. Sec. 799B. Increasing kidney transplants in minority communities. Sec. 799C. Environmental and occupational health programs. Sec. 799D. Understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations. Sec. 799E. Improving access in underserved areas. 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. Sec. 803. Nondiscrimination and health equity in health information tech- nology. Sec. 804. Language access in health information technology. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Sec. 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. Sec. 823. Assessment of use and misuse of de-identified health data. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 6637 IH 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 (including sex ori- entation, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, fa- milial status, sexual orientation, gender identity, or disability status. Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. 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. Sec. 1009. Establish an interagency counsel and grant programs on social de- terminants of health. Sec. 1010. Correcting hurtful and alienating names in government expression (CHANGE). Subtitle B—Gun Violence Sec. 1011. Findings. 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. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 6637 IH 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) Over the next few decades, the United 20 States will face a shortage of health care providers 21 and allied health workers. 22 (4) All efforts to reduce health disparities and 23 barriers to quality health services require better and 24 more consistent data, and better and more con- 25 sistent collection of and access to data. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 6637 IH (5) A full range of culturally and linguistically 1 appropriate health care and public health services 2 must be available and accessible in every community. 3 (6) Racial and ethnic minorities and under- 4 served populations must be included early and equi- 5 tably in health reform innovations. 6 (7) Efforts to improve minority health have 7 been limited by inadequate resources in funding, 8 staffing, stewardship, and accountability. Targeted 9 investments that are focused on disparities elimi- 10 nation must be made in providing care and services 11 that are community-based, including prevention and 12 policies addressing social determinants of health. 13 (8) In 2011, the Department of Health and 14 Human Services developed the HHS Action Plan to 15 Reduce Racial and Ethnic Health Disparities and 16 the National Stakeholder Strategy for Achieving 17 Health Equity, which are 2 strategic plans that rep- 18 resent the first coordinated roadmap in the United 19 States to reducing health disparities. These com- 20 prehensive plans, along with the National Prevention 21 Strategy issued by the National Prevention Council 22 of the Department of Health and Human Services, 23 Healthy People 2030, and the National Quality 24 Strategy of the Agency for Healthcare Research and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 6637 IH Quality, as well as critical resources such as the 1 2012 National Healthcare Quality and Disparities 2 Reports, will work to increase the number of people 3 in the United States who are healthy at every stage 4 of life. 5 (9) The Secretary of Health and Human Serv- 6 ices has also reviewed and advanced updated clinical 7 guidelines and developed other strategic planning 8 documents to combat health disparities with a high 9 impact on minority populations and to provide high- 10 quality family planning services. Such guidelines and 11 documents include the National HIV/AIDS Strategy, 12 the Action Plan for the Prevention, Care, and Treat- 13 ment of Viral Hepatitis, and recommendations of the 14 Centers for Disease Control and Prevention and the 15 Office of Population Affairs. 16 (10) The Patient Protection and Affordable 17 Care Act (Public Law 111–148), as amended by the 18 Health Care and Education Reconciliation Act (Pub- 19 lic Law 111–152), represents the biggest advance- 20 ment for minority health in the 40 years imme- 21 diately preceding the enactment of this Act. 22 (11) The Health Information Technology for 23 Educational and Clinical Health Act of 2009, part 24 of the American Recovery and Reinvestment Act of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 13 •HR 6637 IH 2009 (Public Law 111–5), provides that the nation- 1 wide health information exchange infrastructure be 2 developed and used to reduce health disparities, 3 among other purposes. 4 TITLE I—DATA COLLECTION 5 AND REPORTING 6 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 7 ACT. 8 (a) PURPOSE.—It is the purpose of the amendment 9 made by this section to promote data collection, analysis, 10 and reporting by race, ethnicity, sex, primary language, 11 sexual orientation, disability status, gender identity, age, 12 and socioeconomic status among federally supported 13 health programs. 14 (b) AMENDMENT.—Title XXXIV of the Public 15 Health Service Act, as added by titles II and III of this 16 Act, is further amended by inserting after subtitle B the 17 following: 18 ‘‘Subtitle C—Strengthening Data 19 Collection, Improving Data 20 Analysis, and Expanding Data 21 Reporting 22 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 23 ‘‘(a) REQUIREMENTS.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 14 •HR 6637 IH ‘‘(1) IN GENERAL.—Each health-related pro- 1 gram shall— 2 ‘‘(A) require the collection, by the agency 3 or program involved, of data on the race, eth- 4 nicity, sex, primary language, sexual orienta- 5 tion, disability status, gender identity, age, and 6 socioeconomic status of each applicant for and 7 recipient of health-related assistance under such 8 program, including— 9 ‘‘(i) using, at a minimum, standards 10 for data collection on race, ethnicity, sex, 11 primary language, sexual orientation, gen- 12 der identity, age, socioeconomic status, and 13 disability status as each are developed 14 under section 3101; 15 ‘‘(ii) collecting data for additional 16 population groups if such groups can be 17 aggregated into the race and ethnicity cat- 18 egories outlined by standards developed 19 under section 3101; 20 ‘‘(iii) using, where practicable, the 21 standards developed by the Health and 22 Medicine Division of the National Acad- 23 emies of Sciences, Engineering, and Medi- 24 cine (formerly known as the ‘Institute of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 15 •HR 6637 IH Medicine’) in the 2009 publication, entitled 1 ‘Race, Ethnicity, and Language Data: 2 Standardization for Health Care Quality 3 Improvement’; and 4 ‘‘(iv) where practicable, collecting 5 such data through self-reporting; 6 ‘‘(B) with respect to the collection of the 7 data described in subparagraph (A), for appli- 8 cants and recipients who are minors, require 9 communication assistance in speech or writing, 10 and for applicants and recipients who are other- 11 wise legally incapacitated, require that— 12 ‘‘(i) such data be collected from the 13 parent or legal guardian of such an appli- 14 cant or recipient; and 15 ‘‘(ii) the primary language of the par- 16 ent or legal guardian of such an applicant 17 or recipient be collected; 18 ‘‘(C) systematically analyze such data 19 using the smallest appropriate units of analysis 20 feasible to detect racial and ethnic disparities, 21 as well as disparities along the lines of primary 22 language, sex, disability status, sexual orienta- 23 tion, gender identity, age, and socioeconomic 24 status in health and health care, and report the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 16 •HR 6637 IH results of such analysis to the Secretary, the 1 Director of the Office for Civil Rights, each 2 agency listed in section 3101(c)(1), the Com- 3 mittee on Health, Education, Labor, and Pen- 4 sions and the Committee on Finance of the 5 Senate, and the Committee on Energy and 6 Commerce and the Committee on Ways and 7 Means of the House of Representatives; 8 ‘‘(D) provide such data to the Secretary on 9 at least an annual basis; and 10 ‘‘(E) ensure that the provision of assist- 11 ance to an applicant or recipient of assistance 12 is not denied or otherwise adversely affected be- 13 cause of the failure of the applicant or recipient 14 to provide race, ethnicity, primary language, 15 sex, sexual orientation, disability status, gender 16 identity, age, and socioeconomic status data. 17 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 18 this subsection shall be construed to— 19 ‘‘(A) permit the use of information col- 20 lected under this subsection in a manner that 21 would adversely affect any individual providing 22 any such information; or 23 ‘‘(B) diminish any requirements, including 24 such requirements in effect on or after the date 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 17 •HR 6637 IH of enactment of this section, on health care pro- 1 viders to collect data. 2 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 3 This title does not authorize any health care pro- 4 vider, Federal official, or other entity to compel the 5 disclosure of any data collected under this title. The 6 disclosure of any such data by an individual pursu- 7 ant to this title shall be strictly voluntary. 8 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 9 ensure (through the promulgation of regulations or other- 10 wise) that all data collected pursuant to subsection (a) are 11 protected— 12 ‘‘(1) under the same privacy protections as the 13 Secretary applies to other health data under the reg- 14 ulations promulgated under section 264(c) of the 15 Health Insurance Portability and Accountability Act 16 of 1996 relating to the privacy of individually identi- 17 fiable health information and other protections; and 18 ‘‘(2) from all inappropriate internal use by any 19 entity that collects, stores, or receives the data, in- 20 cluding use of such data in determinations of eligi- 21 bility (or continued eligibility) in health plans, and 22 from other inappropriate uses, as defined by the 23 Secretary. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 18 •HR 6637 IH ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 1 Secretary shall develop and implement a national plan to 2 ensure the collection of data in a culturally and linguis- 3 tically appropriate manner, to improve the collection, anal- 4 ysis, and reporting of racial, ethnic, sex, primary lan- 5 guage, sexual orientation, disability status, gender iden- 6 tity, age, and socioeconomic status data at the Federal, 7 State, territorial, Tribal, and local levels, including data 8 to be collected under subsection (a), and to ensure that 9 data collection activities carried out under this section are 10 in compliance with standards developed under section 11 3101. The Data Council of the Department of Health and 12 Human Services, in consultation with the National Com- 13 mittee on Vital Health Statistics, the Office of Minority 14 Health, Office on Women’s Health, and other appropriate 15 public and private entities, shall make recommendations 16 to the Secretary concerning the development, implementa- 17 tion, and revision of the national plan. Such plan shall 18 include recommendations on how to— 19 ‘‘(1) implement subsection (a) while minimizing 20 the cost and administrative burdens of data collec- 21 tion and reporting; 22 ‘‘(2) expand knowledge among Federal agen- 23 cies, States, territories, Indian Tribes, counties, mu- 24 nicipalities, health providers, health plans, and the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 19 •HR 6637 IH general public that data collection, analysis, and re- 1 porting by race, ethnicity, sex, primary language, 2 sexual orientation, gender identity, age, socio- 3 economic status, and disability status is legal and 4 necessary to assure equity and nondiscrimination in 5 the quality of health care services; 6 ‘‘(3) ensure that future patient record systems 7 follow Federal standards promulgated under the 8 Health Information Technology for Economic and 9 Clinical Health Act for the collection and meaningful 10 use of electronic health data on race, ethnicity, sex, 11 primary language, sexual orientation, gender iden- 12 tity, age, socioeconomic status, and disability status; 13 ‘‘(4) improve health and health care data collec- 14 tion and analysis for more population groups if such 15 groups can be aggregated into the minimum race 16 and ethnicity categories, including exploring the fea- 17 sibility of enhancing collection efforts in States, 18 counties, and municipalities for racial and ethnic 19 groups that comprise a significant proportion of the 20 population of the State, county, or municipality; 21 ‘‘(5) provide researchers with greater access to 22 racial, ethnic, primary language, sex, sexual orienta- 23 tion, gender identity, age, socioeconomic status data, 24 and disability status data, subject to all applicable 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 20 •HR 6637 IH privacy and confidentiality requirements, including 1 HIPAA privacy and security law as defined in sec- 2 tion 3009; and 3 ‘‘(6) safeguard and prevent the misuse of data 4 collected under subsection (a). 5 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 6 lected under subsection (a) shall be obtained, maintained, 7 and presented (including for reporting purposes) in ac- 8 cordance with standards developed under section 3101. 9 ‘‘(e) ANALYSIS OF HEALTH DISPARITY DATA.—The 10 Secretary, acting through the Director of the Agency for 11 Healthcare Research and Quality and in coordination with 12 the Assistant Secretary for Planning and Evaluation, the 13 Administrator of the Centers for Medicare & Medicaid 14 Services, the Director of the National Center for Health 15 Statistics, and the Director of the National Institutes of 16 Health, shall provide technical assistance to agencies of 17 the Department of Health and Human Services in meeting 18 Federal standards for health disparity data collection and 19 for analysis of racial, ethnic, and other disparities in 20 health and health care in programs conducted or sup- 21 ported by such agencies by— 22 ‘‘(1) identifying appropriate quality assurance 23 mechanisms to monitor for health disparities; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 21 •HR 6637 IH ‘‘(2) specifying the clinical, diagnostic, or thera- 1 peutic measures which should be monitored; 2 ‘‘(3) developing new quality measures relating 3 to racial and ethnic disparities and their overlap 4 with other disparity factors in health and health 5 care; 6 ‘‘(4) identifying the level at which data analysis 7 should be conducted; and 8 ‘‘(5) sharing data with external organizations 9 for research and quality improvement purposes. 10 ‘‘(f) DEFINITIONS.—In this section— 11 ‘‘(1) the term ‘health-related program’ means a 12 program that is operated by the Secretary, or that 13 receives funding or reimbursement, in whole or in 14 part, either directly or indirectly from the Sec- 15 retary— 16 ‘‘(A) for activities under the Social Secu- 17 rity Act for health care services; or 18 ‘‘(B) for providing Federal financial assist- 19 ance for health care, biomedical research, or 20 health services research or for otherwise im- 21 proving the health of the public; 22 ‘‘(2) the term ‘primary language data’ includes 23 spoken and written primary language data; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 22 •HR 6637 IH ‘‘(3) the term ‘primary language data collection 1 activities’ includes identifying, collecting, storing, 2 tracking, and analyzing primary language data and 3 information on the methods used to meet the lan- 4 guage access needs of individuals with limited 5 English proficiency. 6 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated to carry out this section 8 such sums as may be necessary for each of fiscal years 9 2021 through 2025. 10 ‘‘SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION 11 IMPROVEMENT ACTIVITIES. 12 ‘‘(a) IN GENERAL.—The Secretary, acting through 13 the Director of the Agency for Healthcare Research and 14 Quality and in consultation with the Deputy Assistant 15 Secretary for Minority Health, the Director of the Na- 16 tional Institutes of Health, the Assistant Secretary for 17 Planning and Evaluation, and the Director of the National 18 Center for Health Statistics, shall establish a technical as- 19 sistance program under which the Secretary provides 20 grants to eligible entities to assist such entities in com- 21 plying with section 3431. 22 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 23 under this section may be used to— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 23 •HR 6637 IH ‘‘(1) enhance or upgrade computer technology 1 that will facilitate collection, analysis, and reporting 2 of racial, ethnic, primary language, sexual orienta- 3 tion, sex, gender identity, socioeconomic status, and 4 disability status data; 5 ‘‘(2) improve methods for health data collection 6 and analysis, including additional population groups 7 if such groups can be aggregated into the race and 8 ethnicity categories outlined by standards developed 9 under section 3101; 10 ‘‘(3) develop mechanisms for submitting col- 11 lected data subject to any applicable privacy and 12 confidentiality regulations; and 13 ‘‘(4) develop educational programs to inform 14 health plans, health providers, health-related agen- 15 cies, and the general public that data collection and 16 reporting by race, ethnicity, primary language, sex- 17 ual orientation, sex, gender identity, disability sta- 18 tus, and socioeconomic status are legal and essential 19 for eliminating health and health care disparities. 20 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 21 under this section, an entity shall be a State, territory, 22 Indian Tribe, municipality, county, health provider, health 23 care organization, or health plan making a demonstrated 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 24 •HR 6637 IH effort to bring data collections into compliance with sec- 1 tion 3431. 2 ‘‘(d) 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 2021 through 2025. 6 ‘‘SEC. 3433. OVERSAMPLING OF UNDERREPRESENTED 7 GROUPS IN FEDERAL HEALTH SURVEYS. 8 ‘‘(a) NATIONAL STRATEGY.— 9 ‘‘(1) IN GENERAL.—The Secretary, acting 10 through the Director of the National Center for 11 Health Statistics of the Centers for Disease Control 12 and Prevention, and other agencies within the De- 13 partment of Health and Human Services as the Sec- 14 retary determines appropriate, shall develop and im- 15 plement an ongoing and sustainable national strat- 16 egy for oversampling underrepresented populations 17 within the categories of race, ethnicity, sex, primary 18 language, sexual orientation, disability status, gen- 19 der identity, and socioeconomic status as determined 20 appropriate by the Secretary in Federal health sur- 21 veys and program data collections. Such national 22 strategy shall include a strategy for oversampling of 23 Asian Americans, Native Hawaiians, and Pacific Is- 24 landers. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 25 •HR 6637 IH ‘‘(2) CONSULTATION.—In developing and imple- 1 menting a national strategy, as described in para- 2 graph (1), not later than 180 days after the date of 3 the enactment of this section, the Secretary shall— 4 ‘‘(A) consult with representatives of com- 5 munity groups, nonprofit organizations, non- 6 governmental organizations, and government 7 agencies working with underrepresented popu- 8 lations; 9 ‘‘(B) solicit the participation of representa- 10 tives from other Federal departments and agen- 11 cies, including subagencies of the Department 12 of Health and Human Services; and 13 ‘‘(C) consult on, and use as models, the 14 2014 National Health Interview Survey over- 15 sample of Native Hawaiian and Pacific Islander 16 populations and the 2017 Behavioral Risk Fac- 17 tor Surveillance System oversample of American 18 Indian and Alaska Native communities. 19 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 20 after the date of the enactment of this section, the Sec- 21 retary shall submit to the Congress a progress report, 22 which shall include the national strategy described in sub- 23 section (a)(1). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 26 •HR 6637 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this section, there are authorized to be appro- 2 priated such sums as may be necessary for fiscal years 3 2021 through 2025.’’. 4 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP- 5 PROPRIATIONS FOR DATA COLLECTION AND 6 ANALYSIS. 7 Section 3101 of the Public Health Service Act (42 8 U.S.C. 300kk) is amended— 9 (1) by striking subsection (h); and 10 (2) by redesignating subsection (i) as subsection 11 (h). 12 SEC. 103. COLLECTION OF DATA FOR THE MEDICARE PRO- 13 GRAM. 14 Part A of title XI of the Social Security Act (42 15 U.S.C. 1301 et seq.) is amended by adding at the end 16 the following: 17 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM 18 ‘‘SEC. 1150C. 19 ‘‘(a) REQUIREMENT.— 20 ‘‘(1) IN GENERAL.—The Commissioner of So- 21 cial Security, in consultation with the Administrator 22 of the Centers for Medicare & Medicaid Services, 23 shall collect data on the race, ethnicity, sex, primary 24 language, sexual orientation, gender identity, socio- 25 economic status, and disability status of all appli- 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 27 •HR 6637 IH cants for Social Security benefits under title II or 1 Medicare benefits under title XVIII. 2 ‘‘(2) DATA COLLECTION STANDARDS.—In col- 3 lecting data under paragraph (1), the Commissioner 4 of Social Security shall at least use the standards 5 for data collection developed under section 3101 of 6 the Public Health Service Act or the standards de- 7 veloped by the Office of Management and Budget, 8 whichever is more disaggregated. In the event there 9 are no standards for the demographic groups listed 10 under paragraph (1), the Commissioner shall consult 11 with stakeholder groups representing the various 12 identities as well as with the Office of Minority 13 Health within the Centers for Medicare & Medicaid 14 Services to develop appropriate standards. 15 ‘‘(3) DATA FOR ADDITIONAL POPULATION 16 GROUPS.—Where practicable, the information col- 17 lected by the Commissioner of Social Security under 18 paragraph (1) shall include data for additional popu- 19 lation groups if such groups can be aggregated into 20 the race and ethnicity categories outlined by the 21 data collection standards described in paragraph (2). 22 ‘‘(4) COLLECTION OF DATA FOR MINORS AND 23 LEGALLY INCAPACITATED INDIVIDUALS.—With re- 24 spect to the collection of the data described in para- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 28 •HR 6637 IH graph (1) of applicants who are under 18 years of 1 age or otherwise legally incapacitated, the Commis- 2 sioner of Social Security shall require that— 3 ‘‘(A) such data be collected from the par- 4 ent or legal guardian of such an applicant; and 5 ‘‘(B) the primary language of the parent 6 or legal guardian of such an applicant or recipi- 7 ent be used in collecting the data. 8 ‘‘(5) QUALITY OF DATA.—The Commissioner of 9 Social Security shall periodically review the quality 10 and completeness of the data collected under para- 11 graph (1) and make adjustments as necessary to im- 12 prove both. 13 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll- 14 ment in Medicare benefits under title XVIII, the 15 Commissioner of Social Security shall transmit an 16 individual’s demographic data as collected under 17 paragraph (1) to the Centers for Medicare & Med- 18 icaid Services. 19 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 20 With respect to data transmitted under paragraph 21 (5), the Administrator of the Centers for Medicare 22 & Medicaid Services, in consultation with the Com- 23 missioner of Social Security shall— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 29 •HR 6637 IH ‘‘(A) require that such data be uniformly 1 analyzed and that such analysis be reported at 2 least annually to Congress; 3 ‘‘(B) incorporate such data in other anal- 4 ysis and reporting on health disparities as ap- 5 propriate; 6 ‘‘(C) make such data available to research- 7 ers, under the protections outlined in paragraph 8 (7); 9 ‘‘(D) provide opportunities to individuals 10 enrolled in Medicare to submit updated data; 11 and 12 ‘‘(E) ensure that the provision of assist- 13 ance or benefits to an applicant is not denied 14 or otherwise adversely affected because of the 15 failure of the applicant to provide any of the 16 data collected under paragraph (1). 17 ‘‘(8) PROTECTION OF DATA.—The Commis- 18 sioner of Social Security shall ensure (through the 19 promulgation of regulations or otherwise) that all 20 data collected pursuant to subsection (a) is pro- 21 tected— 22 ‘‘(A) under the same privacy protections as 23 the Secretary applies to health data under the 24 regulations promulgated under section 264(c) of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 30 •HR 6637 IH the Health Insurance Portability and Account- 1 ability Act of 1996 (relating to the privacy of 2 individually identifiable health information and 3 other protections); and 4 ‘‘(B) from all inappropriate internal use by 5 any entity that collects, stores, or receives the 6 data, including use of such data in determina- 7 tions of eligibility (or continued eligibility) in 8 health plans, and from other inappropriate 9 uses, as defined by the Secretary. 10 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec- 11 tion shall be construed to permit the use of information 12 collected under this section in a manner that would ad- 13 versely affect any individual providing any such informa- 14 tion. 15 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary may, 16 either directly or by grant or contract, provide technical 17 assistance to enable any entity to comply with the require- 18 ments of this section or with regulations implementing this 19 section. 20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 $500 million for 2020 and $100 million for each fiscal 23 year thereafter.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 31 •HR 6637 IH SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 1 (a) IN GENERAL.—Not later than 1 year after the 2 date of enactment of this Act, the Secretary of Health and 3 Human Services shall revise the regulations promulgated 4 under part C of title XI of the Social Security Act (42 5 U.S.C. 1320d et seq.), relating to the collection of data 6 on race, ethnicity, and primary language in a health-re- 7 lated transaction, to require— 8 (1) the use, at a minimum, of standards for 9 data collection on race, ethnicity, primary language, 10 disability, sex, sexual orientation, gender identity, 11 and socioeconomic status developed under section 12 3101 of the Public Health Service Act (42 U.S.C. 13 300kk); and 14 (2) in consultation with the Office of the Na- 15 tional Coordinator for Health Information Tech- 16 nology, the designation of the appropriate racial, 17 ethnic, primary language, disability, sex, and other 18 code sets as required for claims and enrollment data. 19 (b) DISSEMINATION.—The Secretary of Health and 20 Human Services shall disseminate the new standards de- 21 veloped under subsection (a) to all entities that are subject 22 to the regulations described in such subsection and provide 23 technical assistance with respect to the collection of the 24 data involved. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 32 •HR 6637 IH (c) COMPLIANCE.—The Secretary of Health and 1 Human Services shall require that entities comply with the 2 new standards developed under subsection (a) not later 3 than 2 years after the final promulgation of such stand- 4 ards. 5 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 6 Section 306(n) of the Public Health Service Act (42 7 U.S.C. 242k(n)) is amended— 8 (1) in paragraph (1), by striking ‘‘2003’’ and 9 inserting ‘‘2022’’; 10 (2) in paragraph (2), in the first sentence, by 11 striking ‘‘2003’’ and inserting ‘‘2022’’; and 12 (3) in paragraph (3), by striking ‘‘2002’’ and 13 inserting ‘‘2022’’. 14 SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL 15 GOVERNMENT. 16 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec- 17 retary of Health and Human Services, in coordination 18 with the departments, agencies, or offices described in 19 subsection (b), shall establish a centralized electronic re- 20 pository of Government data on factors related to the 21 health and well-being of the population of the United 22 States. 23 (b) COLLECTION; SUBMISSION.—Not later than 180 24 days after the date of the enactment of this Act, and Jan- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 33 •HR 6637 IH uary 31 of each year thereafter, each department, agency, 1 and office of the Federal Government that has collected 2 data on race, ethnicity, sex, primary language, sexual ori- 3 entation, disability status, gender identity, age, or socio- 4 economic status during the preceding calendar year shall 5 submit such data to the repository of Government data 6 established under subsection (a). 7 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 8 Not later than April 30, 2021, and April 30 of each year 9 thereafter, the Secretary of Health and Human Services, 10 acting through the Assistant Secretary for Planning and 11 Evaluation, the Assistant Secretary for Health, the Direc- 12 tor of the Agency for Healthcare Research and Quality, 13 the Director of the National Center for Health Statistics, 14 the Administrator of the Centers for Medicare & Medicaid 15 Services, the Director of the National Institute on Minor- 16 ity Health and Health Disparities, and the Deputy Assist- 17 ant Secretary for Minority Health, shall— 18 (1) prepare and make available datasets for 19 public use that relate to disparities in health status, 20 health care access, health care quality, health out- 21 comes, public health, and other areas of health and 22 well-being by factors that include race, ethnicity, 23 sex, primary language, sexual orientation, disability 24 status, gender identity, and socioeconomic status; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 34 •HR 6637 IH (2) ensure that these datasets are publicly iden- 1 tified on the repository established under subsection 2 (a) as ‘‘disparities’’ data; and 3 (3) submit a report to the Congress on the 4 availability and use of such data by public stake- 5 holders. 6 SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 7 NORITY-SERVING INSTITUTIONS. 8 (a) AUTHORITY.—The Secretary of Health and 9 Human Services, acting through the Director of the Na- 10 tional Institute on Minority Health and Health Disparities 11 and the Deputy Assistant Secretary for Minority Health, 12 shall award grants to eligible entities to access and analyze 13 racial and ethnic data on disparities in health and health 14 care, and where possible other data on disparities in health 15 and health care, to monitor and report on progress to re- 16 duce and eliminate disparities in health and health care. 17 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 18 igible entity’’ means an entity that has an accredited pub- 19 lic health, health policy, or health services research pro- 20 gram and is any of the following: 21 (1) A part B institution, as defined in section 22 322 of the Higher Education Act of 1965 (20 23 U.S.C. 1061). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 35 •HR 6637 IH (2) A Hispanic-serving institution, as defined in 1 section 502 of such Act (20 U.S.C. 1101a). 2 (3) A Tribal College or University, as defined in 3 section 316 of such Act (20 U.S.C. 1059c). 4 (4) An Asian American and Native American 5 Pacific Islander-serving institution, as defined in 6 section 371(c) of such Act (20 U.S.C. 1067q(c)). 7 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 8 out this section, there are authorized to be appropriated 9 such sums as may be necessary for fiscal years 2021 10 through 2025. 11 SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTA- 12 TION, GENDER IDENTITY, AND SOCIO- 13 ECONOMIC STATUS IN COLLECTION OF 14 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, socioeconomic status,’’ 19 before ‘‘and disability status’’; 20 (2) in paragraph (1)(C), by inserting ‘‘sexual 21 orientation, gender identity, socioeconomic status,’’ 22 before ‘‘and disability status’’; and 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 36 •HR 6637 IH (3) in paragraph (2)(B), by inserting ‘‘sexual 1 orientation, gender identity, socioeconomic status,’’ 2 before ‘‘and disability status’’. 3 SEC. 109. SAFETY AND EFFECTIVENESS OF DRUGS WITH 4 RESPECT TO RACIAL AND ETHNIC BACK- 5 GROUND. 6 (a) IN GENERAL.—Chapter V of the Federal Food, 7 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 8 ed by adding after section 505F the following: 9 ‘‘SEC. 505G. SAFETY AND EFFECTIVENESS OF DRUGS WITH 10 RESPECT TO RACIAL AND ETHNIC BACK- 11 GROUND. 12 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 13 that there may be a disparity on the basis of racial or 14 ethnic background as to the safety or effectiveness of a 15 drug or biological product, then— 16 ‘‘(1)(A) in the case of a drug, the investigations 17 required under section 505(b)(1)(A) shall include 18 adequate and well-controlled investigations of the 19 disparity; or 20 ‘‘(B) in the case of a biological product, the evi- 21 dence required under section 351(a) of the Public 22 Health Service Act for approval of a biologics license 23 application for the biological product shall include 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 37 •HR 6637 IH adequate and well-controlled investigations of the 1 disparity; and 2 ‘‘(2) if the investigations described in subpara- 3 graph (A) or (B) of paragraph (1) confirm that 4 there is such a disparity, the labeling of the drug or 5 biological product shall include appropriate informa- 6 tion about the disparity. 7 ‘‘(b) POSTMARKET STUDIES.— 8 ‘‘(1) IN GENERAL.—If there is evidence that 9 there may be a disparity on the basis of racial or 10 ethnic background as to the safety or effectiveness 11 of a drug for which there is an approved application 12 under section 505 of this Act or of a biological prod- 13 uct for which there is an approved license under sec- 14 tion 351 of the Public Health Service Act, the Sec- 15 retary may by order require the holder of the ap- 16 proved application or license to conduct, by a date 17 specified by the Secretary, postmarket studies to in- 18 vestigate the disparity. 19 ‘‘(2) LABELING.—If the Secretary determines 20 that the postmarket studies confirm that there is a 21 disparity described in paragraph (1), the labeling of 22 the drug or biological product shall include appro- 23 priate information about the disparity. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 38 •HR 6637 IH ‘‘(3) STUDY DESIGN.—The Secretary may, in 1 an order under paragraph (1), specify all aspects of 2 the design of the postmarket studies required under 3 such paragraph for a drug or biological product, in- 4 cluding the number of studies and study partici- 5 pants, and the other demographic characteristics of 6 the study participants. 7 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 8 Secretary may, by order and as necessary, modify 9 any aspect of the design of a postmarket study re- 10 quired in an order under paragraph (1) after issuing 11 such order. 12 ‘‘(5) STUDY RESULTS.—The results from a 13 study required under paragraph (1) shall be sub- 14 mitted to the Secretary as a supplement to the drug 15 application or biologics license application. 16 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 17 ‘‘(1) IN GENERAL.—A drug for which an appli- 18 cation has been submitted or approved under section 19 505(j) shall not be considered ineligible for approval 20 under that section or misbranded under section 502 21 on the basis that the labeling of the drug omits in- 22 formation relating to a disparity on the basis of ra- 23 cial or ethnic background as to the safety or effec- 24 tiveness of the drug, whether derived from investiga- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 39 •HR 6637 IH tions or studies required under this section or de- 1 rived from other sources, when the omitted informa- 2 tion is protected by patent or by exclusivity under 3 section 505(j)(5)(F). 4 ‘‘(2) LABELING.—Notwithstanding paragraph 5 (1), the Secretary may require that the labeling of 6 a drug approved under section 505(j) that omits in- 7 formation relating to a disparity on the basis of ra- 8 cial or ethnic background as to the safety or effec- 9 tiveness of the drug include a statement of any ap- 10 propriate contraindications, warnings, or precautions 11 related to the disparity that the Secretary considers 12 necessary. 13 ‘‘(d) DEFINITION.—The term ‘evidence that there 14 may be a disparity on the basis of racial or ethnic back- 15 ground as to the safety or effectiveness’, with respect to 16 a drug or biological product, includes— 17 ‘‘(1) evidence that there is a disparity on the 18 basis of racial or ethnic background as to safety or 19 effectiveness of a drug or biological product in the 20 same chemical class as the drug or biological prod- 21 uct; 22 ‘‘(2) evidence that there is a disparity on the 23 basis of racial or ethnic background in the way the 24 drug or biological product is metabolized; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 40 •HR 6637 IH ‘‘(3) other evidence as the Secretary may deter- 1 mine appropriate.’’. 2 (b) ENFORCEMENT.—Section 502 of the Federal 3 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 4 ed by adding at the end the following: 5 ‘‘(ee) If it is a drug and the holder of the approved 6 application under section 505 or license under section 351 7 of the Public Health Service Act for the drug has failed 8 to complete the investigations or studies, or comply with 9 any other requirement, of section 505G.’’. 10 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 11 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 12 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 13 required’’ the following: ‘‘, including postmarket studies 14 required under section 505G’’. 15 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE 16 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 17 Part B of title III of the Public Health Service Act 18 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 19 tion 317U the following: 20 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 21 LANDER HEALTH DATA. 22 ‘‘(a) DEFINITIONS.—In this section: 23 ‘‘(1) COMMUNITY GROUP.—The term ‘commu- 24 nity group’ means a group of NHOPI who are orga- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 41 •HR 6637 IH nized at the community level, and may include a 1 church group, social service group, national advocacy 2 organization, or cultural group. 3 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI- 4 ZATION.—The term ‘nonprofit, nongovernmental or- 5 ganization’ means a group of NHOPI with a dem- 6 onstrated history of addressing NHOPI issues, in- 7 cluding a NHOPI coalition. 8 ‘‘(3) DESIGNATED ORGANIZATION.—The term 9 ‘designated organization’ means an entity estab- 10 lished to represent NHOPI populations and which 11 has statutory responsibilities to provide, or has com- 12 munity support for providing, health care. 13 ‘‘(4) GOVERNMENT REPRESENTATIVES OF 14 NHOPI POPULATIONS.—The term ‘government rep- 15 resentatives of NHOPI populations’ means rep- 16 resentatives from Hawaii, American Samoa, the 17 Commonwealth of the Northern Mariana Islands, 18 the Federated States of Micronesia, Guam, the Re- 19 public of Palau, and the Republic of the Marshall Is- 20 lands. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 42 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 43 •HR 6637 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 2020, 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 44 •HR 6637 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 2020. 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 2020, the Secretary shall submit to 22 Congress a progress report, which shall include the na- 23 tional strategy described in subsection (b)(1). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 45 •HR 6637 IH ‘‘(e) STUDY AND REPORT BY THE HEALTH AND 1 MEDICINE DIVISION.— 2 ‘‘(1) IN GENERAL.—The Secretary shall enter 3 into an agreement with the Health and Medicine Di- 4 vision of the National Academies of Sciences, Engi- 5 neering, and Medicine to conduct a study, with input 6 from stakeholders in insular areas, on each of the 7 following: 8 ‘‘(A) The standards and definitions of 9 health care applied to health care systems in in- 10 sular areas and the appropriateness of such 11 standards and definitions. 12 ‘‘(B) The status and performance of health 13 care systems in insular areas, evaluated based 14 upon standards and definitions, as the Sec- 15 retary determines appropriate. 16 ‘‘(C) The effectiveness of donor aid in ad- 17 dressing health care needs and priorities in in- 18 sular areas. 19 ‘‘(D) The progress toward implementation 20 of recommendations of the Committee on 21 Health Care Services in the United States—As- 22 sociated Pacific Basin that are set forth in the 23 1998 report entitled ‘Pacific Partnerships for 24 Health: Charting a New Course’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 46 •HR 6637 IH ‘‘(2) REPORT.—An agreement described in 1 paragraph (1) shall require the Health and Medicine 2 Division to submit to the Secretary and to Congress, 3 not later than 2 years after the date of the enact- 4 ment of the Health Equity and Accountability Act of 5 2020, a report containing a description of the results 6 of the study conducted under paragraph (1), includ- 7 ing the conclusions and recommendations of the 8 Health and Medicine Division for each of the items 9 described in subparagraphs (A) through (D) of such 10 paragraph. 11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this section, there are authorized to be appro- 13 priated such sums as may be necessary for fiscal years 14 2021 through 2025.’’. 15 SEC. 111. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 16 REPORTING REQUIREMENT. 17 Section 11(a) of the Food and Nutrition Act of 2008 18 (7 U.S.C. 2020(a)) is amended by adding at the end the 19 following: 20 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 21 REQUIREMENT.—With respect to any obligation of a 22 State agency to comply with the notification require- 23 ment under paragraph (2) of section 421(e) of the 24 Personal Responsibility and Work Opportunity Rec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 47 •HR 6637 IH onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith- 1 standing the requirement to include in that notifica- 2 tion the names of the sponsor and the sponsored 3 alien involved, the State agency shall be considered 4 to have complied with the notification requirement if 5 the State agency submits to the Attorney General a 6 report that includes the aggregate number of excep- 7 tions granted by the State agency under paragraph 8 (1) of that section.’’. 9 TITLE II—CULTURALLY AND LIN- 10 GUISTICALLY APPROPRIATE 11 HEALTH AND HEALTH CARE 12 SEC. 201. DEFINITIONS; FINDINGS. 13 (a) DEFINITIONS.—In this title, the definitions in 14 section 3400 of the Public Health Service Act, as added 15 by section 204, shall apply. 16 (b) FINDINGS.—Congress finds the following: 17 (1) Effective communication is essential to 18 meaningful access to quality physical and mental 19 health care. 20 (2) Research indicates that the lack of appro- 21 priate language services creates language barriers 22 that result in increased risk of misdiagnosis, ineffec- 23 tive treatment plans, and poor health outcomes for 24 individuals with limited English proficiency and indi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 48 •HR 6637 IH viduals with communication disabilities such as cog- 1 nitive, hearing, vision, or print impairments. 2 (3) The number of limited English speaking 3 residents in the United States who speak English 4 less than very well and, therefore, cannot effectively 5 communicate with health and social service providers 6 continues to increase significantly. 7 (4) The responsibility to fund language services 8 in the provision of health care and health-care-re- 9 lated services to individuals with limited English 10 proficiency and individuals with communication dis- 11 abilities such as cognitive hearing, vision, or print 12 impairments is a societal one that cannot fairly be 13 placed solely upon the health care, public health, or 14 social services community. 15 (5) Title VI of the Civil Rights Act of 1964 (42 16 U.S.C. 2000d et seq.) prohibits discrimination based 17 on the grounds of race, color, or national origin by 18 any entity receiving Federal financial assistance. In 19 order to avoid discrimination on the grounds of na- 20 tional origin, all programs or activities administered 21 by the Federal Government must take adequate 22 steps to ensure that their policies and procedures do 23 not deny or have the effect of denying individuals 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 49 •HR 6637 IH with limited English proficiency with equal access to 1 benefits and services for which such persons qualify. 2 (6) Both the Americans with Disabilities Act of 3 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita- 4 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 5 discrimination on the basis of disability and require 6 the provision of appropriate auxiliary aids and serv- 7 ices necessary to ensure effective communication 8 with individuals with disabilities. The type of auxil- 9 iary aid or service necessary to ensure effective com- 10 munication will vary in accordance with the method 11 of communication used by the individual; the nature, 12 length, and complexity of the communication in- 13 volved; and the context in which the communication 14 is taking place. A public accommodation should con- 15 sult with individuals with disabilities whenever pos- 16 sible to determine what type of auxiliary aid is need- 17 ed to ensure effective communication. The public ac- 18 commodation should use the person’s preferred 19 method of communication whenever possible, unless 20 it would be an undue burden to the public accommo- 21 dation and an alternative would provide an equally 22 effective means of communication. The ultimate de- 23 cision as to what measures to take rests with the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 50 •HR 6637 IH public accommodation, provided that the method 1 chosen results in effective communication. 2 (7) Section 1557 of the Patient Protection and 3 Affordable Care Act (42 U.S.C. 18116) builds on 4 Title VI of the Civil Rights Act of 1964 (42 U.S.C. 5 2000d et seq.) and the Rehabilitation Act of 1973 6 (29 U.S.C. 701 et seq.), prohibits discrimination on 7 the basis of race, color, national origin, disability, 8 sex, and age, requires the provision of language serv- 9 ices to ensure effective communication with individ- 10 uals with limited English proficiency, and requires 11 the provision of appropriate auxiliary aids and serv- 12 ices necessary to ensure effective communication 13 with individuals with disabilities. 14 (8) Linguistic diversity in the health care and 15 health-care-related services workforce is important 16 for providing all patients the environment most con- 17 ducive to positive health outcomes. 18 (9) All members of the health care and health- 19 care-related services community should continue to 20 educate their staff and constituents about limited 21 English proficient and disability communication 22 issues and help them identify resources to improve 23 access to quality care for individuals with limited 24 English proficiency and individuals with communica- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 51 •HR 6637 IH tion disabilities such as cognitive, hearing, vision, or 1 print impairments. 2 (10) Access to English as a second language, 3 foreign language, and sign language interpreters, 4 translated and alternative format documents, read- 5 ers, and other auxiliary aids and services, are essen- 6 tial to ensure effective communication and eliminate 7 the language barriers that impede access to health 8 care. 9 (11) Competent language services in health care 10 settings should be available as a matter of course. 11 SEC. 202. IMPROVING ACCESS TO SERVICES FOR INDIVID- 12 UALS WITH LIMITED ENGLISH PROFICIENCY. 13 (a) PURPOSE.—Consistent with the goals provided in 14 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 15 to improving access to services for persons with limited 16 English proficiency), it is the purpose of this section— 17 (1) to improve Federal agency performance re- 18 garding access to federally conducted and federally 19 assisted programs and activities for individuals with 20 limited English proficiency; 21 (2) to require each Federal agency to examine 22 the services it provides and develop and implement 23 a system by which individuals with limited English 24 proficiency can obtain culturally competence services 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 52 •HR 6637 IH and meaningful access to those services consistent 1 with, and without substantially burdening, the fun- 2 damental mission of the agency; 3 (3) to require each Federal agency to ensure 4 that recipients of Federal financial assistance pro- 5 vide culturally competence services and meaningful 6 access to applicants and beneficiaries that are indi- 7 viduals with limited English proficiency; 8 (4) to ensure that recipients of Federal finan- 9 cial assistance take reasonable steps, consistent with 10 the guidelines set forth in the ‘‘Guidance to Federal 11 Financial Assistance Recipients Regarding Title VI 12 Prohibition Against National Origin Discrimination 13 Affecting Limited English Proficient Persons (67 14 Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul- 15 turally and linguistically appropriate access to their 16 programs and activities by individuals with limited 17 English proficiency; and 18 (5) to ensure compliance with title VI of the 19 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 20 and section 1557 of the Patient Protection and Af- 21 fordable Care Act (42 U.S.C. 18116) as published in 22 the Federal Register on May 18, 2016, that health 23 care providers and organizations do not discriminate 24 in the provision of services. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 53 •HR 6637 IH (b) FEDERALLY CONDUCTED PROGRAMS AND AC- 1 TIVITIES.— 2 (1) IN GENERAL.—Not later than 120 days 3 after the date of enactment of this Act, each Federal 4 agency providing financial assistance to, or admin- 5 istering, a health program or activity described in 6 section 203(a) shall prepare a plan or update their 7 current plan to improve culturally and linguistically 8 appropriate access to such program or activity with 9 respect to individuals with limited English pro- 10 ficiency. Not later than 1 year after the date of en- 11 actment of this title, each such Federal agency shall 12 ensure that such plan is fully implemented. 13 (2) PLAN REQUIREMENT.—Each plan under 14 paragraph (1) shall include— 15 (A) the steps the agency will take to en- 16 sure that individuals with limited English pro- 17 ficiency have access to each health program or 18 activity supported or administered by the agen- 19 cy; 20 (B) the policies and procedures for identi- 21 fying, assessing, and meeting the culturally and 22 linguistically appropriate language needs of its 23 beneficiaries that are individuals with limited 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 54 •HR 6637 IH English proficiency served by such program or 1 activity; 2 (C) the steps the agency will take for such 3 program or activity to be culturally and linguis- 4 tically appropriate by providing a range of lan- 5 guage assistance options, notice to individuals 6 with limited English proficiency of the right to 7 competent language services, periodic training 8 of staff, monitoring and quality assessment of 9 the language services and, in appropriate cir- 10 cumstances, the translation of written mate- 11 rials; 12 (D) the steps the agency will take for such 13 program or activity to provide reasonable ac- 14 commodations necessary for individuals with 15 limited English proficiency and communication 16 disabilities to understand communications from 17 the agency; 18 (E) the steps the agency will take to en- 19 sure that applications, forms, and other rel- 20 evant documents for such program or activity 21 are competently translated into the primary 22 language of a client that is an individual with 23 limited English proficiency where such mate- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 55 •HR 6637 IH rials are needed to improve access of such client 1 to such program or activity; 2 (F) the resources the agency will provide 3 to improve cultural and linguistic appropriate- 4 ness to assist recipients of Federal funds to im- 5 prove access to health-care-related programs 6 and activities for individuals with limited 7 English proficiency; 8 (G) the resources the agency will provide 9 to ensure that competent language assistance is 10 provided to patients that are individuals with 11 limited English proficiency by interpreters or 12 trained bilingual staff; and 13 (H) the resources the agency will provide 14 to ensure that family, particularly minor chil- 15 dren, and friends are not used to provide inter- 16 pretation services, except as permitted under 17 regulations implementing section 1557 of the 18 Patient Protection and Affordable Care Act (42 19 U.S.C. 18116) as published in the Federal Reg- 20 ister on May 18, 2016. 21 (3) SUBMISSION OF PLAN TO DOJ.—Each agen- 22 cy that is required to prepare a plan under para- 23 graph (1) shall send a copy of such plan to the At- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 56 •HR 6637 IH torney General, which shall serve as the central re- 1 pository of all such plans. 2 SEC. 203. ENSURING STANDARDS FOR CULTURALLY AND 3 LINGUISTICALLY APPROPRIATE SERVICES IN 4 HEALTH CARE. 5 (a) APPLICABILITY.—This section shall apply to any 6 health program or activity, any part of which is receiving 7 Federal financial assistance, including credits, subsidies, 8 or contracts of insurance, or any program or activity that 9 is administered by an executive agency or any entity estab- 10 lished under title I of the Patient Protection and Afford- 11 able Care Act (42 U.S.C. 18001 et seq.) (or amendments 12 made thereby). 13 (b) STANDARDS.—Each program or activity de- 14 scribed in subsection (a)— 15 (1) shall implement strategies to recruit, retain, 16 and promote individuals at all levels to maintain a 17 diverse staff and leadership that can provide cul- 18 turally and linguistically appropriate health care to 19 patient populations of the service area of the pro- 20 gram or activity; 21 (2) shall educate and train governance, leader- 22 ship, and workforce at all levels and across all dis- 23 ciplines of the program or activity in culturally and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 57 •HR 6637 IH linguistically appropriate policies and practices on an 1 ongoing basis at least yearly; 2 (3) shall offer and provide language assistance, 3 including trained and competent bilingual staff and 4 interpreter services, to individuals with limited 5 English proficiency or who have other communica- 6 tion needs, at no cost to the individual at all points 7 of contact, and during all hours of operation, to fa- 8 cilitate timely access to health care services and 9 health-care-related services; 10 (4) shall for each language group consisting of 11 individuals with limited English proficiency that con- 12 stitutes 5 percent or 500 individuals, whichever is 13 less, of the population of persons eligible to be 14 served or likely to be affected or encountered in the 15 service area of the program or activity, make avail- 16 able at a fifth grade reading level— 17 (A) easily understood patient-related mate- 18 rials, including print and multimedia materials, 19 in the language of such language group; 20 (B) information or notices about termi- 21 nation of benefits in such language; 22 (C) signage; and 23 (D) any other documents or types of docu- 24 ments designated by the Secretary; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 58 •HR 6637 IH (5) shall develop and implement clear goals, 1 policies, operational plans, and management, ac- 2 countability, and oversight mechanisms to provide 3 culturally and linguistically appropriate services and 4 infuse them throughout the planning and operations 5 of the program or activity; 6 (6) shall conduct initial and ongoing organiza- 7 tional assessments of culturally and linguistically ap- 8 propriate services-related activities and integrate 9 valid linguistic, competence-related National Stand- 10 ards for Culturally and Linguistically Appropriate 11 Services (CLAS) measures into the internal audits, 12 performance improvement programs, patient satis- 13 faction assessments, continuous quality improvement 14 activities, and outcomes-based evaluations of the 15 program or activity and develop ways to standardize 16 the assessments, and such assessments must occur 17 at least yearly; 18 (7) shall ensure that, consistent with the pri- 19 vacy protections provided for under the regulations 20 promulgated under section 264(c) of the Health In- 21 surance Portability and Accountability Act of 1996 22 (42 U.S.C. 1320–2 note), data on an individual re- 23 quired to be collected pursuant to section 3101, in- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 59 •HR 6637 IH cluding the individual’s alternative format pref- 1 erences and policy modification needs, are— 2 (A) collected in health records; 3 (B) integrated into the management infor- 4 mation systems of the program or activity; and 5 (C) periodically updated; 6 (8) shall maintain a current demographic, cul- 7 tural, and epidemiological profile of the community, 8 conduct regular assessments of community health 9 assets and needs, and use the results of such assess- 10 ments to accurately plan for and implement services 11 that respond to the cultural and linguistic character- 12 istics of the service area of the program or activity; 13 (9) shall develop participatory, collaborative 14 partnerships with communities and utilize a variety 15 of formal and informal mechanisms to facilitate 16 community and patient involvement in designing, 17 implementing, and evaluating policies and practices 18 to ensure culturally and linguistically appropriate 19 service-related activities; 20 (10) shall ensure that conflict and grievance 21 resolution processes are culturally and linguistically 22 appropriate and capable of identifying, preventing, 23 and resolving cross-cultural conflicts or complaints 24 by patients; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 60 •HR 6637 IH (11) shall regularly make available to the public 1 information about their progress and successful in- 2 novations in implementing the standards under this 3 section and provide public notice in their commu- 4 nities about the availability of this information; and 5 (12) shall, if requested, regularly make avail- 6 able to the head of each Federal entity from which 7 Federal funds are provided, information about the 8 progress and successful innovations of the program 9 or activity in implementing the standards under this 10 section as required by the head of such entity. 11 (c) COMMENTS ACCEPTED THROUGH NOTICE AND 12 COMMENT RULEMAKING.—An agency carrying out a pro- 13 gram described in subsection (a) shall ensure that com- 14 ments with respect to such program that are accepted 15 through notice and comment rulemaking be accepted in 16 all languages, may not require such comments to be sub- 17 mitted only in English, and must ensure these comments 18 are considered equally as comments submitted in English 19 during the agency’s review of comments submitted. 20 SEC. 204. CULTURALLY AND LINGUISTICALLY APPRO- 21 PRIATE HEALTH CARE IN THE PUBLIC 22 HEALTH SERVICE ACT. 23 The Public Health Service Act (42 U.S.C. 201 et 24 seq.) is amended by adding at the end the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 61 •HR 6637 IH ‘‘TITLE XXXIV—CULTURALLY 1 AND LINGUISTICALLY APPRO- 2 PRIATE HEALTH CARE 3 ‘‘SEC. 3400. DEFINITIONS. 4 ‘‘(a) IN GENERAL.—In this title: 5 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 6 respect to an individual, means a person who has 7 sufficient degree of proficiency in 2 languages. 8 ‘‘(2) CULTURAL.—The term ‘cultural’ means 9 relating to integrated patterns of human behavior 10 that include the language, thoughts, communica- 11 tions, actions, customs, beliefs, values, and institu- 12 tions of racial, ethnic, religious, or social groups, in- 13 cluding lesbian, gay, bisexual, transgender, queer, 14 and questioning individuals, and individuals with 15 physical and mental disabilities. 16 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP- 17 PROPRIATE.—The term ‘culturally and linguistically 18 appropriate’ means being respectful of and respon- 19 sive to the cultural and linguistic needs of all indi- 20 viduals. 21 ‘‘(4) EFFECTIVE COMMUNICATION.—The term 22 ‘effective communication’ means an exchange of in- 23 formation between the provider of health care or 24 health-care-related services and the recipient of such 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 62 •HR 6637 IH services who is limited in English proficiency, or has 1 a communication impairment such as a hearing, vi- 2 sion, speaking, or learning impairment, that enables 3 access to, understanding of, and benefit from health 4 care or health-care-related services, and full partici- 5 pation in the development of their treatment plan. 6 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 7 term ‘grievance resolution process’ means all aspects 8 of dispute resolution including filing complaints, 9 grievance and appeal procedures, and court action. 10 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 11 care group’ means a group of physicians organized, 12 at least in part, for the purposes of providing physi- 13 cian services under the Medicaid program under title 14 XIX of the Social Security Act, the State Children’s 15 Health Insurance Program under title XXI of such 16 Act, or the Medicare program under title XVIII of 17 such Act and may include a hospital and any other 18 individual or entity furnishing services covered under 19 any such program that is affiliated with the health 20 care group. 21 ‘‘(7) HEALTH CARE SERVICES.—The term 22 ‘health care services’ means services that address 23 physical as well as mental health conditions in all 24 care settings. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 63 •HR 6637 IH ‘‘(8) HEALTH-CARE-RELATED SERVICES.—The 1 term ‘health-care-related services’ means human or 2 social services programs or activities that provide ac- 3 cess, referrals, or links to health care. 4 ‘‘(9) HEALTH EDUCATOR.—The term ‘health 5 educator’ includes a professional with a bacca- 6 laureate degree who is responsible for designing, im- 7 plementing, and evaluating individual and population 8 health promotion and chronic disease prevention pro- 9 grams. 10 ‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In- 11 dian’ and ‘Indian Tribe’ have the meanings given 12 such terms in section 4 of the Indian Self-Deter- 13 mination and Education Assistance Act. 14 ‘‘(11) INDIVIDUAL WITH A DISABILITY.—The 15 term ‘individual with a disability’ means any indi- 16 vidual who has a disability as defined for the pur- 17 pose of section 504 of the Rehabilitation Act of 18 1973. 19 ‘‘(12) INDIVIDUAL WITH LIMITED ENGLISH 20 PROFICIENCY.—The term ‘individual with limited 21 English proficiency’ means an individual whose pri- 22 mary language for communication is not English 23 and who has a limited ability to read, write, speak, 24 or understand English. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 64 •HR 6637 IH ‘‘(13) INTEGRATED HEALTH CARE DELIVERY 1 SYSTEM.—The term ‘integrated health care delivery 2 system’ means an interdisciplinary system that 3 brings together providers from the primary health, 4 mental health, substance use disorder, and related 5 disciplines to improve the health outcomes of an in- 6 dividual. Such providers may include hospitals, 7 health, mental health, or substance use disorder clin- 8 ics and providers, home health agencies, ambulatory 9 surgery centers, skilled nursing facilities, rehabilita- 10 tion centers, and employed, independent, or con- 11 tracted physicians. 12 ‘‘(14) INTERPRETING; INTERPRETATION.—The 13 terms ‘interpreting’ and ‘interpretation’ mean the 14 transmission of a spoken, written, or signed message 15 from one language or format into another, faithfully, 16 accurately, and objectively. 17 ‘‘(15) LANGUAGE ACCESS.—The term ‘language 18 access’ means the provision of language services to 19 an individual with limited English proficiency or an 20 individual with communication disabilities designed 21 to enhance that individual’s access to, understanding 22 of, or benefit from health care services or health- 23 care-related services. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 65 •HR 6637 IH ‘‘(16) LANGUAGE ASSISTANCE SERVICES.—The 1 term ‘language assistance services’ includes— 2 ‘‘(A) oral language assistance, including in- 3 terpretation in non-English languages provided 4 in-person or remotely by a qualified interpreter 5 for an individual with limited English pro- 6 ficiency, and the use of qualified bilingual or 7 multilingual staff to communicate directly with 8 individuals with limited English proficiency; 9 ‘‘(B) written translation, performed by a 10 qualified and competent translator, of written 11 content in paper or electronic form into lan- 12 guages other than English; and 13 ‘‘(C) taglines. 14 ‘‘(17) MINORITY.— 15 ‘‘(A) IN GENERAL.—The terms ‘minority’ 16 and ‘minorities’ refer to individuals from a mi- 17 nority group. 18 ‘‘(B) POPULATIONS.—The term ‘minority’, 19 with respect to populations, refers to racial and 20 ethnic minority groups, members of sexual and 21 gender minority groups, and individuals with a 22 disability. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 66 •HR 6637 IH ‘‘(18) MINORITY GROUP.—The term ‘minority 1 group’ has the meaning given the term ‘racial and 2 ethnic minority group’. 3 ‘‘(19) ONSITE INTERPRETATION.—The term 4 ‘onsite interpretation’ means a method of inter- 5 preting or interpretation for which the interpreter is 6 in the physical presence of the provider of health 7 care services or health-care-related services and the 8 recipient of such services who is limited in English 9 proficiency or has a communication impairment such 10 as an impairment in hearing, vision, or learning. 11 ‘‘(20) QUALIFIED INDIVIDUAL WITH A DIS- 12 ABILITY.—The term ‘qualified individual with a dis- 13 ability’ means, with respect to a health program or 14 activity, an individual with a disability who, with or 15 without reasonable modifications to policies, prac- 16 tices, or procedures, the removal of architectural, 17 communication, or transportation barriers, or the 18 provision of auxiliary aids and services, meets the es- 19 sential eligibility requirements for the receipt of aids, 20 benefits, or services offered or provided by the health 21 program or activity. 22 ‘‘(21) QUALIFIED INTERPRETER FOR AN INDI- 23 VIDUAL WITH A DISABILITY.—The term ‘qualified 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 67 •HR 6637 IH interpreter for an individual with a disability’, for an 1 individual with a disability— 2 ‘‘(A) means an interpreter who by means 3 of a remote interpreting service or an onsite ap- 4 pearance— 5 ‘‘(i) adheres to generally accepted in- 6 terpreter ethics principles, including client 7 confidentiality; and 8 ‘‘(ii) is able to interpret effectively, ac- 9 curately, and impartially, both receptively 10 and expressively, using any necessary spe- 11 cialized vocabulary, terminology, and phra- 12 seology; and 13 ‘‘(B) may include sign language inter- 14 preters, oral transliterators (individuals who 15 represent or spell in the characters of another 16 alphabet), and cued language transliterators 17 (individuals who represent or spell by using a 18 small number of handshapes). 19 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI- 20 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 21 The term ‘qualified interpreter for an individual with 22 limited English proficiency’ means an interpreter 23 who via a remote interpreting service or an onsite 24 appearance— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 68 •HR 6637 IH ‘‘(A) adheres to generally accepted inter- 1 preter ethics principles, including client con- 2 fidentiality; 3 ‘‘(B) has demonstrated proficiency in 4 speaking and understanding both spoken 5 English and one or more other spoken lan- 6 guages; and 7 ‘‘(C) is able to interpret effectively, accu- 8 rately, and impartially, both receptively and ex- 9 pressly, to and from such languages and 10 English, using any necessary specialized vocab- 11 ulary, terminology, and phraseology. 12 ‘‘(23) QUALIFIED TRANSLATOR.—The term 13 ‘qualified translator’ means a translator who— 14 ‘‘(A) adheres to generally accepted trans- 15 lator ethics principles, including client confiden- 16 tiality; 17 ‘‘(B) has demonstrated proficiency in writ- 18 ing and understanding both written English 19 and one or more other written non-English lan- 20 guages; and 21 ‘‘(C) is able to translate effectively, accu- 22 rately, and impartially to and from such lan- 23 guages and English, using any necessary spe- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 69 •HR 6637 IH cialized vocabulary, terminology, and phrase- 1 ology. 2 ‘‘(24) RACIAL AND ETHNIC MINORITY GROUP.— 3 The term ‘racial and ethnic minority group’ means 4 Indians and Alaska Natives, African Americans (in- 5 cluding Caribbean Blacks, Africans, and other 6 Blacks), Asian Americans, Hispanics (including 7 Latinos), and Native Hawaiians and other Pacific 8 Islanders. 9 ‘‘(25) SEXUAL AND GENDER MINORITY 10 GROUP.—The term ‘sexual and gender minority 11 group’ encompasses lesbian, gay, bisexual, and 12 transgender populations, as well as those whose sex- 13 ual orientation, gender identity and expression, or 14 reproductive development varies from traditional, so- 15 cietal, cultural, or physiological norms. 16 ‘‘(26) SIGHT TRANSLATION.—The term ‘sight 17 translation’ means the transmission of a written 18 message in one language into a spoken or signed 19 message in another language, or an alternative for- 20 mat in English or another language. 21 ‘‘(27) STATE.—Notwithstanding section 2, the 22 term ‘State’ means each of the several States, the 23 District of Columbia, the Commonwealth of Puerto 24 Rico, the United States Virgin Islands, Guam, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 70 •HR 6637 IH American Samoa, and the Commonwealth of the 1 Northern Mariana Islands. 2 ‘‘(28) TELEPHONIC INTERPRETATION.—The 3 term ‘telephonic interpretation’ (also known as ‘over 4 the phone interpretation’ or ‘OPI’) means, with re- 5 spect to interpretation for an individual with limited 6 English proficiency, a method of interpretation in 7 which the interpreter is not in the physical presence 8 of the provider of health care services or health-care- 9 related services and such individual receiving such 10 services, but the interpreter is connected via tele- 11 phone. 12 ‘‘(29) TRANSLATION.—The term ‘translation’ 13 means the transmission of a written message in one 14 language into a written or signed message in an- 15 other language, and includes translation into an- 16 other language or alternative format, such as large 17 print font, Braille, audio recording, or CD. 18 ‘‘(30) VIDEO REMOTE INTERPRETING SERV- 19 ICES.—The term ‘video remote interpreting services’ 20 means the provision, in health care services or 21 health-care-related services, through a qualified in- 22 terpreter for an individual with limited English pro- 23 ficiency, of video remote interpreting services that 24 are— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 71 •HR 6637 IH ‘‘(A) in real-time, full-motion video, and 1 audio over a dedicated high-speed, wide-band- 2 width video connection or wireless connection 3 that delivers high-quality video images that do 4 not produce lags, choppy, blurry, or grainy im- 5 ages, or irregular pauses in communication; and 6 ‘‘(B) in a sharply delineated image that is 7 large enough to display. 8 ‘‘(31) VITAL DOCUMENT.—The term ‘vital doc- 9 ument’ includes applications for government pro- 10 grams that provide health care services, medical or 11 financial consent forms, financial assistance docu- 12 ments, letters containing important information re- 13 garding patient instructions (such as prescriptions, 14 referrals to other providers, and discharge plans) 15 and participation in a program (such as a Medicaid 16 managed care program), notices pertaining to the 17 reduction, denial, or termination of services or bene- 18 fits, notices of the right to appeal such actions, and 19 notices advising individuals with limited English pro- 20 ficiency with communication disabilities of the avail- 21 ability of free language services, alternative formats, 22 and other outreach materials. 23 ‘‘(b) REFERENCE.—In any reference in this title to 24 a regulatory provision applicable to a ‘handicapped indi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 72 •HR 6637 IH vidual’, the term ‘handicapped individual’ in such provi- 1 sion shall have the same meaning as the term ‘individual 2 with a disability’ as defined in subsection (a). 3 ‘‘Subtitle A—Resources and Innova- 4 tion for Culturally and Linguis- 5 tically Appropriate Health Care 6 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 7 AND LINGUISTICALLY APPROPRIATE 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 Cul- 13 turally and Linguistically Appropriate Health Care’ (re- 14 ferred to in this section as the ‘Center’) to carry out each 15 of the following 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) VITAL DOCUMENTS.—The Center 22 shall provide, directly or through contract, vital 23 documents from competent translation services 24 for providers of health care services and health- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 73 •HR 6637 IH care-related services at no cost to such pro- 1 viders. Such documents may be submitted by 2 covered entities (as defined in section 92.4 of 3 title 42, Code of Federal Regulations, as in ef- 4 fect on May 16, 2016) for translation into non- 5 English languages or alternative formats at a 6 fifth-grade reading level. Such translation serv- 7 ices shall be provided in a timely and reason- 8 able manner. The quality of such translation 9 services shall be monitored and reported pub- 10 licly. 11 ‘‘(B) FORMS.—For each form developed or 12 revised by the Secretary that will be used by in- 13 dividuals with limited English proficiency in 14 health care or health-care-related settings, the 15 Center shall translate the form, at a minimum, 16 into the top 15 non-English languages in the 17 United States according to the most recent data 18 from the American Community Survey or its re- 19 placement. The translation shall be completed 20 within 45 calendar days of the Secretary receiv- 21 ing final approval of the form from the Office 22 of Management and Budget. The Center shall 23 post all translated forms on its website so that 24 other entities may use the same translations. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 74 •HR 6637 IH ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 1 PHONE NUMBER.—The Center shall provide, 2 through a toll-free number, a customer service line 3 for individuals with limited English proficiency— 4 ‘‘(A) to obtain information about federally 5 conducted or funded health programs, including 6 the Medicare program under title XVIII of the 7 Social Security Act, the Medicaid program 8 under title XIX of such Act, and the State Chil- 9 dren’s Health Insurance Program under title 10 XXI of such Act, marketplace coverage avail- 11 able pursuant to title XXVII of this Act and 12 the Patient Protection and Affordable Care Act, 13 and other sources of free or reduced care in- 14 cluding federally qualified health centers, title 15 X clinics, and public health departments; 16 ‘‘(B) to obtain assistance with applying for 17 or accessing these programs and understanding 18 Federal notices written in English; and 19 ‘‘(C) to learn how to access language serv- 20 ices. 21 ‘‘(4) HEALTH INFORMATION CLEARING- 22 HOUSE.— 23 ‘‘(A) IN GENERAL.—The Center shall de- 24 velop and maintain an information clearing- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 75 •HR 6637 IH house to facilitate the provision of language 1 services by providers of health care services and 2 health-care-related services to reduce medical 3 errors, improve medical outcomes, improve cul- 4 tural competence, reduce health care costs 5 caused by miscommunication with individuals 6 with limited English proficiency, and reduce or 7 eliminate the duplication of efforts to translate 8 materials. The clearinghouse shall include the 9 information described in subparagraphs (B) 10 through (F) and make such information avail- 11 able on the internet and in print. 12 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 13 ter shall collect and evaluate for accuracy, de- 14 velop, and make available templates for stand- 15 ard documents that are necessary for patients 16 and consumers to access and make educated de- 17 cisions about their health care, including tem- 18 plates for each of the following: 19 ‘‘(i) Administrative and legal docu- 20 ments, including— 21 ‘‘(I) intake forms; 22 ‘‘(II) forms related to the Medi- 23 care program under title XVIII of the 24 Social Security Act, the Medicaid pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 76 •HR 6637 IH gram under title XIX of such Act, 1 and the State Children’s Health In- 2 surance Program under title XXI of 3 such Act, including eligibility informa- 4 tion for such programs; 5 ‘‘(III) forms informing patients 6 of the compliance and consent re- 7 quirements pursuant to the regula- 8 tions under section 264(c) of the 9 Health Insurance Portability and Ac- 10 countability Act of 1996 (42 U.S.C. 11 1320–2 note); 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 77 •HR 6637 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 and linguistically 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 and linguistically ap- 12 propriate for the target 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 78 •HR 6637 IH lection and dissemination of information on cur- 1 rent examples of language assistance programs 2 and strategies to improve language services for 3 individuals with limited English proficiency, in- 4 cluding case studies using de-identified patient 5 information, program summaries, and program 6 evaluations. 7 ‘‘(E) CULTURALLY AND LINGUISTICALLY 8 APPROPRIATE MATERIALS.—The Center shall 9 provide information relating to culturally and 10 linguistically appropriate health care for minor- 11 ity populations residing in the United States to 12 all health care providers and health-care-related 13 services at no cost. Such information shall in- 14 clude— 15 ‘‘(i) tenets of culturally and linguis- 16 tically appropriate care; 17 ‘‘(ii) culturally and linguistically ap- 18 propriate self-assessment tools; 19 ‘‘(iii) culturally and linguistically ap- 20 propriate training tools; 21 ‘‘(iv) strategic plans to increase cul- 22 tural and linguistic appropriateness in dif- 23 ferent types of providers of health care 24 services and health-care-related services, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 79 •HR 6637 IH including regional collaborations among 1 health care organizations; and 2 ‘‘(v) culturally and linguistically ap- 3 propriate information for educators, practi- 4 tioners, and researchers. 5 ‘‘(F) TRANSLATION GLOSSARIES.—The 6 Center shall— 7 ‘‘(i) develop and publish on its website 8 translation glossaries that provide stand- 9 ardized translations of commonly used 10 terms and phrases utilized in documents 11 translated by the Center; and 12 ‘‘(ii) make these glossaries available— 13 ‘‘(I) free of charge; 14 ‘‘(II) in the 15 languages in 15 which the Center translates materials; 16 and 17 ‘‘(III) in alternative formats in 18 accordance with the Americans with 19 Disabilities Act of 1990 (42 U.S.C. 20 12101 et seq.). 21 ‘‘(G) INFORMATION ABOUT PROGRESS.— 22 The Center shall regularly collect and make 23 publicly available information about the 24 progress of entities receiving grants under sec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 80 •HR 6637 IH tion 3402 regarding successful innovations in 1 implementing the obligations under this sub- 2 section and provide public notice in the entities’ 3 communities about the availability of this infor- 4 mation. 5 ‘‘(b) DIRECTOR.—The Center shall be headed by a 6 Director who shall be appointed by, and who shall report 7 to, the Director of the Agency for Healthcare Research 8 and Quality. 9 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 10 rector shall collaborate with the Deputy Assistant Sec- 11 retary for Minority Health, the Administrator of the Cen- 12 ters for Medicare & Medicaid Services, and the Adminis- 13 trator of the Health Resources and Services Administra- 14 tion to notify health care providers and health care organi- 15 zations about the availability of language access services 16 by the Center. 17 ‘‘(d) EDUCATION.—The Secretary, directly or 18 through contract, shall undertake a national education 19 campaign to inform providers, individuals with limited 20 English proficiency, individuals with hearing or vision im- 21 pairments, health professionals, graduate schools, and 22 community health centers about— 23 ‘‘(1) Federal and State laws and guidelines gov- 24 erning access to language services; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 81 •HR 6637 IH ‘‘(2) the value of using trained and competent 1 interpreters and the risks associated with using fam- 2 ily members, friends, minors, and untrained bilin- 3 gual staff; 4 ‘‘(3) funding sources for developing and imple- 5 menting language services; and 6 ‘‘(4) promising practices to effectively provide 7 language services. 8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 $5,000,000 for each of fiscal years 2021 through 2025. 11 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS- 12 TICALLY APPROPRIATE HEALTH CARE 13 GRANTS. 14 ‘‘(a) IN GENERAL.— 15 ‘‘(1) GRANTS.—The Secretary, acting through 16 the Director of the Agency for Healthcare Research 17 and Quality, shall award grants to eligible entities to 18 enable such entities to design, implement, and evalu- 19 ate innovative, cost-effective programs to improve 20 culturally and linguistically appropriate access to 21 health care services for individuals with limited 22 English proficiency. 23 ‘‘(2) COORDINATION.—The Director of the 24 Agency for Healthcare Research and Quality shall 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 82 •HR 6637 IH coordinate with, and ensure the participation of, 1 other agencies including the Health Resources and 2 Services Administration, the National Institute on 3 Minority Health and Health Disparities at the Na- 4 tional Institutes of Health, and the Office of Minor- 5 ity Health, regarding the design and evaluation of 6 the grants program. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 8 under subsection (a), an entity shall— 9 ‘‘(1) be— 10 ‘‘(A) a city, county, Indian Tribe, State, or 11 subdivision thereof; 12 ‘‘(B) an organization described in section 13 501(c)(3) of the Internal Revenue Code of 1986 14 and exempt from tax under section 501(a) of 15 such Code; 16 ‘‘(C) a community health, mental health, 17 or substance use disorder center or clinic; 18 ‘‘(D) a solo or group physician practice; 19 ‘‘(E) an integrated health care delivery 20 system; 21 ‘‘(F) a public hospital; 22 ‘‘(G) a health care group, university, or 23 college; or 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 83 •HR 6637 IH ‘‘(H) any other entity designated by the 1 Secretary; and 2 ‘‘(2) prepare and submit to the Secretary an 3 application, at such time, in such manner, and con- 4 taining such additional information as the Secretary 5 may reasonably require. 6 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 7 ceived through a grant under this section to— 8 ‘‘(1) develop, implement, and evaluate models of 9 providing competent interpretation services through 10 onsite interpretation, telephonic interpretation, or 11 video remote interpreting services; 12 ‘‘(2) implement strategies to recruit, retain, and 13 promote individuals at all levels of the organization 14 to maintain a diverse staff and leadership that can 15 promote and provide language services to patient 16 populations of the service area of the entity; 17 ‘‘(3) develop and maintain a needs assessment 18 that identifies the current demographic, cultural, 19 and epidemiological profile of the community to ac- 20 curately plan for and implement language services 21 needed in the service area of the entity; 22 ‘‘(4) develop a strategic plan to implement lan- 23 guage services; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 84 •HR 6637 IH ‘‘(5) develop participatory, collaborative part- 1 nerships with communities encompassing the patient 2 populations of individuals with limited English pro- 3 ficiency served by the grant to gain input in design- 4 ing and implementing language services; 5 ‘‘(6) develop and implement grievance resolu- 6 tion processes that are culturally and linguistically 7 appropriate and capable of identifying, preventing, 8 and resolving complaints by individuals with limited 9 English proficiency; 10 ‘‘(7) develop short-term medical and mental 11 health interpretation training courses and incentives 12 for bilingual health care staff who are asked to pro- 13 vide interpretation services in the workplace; 14 ‘‘(8) develop formal training programs, includ- 15 ing continued professional development and edu- 16 cation programs as well as supervision, for individ- 17 uals interested in becoming dedicated health care in- 18 terpreters and culturally and linguistically appro- 19 priate providers; 20 ‘‘(9) provide staff language training instruction, 21 which shall include information on the practical limi- 22 tations of such instruction for nonnative speakers; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 85 •HR 6637 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 and 13 any applicable State privacy laws, data on the indi- 14 vidual patient or recipient’s race, ethnicity, and pri- 15 mary language are collected (and periodically up- 16 dated) in health records and integrated into the or- 17 ganization’s information management systems or 18 any similar system used to store and retrieve data. 19 ‘‘(d) PRIORITY.—In awarding grants under this sec- 20 tion, the Secretary shall give priority to entities that pri- 21 marily engage in providing direct care and that have devel- 22 oped partnerships with community organizations or with 23 agencies with experience in improving language access. 24 ‘‘(e) EVALUATION.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 86 •HR 6637 IH ‘‘(1) BY GRANTEES.—An entity that receives a 1 grant under this section shall submit to the Sec- 2 retary an evaluation that describes, in the manner 3 and to the extent required by the Secretary, the ac- 4 tivities carried out with funds received under the 5 grant, and how such activities improved access to 6 health care services and health-care-related services 7 and the quality of health care for individuals with 8 limited English proficiency. Such evaluation shall be 9 collected and disseminated through the Robert T. 10 Matsui Center for Culturally and Linguistically Ap- 11 propriate Health Care established under section 12 3401. The Director of the Agency for Healthcare 13 Research and Quality shall notify grantees of the 14 availability of technical assistance for the evaluation 15 and provide such assistance upon request. 16 ‘‘(2) BY SECRETARY.—The Director of the 17 Agency for Healthcare Research and Quality shall 18 evaluate or arrange with other individuals or organi- 19 zations to evaluate projects funded under this sec- 20 tion. 21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 22 is authorized to be appropriated to carry out this section 23 $5,000,000 for each of fiscal years 2021 through 2025. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 87 •HR 6637 IH ‘‘SEC. 3403. 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 services. 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 conduct such re- 10 search. 11 ‘‘(c) USE OF FUNDS.—Research conducted under 12 this section shall be designed to do one or more of the 13 following: 14 ‘‘(1) To identify the barriers to mental and be- 15 havioral services that are faced by individuals with 16 limited English proficiency. 17 ‘‘(2) To identify health care providers’ and 18 health administrators’ attitudes, knowledge, and 19 awareness of the barriers to quality health care serv- 20 ices that are faced by individuals with limited 21 English proficiency. 22 ‘‘(3) To identify optimal approaches for deliv- 23 ering language access. 24 ‘‘(4) To identify best practices for data collec- 25 tion, including— 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 88 •HR 6637 IH ‘‘(A) the collection by providers of health 1 care services and health-care-related services of 2 data on the race, ethnicity, and primary lan- 3 guage of recipients of such services, taking into 4 account existing research conducted by the Gov- 5 ernment or private sector; 6 ‘‘(B) the development and implementation 7 of data collection and reporting systems; and 8 ‘‘(C) effective privacy safeguards for col- 9 lected data. 10 ‘‘(5) To develop a minimum data collection set 11 for primary language. 12 ‘‘(6) To evaluate the most effective ways in 13 which the Secretary can create or coordinate, and 14 subsidize or otherwise fund, telephonic interpretation 15 services for health care providers, taking into consid- 16 eration, among other factors, the flexibility necessary 17 for such a system to accommodate variations in— 18 ‘‘(A) provider type; 19 ‘‘(B) languages needed and their frequency 20 of use; 21 ‘‘(C) type of encounter; 22 ‘‘(D) time of encounter, including regular 23 business hours and after hours; and 24 ‘‘(E) location of encounter. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 89 •HR 6637 IH ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 $5,000,000 for each of fiscal years 2021 through 2025.’’. 3 SEC. 205. PILOT PROGRAM FOR IMPROVEMENT AND DE- 4 VELOPMENT OF STATE MEDICAL INTER- 5 PRETING SERVICES. 6 (a) GRANTS AUTHORIZED.—The Secretary of Health 7 and Human Services shall award 1 grant in accordance 8 with this section to each of 3 States (to be selected by 9 the Secretary) to assist each such State in designing, im- 10 plementing, and evaluating a statewide program to provide 11 onsite interpreter services under the State Medicaid plan. 12 (b) GRANT PERIOD.—A grant awarded under this 13 section is authorized for the period of 3 fiscal years begin- 14 ning on October 1, 2021, and ending on September 30, 15 2024. 16 (c) PREFERENCE.—In awarding a grant under this 17 section, the Secretary shall give preference to a State— 18 (1) that has a high proportion of qualified LEP 19 enrollees, as determined by the Secretary; 20 (2) that has a large number of qualified LEP 21 enrollees, as determined by the Secretary; 22 (3) that has a high growth rate of the popu- 23 lation of individuals with limited English proficiency, 24 as determined by the Secretary; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 90 •HR 6637 IH (4) that has a population of qualified LEP en- 1 rollees that is linguistically diverse, requiring inter- 2 preter services in at least 200 non-English lan- 3 guages. 4 (d) USE OF FUNDS.—A State receiving a grant under 5 this section shall use the grant funds to— 6 (1) ensure that all health care providers in the 7 State participating in the State Medicaid plan have 8 access to onsite interpreter services, for the purpose 9 of enabling effective communication between such 10 providers and qualified LEP enrollees during the 11 furnishing of items and services and administrative 12 interactions; 13 (2) establish, expand, procure, or contract for— 14 (A) a statewide health care information 15 technology system that is designed to achieve 16 efficiencies and economies of scale with respect 17 to onsite interpreter services provided to health 18 care providers in the State participating in the 19 State Medicaid plan; and 20 (B) an entity to administer such system, 21 the duties of which shall include— 22 (i) procuring and scheduling inter- 23 preter services for qualified LEP enrollees; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 91 •HR 6637 IH (ii) procuring and scheduling inter- 1 preter services for individuals with limited 2 English proficiency seeking to enroll in the 3 State Medicaid plan; 4 (iii) ensuring that interpreters receive 5 payment for interpreter services rendered 6 under the system; and 7 (iv) consulting regularly with organi- 8 zations representing consumers, inter- 9 preters, and health care providers; and 10 (3) develop mechanisms to establish, improve, 11 and strengthen the competency of the medical inter- 12 pretation workforce that serves qualified LEP enroll- 13 ees in the State, including a national certification 14 process that is valid, credible, and vendor-neutral. 15 (e) APPLICATION.—To receive a grant under this sec- 16 tion, a State shall submit an application at such time and 17 containing such information as the Secretary may require, 18 which shall include the following: 19 (1) A description of the language access needs 20 of individuals in the State enrolled in the State Med- 21 icaid plan. 22 (2) A description of the extent to which the 23 program will— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 92 •HR 6637 IH (A) use the grant funds for the purposes 1 described in subsection (d); 2 (B) meet the health care needs of rural 3 populations of the State; and 4 (C) collect information that accurately 5 tracks the language services requested by con- 6 sumers as compared to the language services 7 provided by health care providers in the State 8 participating in the State Medicaid plan. 9 (3) A description of how the program will be 10 evaluated, including a proposal for collaboration with 11 organizations representing interpreters, consumers, 12 and individuals with limited English proficiency. 13 (f) DEFINITIONS.—In this section: 14 (1) QUALIFIED LEP ENROLLEE.—The term 15 ‘‘qualified LEP enrollee’’ means an individual— 16 (A) who is limited English proficient; and 17 (B) who is enrolled in a State Medicaid 18 plan. 19 (2) STATE.—The term ‘‘State’’ has the mean- 20 ing given the term in section 1101(a)(1) of the So- 21 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 22 poses of title XIX of such Act (42 U.S.C. 1396 et 23 seq.). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 93 •HR 6637 IH (3) STATE MEDICAID PLAN.—The term ‘‘State 1 Medicaid plan’’ means a State plan under title XIX 2 of the Social Security Act (42 U.S.C. 1396 et seq.) 3 or a waiver of such a plan. 4 (4) UNITED STATES.—The term ‘‘United 5 States’’ has the meaning given the term in section 6 1101(a)(2) of the Social Security Act (42 U.S.C. 7 1301(a)(2)), for purposes of title XIX of such Act 8 (42 U.S.C. 1396 et seq.). 9 (g) CONTINUATION PAST DEMONSTRATION.—Any 10 State receiving a grant under this section must agree to 11 directly pay for language services in Medicaid for all Med- 12 icaid providers by the end of the grant period. 13 (h) FUNDING.— 14 (1) AUTHORIZATION OF APPROPRIATIONS.— 15 There is authorized to be appropriated $5,000,000 16 to carry out this section. 17 (2) AVAILABILITY OF FUNDS.—Amounts appro- 18 priated pursuant to the authorization in paragraph 19 (1) are authorized to remain available without fiscal 20 year limitation. 21 (3) INCREASED FEDERAL FINANCIAL PARTICI- 22 PATION.—Section 1903(a)(2)(E) of the Social Secu- 23 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 24 inserting ‘‘(or, in the case of a State that was 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 94 •HR 6637 IH awarded a grant under section 203 of the Health 1 Equity and Accountability Act of 2020, 100 percent 2 for each quarter occurring during the grant period 3 specified in subsection (b) of such section)’’ after 4 ‘‘75 percent’’. 5 (i) LIMITATION.—No Federal funds awarded under 6 this section may be used to provide interpreter services 7 from a location outside the United States. 8 SEC. 206. TRAINING TOMORROW’S DOCTORS FOR CUL- 9 TURALLY AND LINGUISTICALLY APPRO- 10 PRIATE CARE: GRADUATE MEDICAL EDU- 11 CATION. 12 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 13 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 14 1395ww(h)(4)) is amended by adding at the end the fol- 15 lowing new subparagraph: 16 ‘‘(L) TREATMENT OF CULTURALLY AND 17 LINGUISTICALLY APPROPRIATE TRAINING.—In 18 determining a hospital’s number of full-time 19 equivalent residents for purposes of this sub- 20 section, all the time that is spent by an intern 21 or resident in an approved medical residency 22 training program for education and training in 23 culturally and linguistically appropriate service 24 delivery, which shall include all diverse popu- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 95 •HR 6637 IH lations including people with disabilities and the 1 Lesbian, gay, bisexual, transgender, queer, 2 questioning, questioning and intersex 3 (LGBTQIA) community, shall be counted to- 4 ward the determination of full-time equiva- 5 lency.’’. 6 (b) INDIRECT MEDICAL EDUCATION.—Section 7 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 8 1395ww(d)(5)(B)) is amended— 9 (1) by redesignating the clause (x) added by 10 section 5505(b) of the Patient Protection and Af- 11 fordable Care Act as clause (xi); and 12 (2) by adding at the end the following new 13 clause: 14 ‘‘(xii) The provisions of subparagraph (L) of 15 subsection (h)(4) shall apply under this subpara- 16 graph in the same manner as they apply under such 17 subsection.’’. 18 (c) EFFECTIVE DATE.—The amendments made by 19 subsections (a) and (b) shall apply with respect to pay- 20 ments made to hospitals on or after the date that is one 21 year after the date of the enactment of this Act. 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 96 •HR 6637 IH SEC. 207. 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 (as referred to in section 1115A of the Social 15 Security Act (42 U.S.C. 1315a)), shall establish 16 a demonstration program under which the Sec- 17 retary shall award grants to eligible Medicare 18 service providers to improve communication be- 19 tween such providers and Medicare beneficiaries 20 who are limited English proficient, including 21 beneficiaries who live in diverse and under- 22 served communities. 23 (B) APPLICATION OF INNOVATION 24 RULES.—The demonstration project under sub- 25 paragraph (A) shall be conducted in a manner 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 97 •HR 6637 IH that is consistent with the applicable provisions 1 of subsections (b), (c), and (d) of section 1115A 2 of the Social Security Act (42 U.S.C. 1315a). 3 (C) NUMBER OF GRANTS.—To the extent 4 practicable, the Secretary shall award not less 5 than 24 grants under this subsection. 6 (D) GRANT PERIOD.—Except as provided 7 under paragraph (2)(D), each grant awarded 8 under this subsection shall be for a 3-year pe- 9 riod. 10 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 11 ble for a grant under this subsection, an entity must 12 meet the following requirements: 13 (A) MEDICARE PROVIDER.—The entity 14 must be— 15 (i) a provider of services under part A 16 of title XVIII of the Social Security Act 17 (42 U.S.C. 1395c et seq.); 18 (ii) a provider of services under part 19 B of such title (42 U.S.C. 1395j et seq.); 20 (iii) a Medicare Advantage organiza- 21 tion offering a Medicare Advantage plan 22 under part C of such title (42 U.S.C. 23 1395w–21 et seq.); or 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 98 •HR 6637 IH (iv) a PDP sponsor offering a pre- 1 scription drug plan under part D of such 2 title (42 U.S.C. 1395w–101 et seq.). 3 (B) UNDERSERVED COMMUNITIES.—The 4 entity must serve a community that, with re- 5 spect to necessary language services for improv- 6 ing access and utilization of health care among 7 English learners, is disproportionally under- 8 served. 9 (C) APPLICATION.—The entity must pre- 10 pare and submit to the Secretary an applica- 11 tion, at such time, in such manner, and accom- 12 panied by such additional information as the 13 Secretary may require. 14 (D) REPORTING.—In the case of a grantee 15 that received a grant under this subsection in 16 a previous year, such grantee is only eligible for 17 continued payments under a grant under this 18 subsection if the grantee met the reporting re- 19 quirements under paragraph (9) for such year. 20 If a grantee fails to meet the requirement of 21 such paragraph for the first year of a grant, the 22 Secretary may terminate the grant and solicit 23 applications from new grantees to participate in 24 the demonstration program. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 99 •HR 6637 IH (3) DISTRIBUTION.—To the extent feasible, the 1 Secretary shall award— 2 (A) at least 6 grants to providers of serv- 3 ices described in paragraph (2)(A)(i); 4 (B) at least 6 grants to service providers 5 described in paragraph (2)(A)(ii); 6 (C) at least 6 grants to organizations de- 7 scribed in paragraph (2)(A)(iii); and 8 (D) at least 6 grants to sponsors described 9 in paragraph (2)(A)(iv). 10 (4) CONSIDERATIONS IN AWARDING GRANTS.— 11 (A) VARIATION IN GRANTEES.—In award- 12 ing grants under this subsection, the Secretary 13 shall select grantees to ensure the following: 14 (i) The grantees provide many dif- 15 ferent types of language services. 16 (ii) The grantees serve Medicare bene- 17 ficiaries who speak different languages, 18 and who, as a population, have differing 19 needs for language services. 20 (iii) The grantees serve Medicare 21 beneficiaries in both urban and rural set- 22 tings. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 100 •HR 6637 IH (iv) The grantees serve Medicare 1 beneficiaries in at least two geographic re- 2 gions, as defined by the Secretary. 3 (v) The grantees serve Medicare bene- 4 ficiaries in at least two large metropolitan 5 statistical areas with racial, ethnic, sexual, 6 gender, disability, and economically diverse 7 populations. 8 (B) PRIORITY FOR PARTNERSHIPS WITH 9 COMMUNITY ORGANIZATIONS AND AGENCIES.— 10 In awarding grants under this subsection, the 11 Secretary shall give priority to eligible entities 12 that have a partnership with— 13 (i) a community organization; or 14 (ii) a consortia of community organi- 15 zations, State agencies, and local agencies, 16 that has experience in providing language serv- 17 ices. 18 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 19 SERVICES.— 20 (A) IN GENERAL.—Subject to subpara- 21 graph (E), a grantee may only use grant funds 22 received under this subsection to pay for the 23 provision of competent language services to 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 101 •HR 6637 IH Medicare beneficiaries who are English learn- 1 ers. 2 (B) COMPETENT LANGUAGE SERVICES DE- 3 FINED.—For purposes of this subsection, the 4 term ‘‘competent language services’’ means— 5 (i) interpreter and translation services 6 that— 7 (I) subject to the exceptions 8 under subparagraph (C)— 9 (aa) if the grantee operates 10 in a State that has statewide 11 health care interpreter standards, 12 meet the State standards cur- 13 rently in effect; or 14 (bb) if the grantee operates 15 in a State that does not have 16 statewide health care interpreter 17 standards, utilizes competent in- 18 terpreters who follow the Na- 19 tional Council on Interpreting in 20 Health Care’s Code of Ethics and 21 Standards of Practice and com- 22 ply with the requirements of sec- 23 tion 1557 of the Patient Protec- 24 tion and Affordable Care Act (42 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 102 •HR 6637 IH U.S.C. 18116) as published in 1 the Federal Register on May 18, 2 2016; and 3 (II) that, in the case of inter- 4 preter services, are provided 5 through— 6 (aa) onsite interpretation; 7 (bb) telephonic interpreta- 8 tion; or 9 (cc) video interpretation; 10 and 11 (ii) the direct provision of health care 12 or health-care-related services by a com- 13 petent bilingual health care provider. 14 (C) EXCEPTIONS.—The requirements of 15 subparagraph (B)(i)(I) do not apply, with re- 16 spect to interpreter and translation services and 17 a grantee— 18 (i) in the case of a Medicare bene- 19 ficiary who is an English learner if— 20 (I) such beneficiary has been in- 21 formed, in the beneficiary’s primary 22 language, of the availability of free in- 23 terpreter and translation services and 24 the beneficiary instead requests that a 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 103 •HR 6637 IH family member, friend, or other per- 1 son provide such services; and 2 (II) the grantee documents such 3 request in the beneficiary’s medical 4 record; or 5 (ii) in the case of a medical emergency 6 where the delay directly associated with ob- 7 taining a competent interpreter or trans- 8 lation services would jeopardize the health 9 of the patient. 10 Clause (ii) shall not be construed to exempt 11 emergency rooms or similar entities that regu- 12 larly provide health care services in medical 13 emergencies to patients who are English learn- 14 ers from any applicable legal or regulatory re- 15 quirements related to providing competent in- 16 terpreter and translation services without undue 17 delay. 18 (D) MEDICARE ADVANTAGE ORGANIZA- 19 TIONS AND PDP SPONSORS.—If a grantee is a 20 Medicare Advantage organization offering a 21 Medicare Advantage plan under part C of title 22 XVIII of the Social Security Act (42 U.S.C. 23 1395w–21 et seq.) or a PDP sponsor offering 24 a prescription drug plan under part D of such 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 104 •HR 6637 IH title (42 U.S.C. 1395w–101 et seq.), such entity 1 must provide at least 50 percent of the grant 2 funds that the entity receives under this sub- 3 section directly to the entity’s network providers 4 (including all health providers and pharmacists) 5 for the purpose of providing support for such 6 providers to provide competent language serv- 7 ices to Medicare beneficiaries who are English 8 learners. 9 (E) ADMINISTRATIVE AND REPORTING 10 COSTS.—A grantee may use up to 10 percent of 11 the grant funds to pay for administrative costs 12 associated with the provision of competent lan- 13 guage services and for reporting required under 14 paragraph (9). 15 (6) DETERMINATION OF AMOUNT OF GRANT 16 PAYMENTS.— 17 (A) IN GENERAL.—Payments to grantees 18 under this subsection shall be calculated based 19 on the estimated numbers of Medicare bene- 20 ficiaries who are English learners in a grantee’s 21 service area utilizing— 22 (i) data on the numbers of English 23 learners who speak English less than ‘‘very 24 well’’ from the most recently available data 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 105 •HR 6637 IH from the Bureau of the Census or other 1 State-based study the Secretary determines 2 likely to yield accurate data regarding the 3 number of such individuals in such service 4 area; or 5 (ii) data provided by the grantee, if 6 the grantee routinely collects data on the 7 primary language of the Medicare bene- 8 ficiaries that the grantee serves and the 9 Secretary determines that the data is accu- 10 rate and shows a greater number of 11 English learners than would be estimated 12 using the data under clause (i). 13 (B) DISCRETION OF SECRETARY.—Subject 14 to subparagraph (C), the amount of payment 15 made to a grantee under this subsection may be 16 modified annually at the discretion of the Sec- 17 retary, based on changes in the data under sub- 18 paragraph (A) with respect to the service area 19 of a grantee for the year. 20 (C) LIMITATION ON AMOUNT.—The 21 amount of a grant made under this subsection 22 to a grantee may not exceed $500,000 for the 23 period under paragraph (1)(D). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 106 •HR 6637 IH (7) ASSURANCES.—Grantees under this sub- 1 section shall, as a condition of receiving a grant 2 under this subsection— 3 (A) ensure that clinical and support staff 4 receive appropriate ongoing education and 5 training in linguistically appropriate service de- 6 livery; 7 (B) ensure the linguistic competence of bi- 8 lingual providers; 9 (C) offer and provide appropriate language 10 services at no additional charge to each patient 11 who is an English learner for all points of con- 12 tact between the patient and the grantee, in a 13 timely manner during all hours of operation; 14 (D) notify Medicare beneficiaries of their 15 right to receive language services in their pri- 16 mary language; 17 (E) post signage in the primary languages 18 commonly used by the patient population in the 19 service area of the organization; and 20 (F) ensure that— 21 (i) primary language data are col- 22 lected for recipients of language services 23 and such data are consistent with stand- 24 ards developed under title XXXIV of the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 107 •HR 6637 IH Public Health Service Act, as added by 1 section 202 of this Act, to the extent such 2 standards are available upon the initiation 3 of the demonstration program; and 4 (ii) consistent with the privacy protec- 5 tions provided under the regulations pro- 6 mulgated pursuant to section 264(c) of the 7 Health Insurance Portability and Account- 8 ability Act of 1996 (42 U.S.C. 1320d–2 9 note), if the recipient of language services 10 is a minor or is incapacitated, primary lan- 11 guage data are collected on the parent or 12 legal guardian of such recipient. 13 (8) NO COST SHARING.—Medicare beneficiaries 14 who are English learners shall not have to pay cost 15 sharing or co-payments for competent language serv- 16 ices provided under this demonstration program. 17 (9) REPORTING REQUIREMENTS FOR GRANT- 18 EES.—Not later than the end of each calendar year, 19 a grantee that receives funds under this subsection 20 in such year shall submit to the Secretary a report 21 that includes the following information: 22 (A) The number of Medicare beneficiaries 23 to whom competent language services are pro- 24 vided. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 108 •HR 6637 IH (B) The primary languages of those Medi- 1 care beneficiaries. 2 (C) The types of language services pro- 3 vided to such beneficiaries. 4 (D) Whether such language services were 5 provided by employees of the grantee or 6 through a contract with external contractors or 7 agencies. 8 (E) The types of interpretation services 9 provided to such beneficiaries, and the approxi- 10 mate length of time such service is provided to 11 such beneficiaries. 12 (F) The costs of providing competent lan- 13 guage services. 14 (G) An account of the training or accredi- 15 tation of bilingual staff, interpreters, and trans- 16 lators providing services funded by the grant 17 under this subsection. 18 (10) EVALUATION AND REPORT TO CON- 19 GRESS.—Not later than 1 year after the completion 20 of a 3-year grant under this subsection, the Sec- 21 retary shall conduct an evaluation of the demonstra- 22 tion program under this subsection and shall submit 23 to the Congress a report that includes the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 109 •HR 6637 IH (A) An analysis of the patient outcomes 1 and the costs of furnishing care to the Medicare 2 beneficiaries who are English learners partici- 3 pating in the project as compared to such out- 4 comes and costs for such Medicare beneficiaries 5 not participating, based on the data provided 6 under paragraph (9) and any other information 7 available to the Secretary. 8 (B) The effect of delivering language serv- 9 ices on— 10 (i) Medicare beneficiary access to care 11 and utilization of services; 12 (ii) the efficiency and cost effective- 13 ness of health care delivery; 14 (iii) patient satisfaction; 15 (iv) health outcomes; and 16 (v) the provision of culturally appro- 17 priate services provided to such bene- 18 ficiaries. 19 (C) The extent to which bilingual staff, in- 20 terpreters, and translators providing services 21 under such demonstration were trained or ac- 22 credited and the nature of accreditation or 23 training needed by type of provider, service, or 24 other category as determined by the Secretary 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 110 •HR 6637 IH to ensure the provision of high-quality interpre- 1 tation, translation, or other language services to 2 Medicare beneficiaries if such services are ex- 3 panded pursuant to section 1115A(c) of the So- 4 cial Security Act (42 U.S.C. 1315a(c)). 5 (D) Recommendations, if any, regarding 6 the extension of such project to the entire Medi- 7 care Program, subject to the provisions of such 8 section 1115A(c). 9 (11) APPROPRIATIONS.—There is appropriated 10 to carry out this subsection, in equal parts from the 11 Federal Hospital Insurance Trust Fund under sec- 12 tion 1817 of the Social Security Act (42 U.S.C. 13 1395i) and the Federal Supplementary Medical In- 14 surance Trust Fund under section 1841 of such Act 15 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 16 of the demonstration program. 17 (12) ENGLISH LEARNER DEFINED.—In this 18 subsection, the term ‘‘English learner’’ has the 19 meaning given such term in section 8101(20) of the 20 Elementary and Secondary Education Act of 1965, 21 except that subparagraphs (A), (B), and (D) of such 22 section shall not apply. 23 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE 24 MEDICARE PROGRAM.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 111 •HR 6637 IH (1) INCLUSION AS RURAL HEALTH CLINIC 1 SERVICES.—Section 1861 of the Social Security Act 2 (42 U.S.C. 1395x) is amended— 3 (A) in subsection (aa)(1)— 4 (i) in subparagraph (B), by striking 5 ‘‘and’’ at the end; 6 (ii) by adding ‘‘and’’ at the end of 7 subparagraph (C); and 8 (iii) by inserting after subparagraph 9 (C) the following new subparagraph: 10 ‘‘(D) language assistance services as defined in 11 subsection (jjj)(1),’’; and 12 (B) by adding at the end the following new 13 subsection: 14 ‘‘Language Assistance Services and Related Terms 15 ‘‘(kkk)(1) The term ‘language assistance services’ 16 means ‘language access’ or ‘language assistance services’ 17 (as those terms are defined in section 3400 of the Public 18 Health Service Act) furnished by a ‘qualified interpreter 19 for an individual with limited English proficiency’ or a 20 ‘qualified translator’ (as those terms are defined in such 21 section 3400) to an ‘individual with limited English pro- 22 ficiency’ (as defined in such section 3400) or an ‘English 23 learner’ (as defined in paragraph (2)). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 112 •HR 6637 IH ‘‘(2) The term ‘English learner’ has the meaning 1 given that term in section 8101(20) of the Elementary and 2 Secondary Education Act of 1965, except that subpara- 3 graphs (A), (B), and (D) of such section shall not apply.’’. 4 (2) COVERAGE.—Section 1832(a)(2) of the So- 5 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 6 ed— 7 (A) by striking ‘‘and’’ at the end of sub- 8 paragraph (I); 9 (B) by striking the period at the end of 10 subparagraph (J) and inserting ‘‘; and’’; and 11 (C) by adding at the end the following new 12 subparagraph: 13 ‘‘(K) language assistance services (as de- 14 fined in section 1861(jjj)(1)).’’. 15 (3) PAYMENT.—Section 1833(a) of the Social 16 Security Act (42 U.S.C. 1395l(a)) is amended— 17 (A) by striking ‘‘and’’ at the end of para- 18 graph (8); 19 (B) by striking the period at the end of 20 paragraph (9) and inserting ‘‘; and’’; and 21 (C) by inserting after paragraph (9) the 22 following new paragraph: 23 ‘‘(10) in the case of language assistance serv- 24 ices (as defined in section 1861(jjj)(1)), 100 percent 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 113 •HR 6637 IH of the reasonable charges for such services, as deter- 1 mined in consultation with the Medicare Payment 2 Advisory Commission.’’. 3 (4) WAIVER OF BUDGET NEUTRALITY.—For 4 the 3-year period beginning on the date of enact- 5 ment of this section, the budget neutrality provision 6 of section 1848(c)(2)(B)(ii) of the Social Security 7 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 8 apply with respect to language assistance services 9 (as defined in section 1861(kkk)(1) of such Act). 10 (c) MEDICARE PARTS C AND D.— 11 (1) IN GENERAL.—Medicare Advantage plans 12 under part C of title XVIII of the Social Security 13 Act (42 U.S.C. 1395w–21 et seq.) and prescription 14 drug plans under part D of such title (42 U.S.C. 15 1395q–101) shall comply with title VI of the Civil 16 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 17 section 1557 of the Patient Protection and Afford- 18 able Care Act (42 U.S.C. 18116) to provide effective 19 language services to enrollees of such plans. 20 (2) MEDICARE ADVANTAGE PLANS AND PRE- 21 SCRIPTION DRUG PLANS REPORTING REQUIRE- 22 MENT.—Section 1857(e) of the Social Security Act 23 (42 U.S.C. 1395w–27(e)) is amended by adding at 24 the end the following new paragraph: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 114 •HR 6637 IH ‘‘(5) REPORTING REQUIREMENTS RELATING TO 1 EFFECTIVE LANGUAGE SERVICES.—A contract under 2 this part shall require a Medicare Advantage organi- 3 zation (and, through application of section 1860D– 4 12(b)(3)(D), a contract under section 1860D–12 5 shall require a PDP sponsor) to annually submit 6 (for each year of the contract) a report that contains 7 information on the internal policies and procedures 8 of the organization (or sponsor) related to recruit- 9 ment and retention efforts directed to workforce di- 10 versity and linguistically and culturally appropriate 11 provision of services in each of the following con- 12 texts: 13 ‘‘(A) The collection of data in a manner 14 that meets the requirements of title I of the 15 Health Equity and Accountability Act of 2020, 16 regarding the enrollee population. 17 ‘‘(B) Education of staff and contractors 18 who have routine contact with enrollees regard- 19 ing the various needs of the diverse enrollee 20 population. 21 ‘‘(C) Evaluation of the language services 22 programs and services offered by the organiza- 23 tion (or sponsor) with respect to the enrollee 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 115 •HR 6637 IH population, such as through analysis of com- 1 plaints or satisfaction survey results. 2 ‘‘(D) Methods by which the plan provides 3 to the Secretary information regarding the eth- 4 nic diversity of the enrollee population. 5 ‘‘(E) The periodic provision of educational 6 information to plan enrollees on the language 7 services and programs offered by the organiza- 8 tion (or sponsor).’’. 9 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 10 AND CHIP.— 11 (1) PAYMENTS TO STATES.—Section 12 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 13 1396b(a)(2)(E)), as amended by section 203(g)(3), 14 is further amended by— 15 (A) striking ‘‘75’’ and inserting ‘‘95’’; 16 (B) striking ‘‘translation or interpretation 17 services’’ and inserting ‘‘language assistance 18 services’’; and 19 (C) striking ‘‘children of families’’ and in- 20 serting ‘‘individuals’’. 21 (2) STATE PLAN REQUIREMENTS.—Section 22 1902(a)(10)(A) of the Social Security Act (42 23 U.S.C. 1396a(a)(10)(A)) is amended by striking 24 ‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 116 •HR 6637 IH (3) DEFINITION OF MEDICAL ASSISTANCE.— 1 Section 1905(a) of the Social Security Act (42 2 U.S.C. 1396d(a)) is amended— 3 (A) in paragraph (29), by striking ‘‘and’’ 4 at the end; 5 (B) by redesignating paragraph (30) as 6 paragraph (31); and 7 (C) by inserting after paragraph (29) the 8 following new paragraph: 9 ‘‘(30) language assistance services, as such 10 term is defined in section 1861(kkk)(1), provided in 11 a timely manner to individuals with limited English 12 proficiency as defined in section 3400 of the Public 13 Health Service Act; and’’. 14 (4) USE OF DEDUCTIONS AND COST SHAR- 15 ING.—Section 1916(a)(2) of the Social Security Act 16 (42 U.S.C. 1396o(a)(2)) is amended— 17 (A) by striking ‘‘or’’ at the end of subpara- 18 graph (D); 19 (B) by striking ‘‘; and’’ at the end of sub- 20 paragraph (E) and inserting ‘‘, or’’; and 21 (C) by adding at the end the following new 22 subparagraph: 23 ‘‘(F) language assistance services described 24 in section 1905(a)(29); and’’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 117 •HR 6637 IH (5) CHIP COVERAGE REQUIREMENTS.—Section 1 2103 of the Social Security Act (42 U.S.C. 1397cc) 2 is amended— 3 (A) in subsection (a), in the matter before 4 paragraph (1), by striking ‘‘and (7)’’ and in- 5 serting ‘‘(7), and (10)’’; 6 (B) in subsection (c), by adding at the end 7 the following new paragraph: 8 ‘‘(10) LANGUAGE ASSISTANCE SERVICES.—The 9 child health assistance provided to a targeted low-in- 10 come child shall include coverage of language assist- 11 ance services, as such term is defined in section 12 1861(jjj)(1), provided in a timely manner to individ- 13 uals with limited English proficiency (as defined in 14 section 3400 of the Public Health Service Act).’’; 15 and 16 (C) in subsection (e)(2)— 17 (i) in the heading, by striking ‘‘PRE- 18 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 19 (ii) by inserting ‘‘or subsection 20 (c)(10)’’ after ‘‘subsection (c)(1)(D)’’. 21 (6) DEFINITION OF CHILD HEALTH ASSIST- 22 ANCE.—Section 2110(a)(27) of the Social Security 23 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 118 •HR 6637 IH ing ‘‘translation’’ and inserting ‘‘language assistance 1 services as described in section 2103(c)(10)’’. 2 (7) STATE DATA COLLECTION.—Pursuant to 3 the reporting requirement described in section 4 2107(b)(1) of the Social Security Act (42 U.S.C. 5 1397gg(b)(1)), the Secretary of Health and Human 6 Services shall require that States collect data on— 7 (A) the primary language of individuals re- 8 ceiving child health assistance under title XXI 9 of the Social Security Act (42 U.S.C. 1397aa et 10 seq.); and 11 (B) in the case of such individuals who are 12 minors or incapacitated, the primary language 13 of the individual’s parent or guardian. 14 (8) CHIP PAYMENTS TO STATES.—Section 15 2105 of the Social Security Act (42 U.S.C. 1397ee) 16 is amended— 17 (A) in subsection (a)(1), by striking ‘‘75’’ 18 and inserting ‘‘90’’; and 19 (B) in subsection (c)(2)(A), by inserting 20 before the period at the end the following: ‘‘, 21 except that expenditures pursuant to clause (iv) 22 of subparagraph (D) of such paragraph shall 23 not count towards this total’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 119 •HR 6637 IH (e) FUNDING LANGUAGE ASSISTANCE SERVICES 1 FURNISHED BY PROVIDERS OF HEALTH CARE AND 2 HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH 3 RATES OF UNINSURED LEP INDIVIDUALS.— 4 (1) PAYMENT OF COSTS.— 5 (A) IN GENERAL.—Subject to subpara- 6 graph (B), the Secretary of Health and Human 7 Services (referred to in this subsection as the 8 ‘‘Secretary’’) shall make payments (on a quar- 9 terly basis) directly to eligible entities to sup- 10 port the provision of language assistance serv- 11 ices to English learners in an amount equal to 12 an eligible entity’s eligible costs for providing 13 such services for the quarter. 14 (B) FUNDING.—Out of any funds in the 15 Treasury not otherwise appropriated, there are 16 appropriated to the Secretary of Health and 17 Human Services such sums as may be nec- 18 essary for each of fiscal years 2021 through 19 2025. 20 (C) RELATION TO MEDICAID DSH.—Pay- 21 ments under this subsection shall not offset or 22 reduce payments under section 1923 of the So- 23 cial Security Act (42 U.S.C. 1396r–4), nor 24 shall payments under such section be consid- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 120 •HR 6637 IH ered when determining uncompensated costs as- 1 sociated with the provision of language assist- 2 ance services for the purposes of this section. 3 (2) METHODOLOGY FOR PAYMENT OF 4 CLAIMS.— 5 (A) IN GENERAL.—The Secretary shall es- 6 tablish a methodology to determine the average 7 per person cost of language assistance services. 8 (B) DIFFERENT ENTITIES.—In estab- 9 lishing such methodology, the Secretary may es- 10 tablish different methodologies for different 11 types of eligible entities. 12 (C) NO INDIVIDUAL CLAIMS.—The Sec- 13 retary may not require eligible entities to sub- 14 mit individual claims for language assistance 15 services for individual patients as a requirement 16 for payment under this subsection. 17 (3) DATA COLLECTION INSTRUMENT.—For pur- 18 poses of this subsection, the Secretary shall create a 19 standard data collection instrument that is con- 20 sistent with any existing reporting requirements by 21 the Secretary or relevant accrediting organizations 22 regarding the number of individuals to whom lan- 23 guage access are provided. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 121 •HR 6637 IH (4) GUIDELINES.—Not later than 6 months 1 after the date of enactment of this Act, the Sec- 2 retary shall establish and distribute guidelines con- 3 cerning the implementation of this subsection. 4 (5) REPORTING REQUIREMENTS.— 5 (A) REPORT TO SECRETARY.—Entities re- 6 ceiving payment under this subsection shall pro- 7 vide the Secretary with a quarterly report on 8 how the entity used such funds. Such report 9 shall contain aggregate (and may not contain 10 individualized) data collected using the instru- 11 ment under paragraph (3) and shall otherwise 12 be in a form and manner determined by the 13 Secretary. 14 (B) REPORT TO CONGRESS.—Not later 15 than 2 years after the date of enactment of this 16 Act, and every 2 years thereafter, the Secretary 17 shall submit a report to Congress concerning 18 the implementation of this subsection. 19 (6) DEFINITIONS.—In this subsection: 20 (A) ELIGIBLE COSTS.—The term ‘‘eligible 21 costs’’ means, with respect to an eligible entity 22 that provides language assistance services to 23 English learners, the product of— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 122 •HR 6637 IH (i) the average per person cost of lan- 1 guage assistance services, determined ac- 2 cording to the methodology devised under 3 paragraph (2); and 4 (ii) the number of English learners 5 who are provided language assistance serv- 6 ices by the entity and for whom no reim- 7 bursement is available for such services 8 under the amendments made by subsection 9 (a), (b), (c), or (d) or by private health in- 10 surance. 11 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 12 entity’’ means an entity that— 13 (i) is a Medicaid provider that is— 14 (I) a physician; 15 (II) a hospital with a low-income 16 utilization rate (as defined in section 17 1923(b)(3) of the Social Security Act 18 (42 U.S.C. 1396r–4(b)(3))) of greater 19 than 25 percent; or 20 (III) a federally qualified health 21 center (as defined in section 22 1905(l)(2)(B) of the Social Security 23 Act (42 U.S.C. 1396d(l)(2)(B))); 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 123 •HR 6637 IH (ii) not later than 6 months after the 1 date of the enactment of this Act, provides 2 language assistance services to not less 3 than 8 percent of the entity’s total number 4 of patients; and 5 (iii) prepares and submits an applica- 6 tion to the Secretary, at such time, in such 7 manner, and accompanied by such infor- 8 mation as the Secretary may require, to 9 ascertain the entity’s eligibility for funding 10 under this subsection. 11 (C) ENGLISH LEARNER.—The term 12 ‘‘English learner’’ has the meaning given such 13 term in section 8101(20) of the Elementary 14 and Secondary Education Act of 1965 (20 15 U.S.C. 7801(20)), except that subparagraphs 16 (A), (B), and (D) of such section shall not 17 apply. 18 (D) LANGUAGE ASSISTANCE SERVICES.— 19 The term ‘‘language assistance services’’ has 20 the meaning given such term in section 21 1861(kkk)(1) of the Social Security Act, as 22 added by subsection (b). 23 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 24 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 124 •HR 6637 IH OTHER LAWS.—Nothing in this section shall be construed 1 to limit otherwise existing obligations of recipients of Fed- 2 eral financial assistance under title VI of the Civil Rights 3 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 4 the Affordable Care Act, or other laws that protect the 5 civil rights of individuals. 6 (g) EFFECTIVE DATE.— 7 (1) IN GENERAL.—Except as otherwise pro- 8 vided and subject to paragraph (2), the amendments 9 made by this section shall take effect on January 1, 10 2021. 11 (2) EXCEPTION IF STATE LEGISLATION RE- 12 QUIRED.—In the case of a State plan for medical as- 13 sistance under title XIX of the Social Security Act 14 (42 U.S.C. 1396 et seq.) which the Secretary of 15 Health and Human Services determines requires 16 State legislation (other than legislation appro- 17 priating funds) in order for the plan to meet the ad- 18 ditional requirement imposed by the amendments 19 made by this section, the State plan shall not be re- 20 garded as failing to comply with the requirements of 21 such title solely on the basis of its failure to meet 22 this additional requirement before the first day of 23 the first calendar quarter beginning after the close 24 of the first regular session of the State legislature 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 125 •HR 6637 IH that begins after the date of the enactment of this 1 Act. For purposes of the previous sentence, in the 2 case of a State that has a 2-year legislative session, 3 each year of such session shall be deemed to be a 4 separate regular session of the State legislature. 5 SEC. 208. INCREASING UNDERSTANDING OF AND IMPROV- 6 ING HEALTH LITERACY. 7 (a) IN GENERAL.—The Secretary, acting through the 8 Director of the Agency for Healthcare Research and Qual- 9 ity with respect to grants under subsection (c)(1) and 10 through the Administrator of the Health Resources and 11 Services Administration with respect to grants under sub- 12 section (c)(2), in consultation with the Director of the Na- 13 tional Institute on Minority Health and Health Disparities 14 and the Deputy Assistant Secretary for Minority Health, 15 shall award grants to eligible entities to improve health 16 care for patient populations that have low functional 17 health literacy. 18 (b) ELIGIBILITY.—To be eligible to receive a grant 19 under subsection (a), an entity shall— 20 (1) be a hospital, health center or clinic, health 21 plan, or other health entity (including a nonprofit 22 minority health organization or association); and 23 (2) prepare and submit to the Secretary an ap- 24 plication at such time, in such manner, and con- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 126 •HR 6637 IH taining such information as the Secretary may rea- 1 sonably require. 2 (c) USE OF FUNDS.— 3 (1) AGENCY FOR HEALTHCARE RESEARCH AND 4 QUALITY.—A grant awarded under subsection (a) 5 through the Director of the Agency for Healthcare 6 Research and Quality shall be used— 7 (A) to define and increase the under- 8 standing of health literacy; 9 (B) to investigate the correlation between 10 low health literacy and health and health care; 11 (C) to clarify which aspects of health lit- 12 eracy have an effect on health outcomes; and 13 (D) for any other activity determined ap- 14 propriate by the Director. 15 (2) HEALTH RESOURCES AND SERVICES ADMIN- 16 ISTRATION.—A grant awarded under subsection (a) 17 through the Administrator of the Health Resources 18 and Services Administration shall be used to conduct 19 demonstration projects for interventions for patients 20 with low health literacy that may include— 21 (A) the development of new disease man- 22 agement programs for patients with low health 23 literacy; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 127 •HR 6637 IH (B) the tailoring of disease management 1 programs addressing mental, physical, oral, and 2 behavioral health conditions for patients with 3 low health literacy; 4 (C) the translation of written health mate- 5 rials for patients with low health literacy; 6 (D) the identification, implementation, and 7 testing of low health literacy screening tools; 8 (E) the conduct of educational campaigns 9 for patients and providers about low health lit- 10 eracy; 11 (F) the conduct of educational campaigns 12 concerning health directed specifically at pa- 13 tients with mental disabilities, including those 14 with cognitive and intellectual disabilities, de- 15 signed to reduce the incidence of low health lit- 16 eracy among these populations, which shall 17 have instructional materials in the plain lan- 18 guage standards promulgated under the Plain 19 Writing Act of 2010 (5 U.S.C. 301 note) for 20 Federal agencies; and 21 (G) other activities determined appropriate 22 by the Administrator. 23 (d) DEFINITIONS.—In this section, the term ‘‘low 24 health literacy’’ means the inability of an individual to ob- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 128 •HR 6637 IH tain, process, and understand basic health information 1 and services needed to make appropriate health decisions. 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 2021 through 2025. 6 SEC. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR AC- 7 TIVITIES RECEIVING FEDERAL FUNDS. 8 (a) COVERED ENTITY; COVERED PROGRAM OR AC- 9 TIVITY.—In this section— 10 (1) the term ‘‘covered entity’’ has the meaning 11 given such term in section 92.4 of title 42, Code of 12 Federal Regulations, as in effect on May 16, 2016; 13 and 14 (2) the term ‘‘covered program or activity’’ has 15 the meaning given such term in section 92.4 of title 16 42, Code of Federal Regulations, as in effect on May 17 16, 2016. 18 (b) REQUIREMENTS.—A covered entity, in order to 19 ensure the right of individuals with limited English pro- 20 ficiency to receive access to high-quality health care 21 through the covered program or activity, shall— 22 (1) ensure that appropriate clinical and support 23 staff receive ongoing education and training in cul- 24 turally and linguistically appropriate service delivery; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 129 •HR 6637 IH (2) offer and provide appropriate language as- 1 sistance services at no additional charge to each pa- 2 tient that is an individual with limited English pro- 3 ficiency at all points of contact, in a timely manner 4 during all hours of operation; 5 (3) notify patients of their right to receive lan- 6 guage services in their primary language; and 7 (4) utilize only qualified interpreters for an in- 8 dividual with limited English proficiency or qualified 9 translators, except as provided in subsection (c). 10 (c) EXEMPTIONS.—The requirements of subsection 11 (b)(4) shall not apply as follows: 12 (1) When a patient requests the use of family, 13 friends, or other persons untrained in interpretation 14 or translation if each of the following conditions are 15 met: 16 (A) The interpreter requested by the pa- 17 tient is over the age of 18. 18 (B) The covered entity informs the patient 19 in the primary language of the patient that he 20 or she has the option of having the entity pro- 21 vide to the patient an interpreter and trans- 22 lation services without charge. 23 (C) The covered entity informs the patient 24 that the entity may not require an individual 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 130 •HR 6637 IH with a limited English proficiency to use a fam- 1 ily member or friend as an interpreter. 2 (D) The covered entity evaluates whether 3 the person the patient wishes to use as an in- 4 terpreter is competent. If the covered entity has 5 reason to believe that such person is not com- 6 petent as an interpreter, the entity provides its 7 own interpreter to protect the covered entity 8 from liability if the patient’s interpreter is later 9 found not competent. 10 (E) If the covered entity has reason to be- 11 lieve that there is a conflict of interest between 12 the interpreter and patient, the covered entity 13 may not use the patient’s interpreter. 14 (F) The covered entity has the patient sign 15 a waiver, witnessed by at least 1 individual not 16 related to the patient, that includes the infor- 17 mation stated in subparagraphs (A) through 18 (E) and is translated into the patient’s primary 19 language. 20 (2) When a medical emergency exists and the 21 delay directly associated with obtaining competent 22 interpreter or translation services would jeopardize 23 the health of the patient, but only until a competent 24 interpreter or translation service is available. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 131 •HR 6637 IH (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 1 shall not be construed to mean that emergency rooms or 2 similar entities that regularly provide health care services 3 in medical emergencies are exempt from legal or regu- 4 latory requirements related to competent interpreter serv- 5 ices. 6 SEC. 210. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 7 TURALLY AND LINGUISTICALLY APPRO- 8 PRIATE HEALTH CARE SERVICES. 9 (a) REPORT.—Not later than 1 year after the date 10 of enactment of this Act and annually thereafter, the Sec- 11 retary of Health and Human Services shall enter into a 12 contract with the National Academy of Medicine for the 13 preparation and publication of a report that describes 14 Federal efforts to ensure that all individuals with limited 15 English proficiency have meaningful access to health care 16 services and health-care-related services that are culturally 17 and linguistically appropriate. Such report shall include— 18 (1) a description and evaluation of the activities 19 carried out under this Act; 20 (2) a description and analysis of best practices, 21 model programs, guidelines, and other effective 22 strategies for providing access to culturally and lin- 23 guistically appropriate health care services; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 132 •HR 6637 IH (3) recommendations on the development and 1 implementation of policies and practices by providers 2 of health care services and health-care-related serv- 3 ices for individuals with limited English proficiency, 4 including people with cognitive, hearing, vision, or 5 print impairments; 6 (4) recommend guidelines or standards for 7 health literacy and plain language, informed consent, 8 discharge instructions, and written communications, 9 and for improvement of health care access; 10 (5) a description of the effect of providing lan- 11 guage services on quality of health care and access 12 to care; and 13 (6) a description of the costs associated with or 14 savings related to the provision of language services. 15 (b) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2021 through 2025. 19 SEC. 211. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 20 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 21 cation is authorized to provide grants to eligible entities 22 for the provision of English as a second language (in this 23 section referred to as ‘‘ESL’’) instruction and shall deter- 24 mine, after consultation with appropriate stakeholders, the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 133 •HR 6637 IH mechanism for administering and distributing such 1 grants. 2 (b) ELIGIBLE ENTITY DEFINED.—In this section, 3 the term ‘‘eligible entity’’ means a State or community- 4 based organization that employs and serves minority popu- 5 lations. 6 (c) APPLICATION.—An eligible entity may apply for 7 a grant under this section by submitting such information 8 as the Secretary of Education may require and in such 9 form and manner as the Secretary may require. 10 (d) USE OF GRANT.—As a condition of receiving a 11 grant under this section, an eligible entity shall— 12 (1) develop and implement a plan for assuring 13 the availability of ESL instruction that effectively 14 integrates information about the nature of the 15 United States health care system, how to access 16 care, and any special language skills that may be re- 17 quired for individuals to access and regularly nego- 18 tiate the system effectively; 19 (2) develop a plan, including, where appro- 20 priate, public-private partnerships, for making ESL 21 instruction progressively available to all individuals 22 seeking instruction; and 23 (3) maintain current ESL instruction efforts by 24 using funds available under this section to supple- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 134 •HR 6637 IH ment rather than supplant any funds expended for 1 ESL instruction in the State as of January 1, 2020. 2 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 3 Secretary of Education shall— 4 (1) collect and publicize annual data on how 5 much Federal, State, and local governments spend 6 on ESL instruction; 7 (2) collect data from State and local govern- 8 ments to identify the unmet needs of English lan- 9 guage learners for appropriate ESL instruction, in- 10 cluding— 11 (A) the preferred written and spoken lan- 12 guage of such English language learners; 13 (B) the extent of waiting lists for ESL in- 14 struction, including how many programs main- 15 tain waiting lists and, for programs that do not 16 have waiting lists, the reasons why not; 17 (C) the availability of programs to geo- 18 graphically isolated communities; 19 (D) the impact of course enrollment poli- 20 cies, including open enrollment, on the avail- 21 ability of ESL instruction; 22 (E) the number individuals in the State 23 and each participating locality; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 135 •HR 6637 IH (F) the effectiveness of the instruction in 1 meeting the needs of individuals receiving in- 2 struction and those needing instruction; 3 (G) as assessment of the need for pro- 4 grams that integrate job training and ESL in- 5 struction, to assist individuals to obtain better 6 jobs; and 7 (H) the availability of ESL slots by State 8 and locality; 9 (3) determine the cost and most appropriate 10 methods of making ESL instruction available to all 11 English language learners seeking instruction; and 12 (4) not later than 1 year after the date of en- 13 actment of this Act, issue a report to Congress that 14 assesses the information collected in paragraphs (1), 15 (2), and (3) and makes recommendations on steps 16 that should be taken to progressively realize the goal 17 of making ESL instruction available to all English 18 language learners seeking instruction. 19 (f) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to the Secretary of Edu- 21 cation $250,000,000 for each of fiscal years 2021 through 22 2024 to carry out this section. 23 SEC. 212. IMPLEMENTATION. 24 (a) GENERAL PROVISIONS.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 136 •HR 6637 IH (1) IMMUNITY.—A State shall not be immune 1 under the 11th Amendment to the Constitution of 2 the United States from suit in Federal court for a 3 violation of this title (including an amendment made 4 by this title). 5 (2) REMEDIES.—In a suit against a State for 6 a violation of this title (including an amendment 7 made by this title), remedies (including remedies 8 both at law and in equity) are available for such a 9 violation to the same extent as such remedies are 10 available for such a violation in a suit against any 11 public or private entity other than a State. 12 (b) RULE OF CONSTRUCTION.—Nothing in this title 13 shall be construed to limit otherwise existing obligations 14 of recipients of Federal financial assistance under title VI 15 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 16 or any other Federal statute. 17 SEC. 213. LANGUAGE ACCESS SERVICES. 18 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 19 the Patient Protection and Affordable Care Act (42 20 U.S.C. 18022(b)(1)) is amended by adding at the end the 21 following: 22 ‘‘(K) Language access services, including 23 oral interpretation and written translations.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 137 •HR 6637 IH (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 1 COVERAGE.— 2 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 3 Internal Revenue Code of 1986 is amended by redes- 4 ignating clauses (iii) and (iv) as clauses (iv) and (v), 5 respectively, and by inserting after clause (ii) the fol- 6 lowing new clause: 7 ‘‘(iii) COVERAGE MUST INCLUDE LAN- 8 GUAGE ACCESS AND SERVICES.—Except as 9 provided in clause (iv), an employee shall 10 not be treated as eligible for minimum es- 11 sential coverage if such coverage consists 12 of an eligible employer-sponsored plan (as 13 defined in section 5000A(f)(2)) and the 14 plan does not provide coverage for lan- 15 guage access services, including oral inter- 16 pretation and written translations.’’. 17 (2) CONFORMING AMENDMENTS.— 18 (A) Section 36B(c)(2)(C) of such Code is 19 amended by striking ‘‘clause (iii)’’ each place it 20 appears in clauses (i) and (ii) and inserting 21 ‘‘clause (iv)’’. 22 (B) Section 36B(c)(2)(C)(iv) of such Code, 23 as redesignated by this subsection, is amended 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 138 •HR 6637 IH by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 1 and (iii)’’. 2 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 3 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 4 amended— 5 (1) by striking ‘‘and’’ at the end of subpara- 6 graph (C); 7 (2) by striking the period at the end of sub- 8 paragraph (D) and inserting ‘‘; and’’; and 9 (3) by adding at the end the following new sub- 10 paragraph: 11 ‘‘(E) reduce health disparities through the 12 provision of language access services, including 13 oral interpretation and written translations.’’. 14 (d) REGULATIONS REGARDING INTERNAL CLAIMS 15 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 16 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 17 The Secretary of the Treasury, the Secretary of Labor, 18 and the Secretary of Health and Human Services shall 19 amend the regulations in section 54.9815–2719(e) of title 20 26, Code of Federal Regulations, section 2590.715– 21 2719(e) of title 29, Code of Federal Regulations, and sec- 22 tion 147.136(e) of title 45, Code of Federal Regulations, 23 respectively, to require group health plans and health in- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 139 •HR 6637 IH surance issuers offering group or individual health insur- 1 ance coverage to which such sections apply— 2 (1) to provide oral interpretation services with- 3 out any threshold requirements; 4 (2) to provide in the English versions of all no- 5 tices a statement prominently displayed in not less 6 than 15 non-English languages clearly indicating 7 how to access the language services provided by the 8 plan or issuer; and 9 (3) with respect to the requirements for pro- 10 viding relevant notices in a culturally and linguis- 11 tically appropriate manner in the applicable non- 12 English languages, to apply a threshold that 5 per- 13 cent of the population, or not less than 500 individ- 14 uals, in the county is literate only in the same non- 15 English language in order for the language to be 16 considered an applicable non-English language. 17 (e) DATA COLLECTION AND REPORTING.—The Sec- 18 retary of Health and Human Services shall— 19 (1) amend the single streamlined application 20 form developed pursuant to section 1413 of the Pa- 21 tient Protection and Affordable Care Act (42 U.S.C. 22 18083) to collect the preferred spoken and written 23 language for each household member applying for 24 coverage under a qualified health plan through an 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 140 •HR 6637 IH Exchange under title I of such Act (42 U.S.C. 1 18001 et seq.); 2 (2) require navigators, certified application 3 counselors, and other individuals assisting with en- 4 rollment to collect and report requests for language 5 assistance; and 6 (3) require the toll-free telephone hotlines es- 7 tablished pursuant to section 1311(d)(4)(B) of the 8 Patient Protection and Affordable Care Act (42 9 U.S.C. 18031(d)(4)(B)) to submit an annual report 10 documenting the number of language assistance re- 11 quests, the types of languages requested, the range 12 and average wait time for a consumer to speak with 13 an interpreter, and any steps the hotline, and any 14 entity contracting with the Secretary to provide lan- 15 guage services, have taken to actively address some 16 of the consumer complaints. 17 (f) EFFECTIVE DATE.—The amendments made by 18 this section shall not apply to plans beginning prior to the 19 date of the enactment of this Act. 20 SEC. 214. MEDICALLY UNDERSERVED POPULATIONS. 21 Section 330(a) of the Public Health Service Act (42 22 U.S.C. 254b(a)) is amended by adding at the end the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 141 •HR 6637 IH ‘‘(3) MEDICALLY UNDERSERVED.—The term 1 ‘medically underserved’, with respect to a popu- 2 lation, means— 3 ‘‘(A) the population of an urban or rural 4 area designated by the Secretary as— 5 ‘‘(i) an area with a shortage of per- 6 sonal health services; or 7 ‘‘(ii) a population group having a 8 shortage of such services; or 9 ‘‘(B) a population of individuals, not con- 10 fined to a particular urban or rural area, who 11 are designated by the Secretary as having a 12 shortage of personal health services due to a 13 specific demographic trait.’’. 14 TITLE III—HEALTH WORKFORCE 15 DIVERSITY 16 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 17 ACT. 18 Title XXXIV of the Public Health Service Act, as 19 added by section 204, is amended by adding at the end 20 the following: 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 142 •HR 6637 IH ‘‘Subtitle B—Diversifying the 1 Health Care Workplace 2 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 3 DIVERSITY. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Bureau of Health Workforce of the Health Resources 6 and Services Administration, shall award a grant to an 7 entity determined appropriate by the Secretary for the es- 8 tablishment of a national working group on workforce di- 9 versity. 10 ‘‘(b) REPRESENTATION.—In establishing the national 11 working group under subsection (a): 12 ‘‘(1) The grantee shall ensure that the group 13 has representatives of each of the following: 14 ‘‘(A) The Health Resources and Services 15 Administration. 16 ‘‘(B) The Department of Health and 17 Human Services Data Council. 18 ‘‘(C) The Office of Minority Health of the 19 Department of Health and Human Services. 20 ‘‘(D) The Substance Abuse and Mental 21 Health Services Administration. 22 ‘‘(E) The Bureau of Labor Statistics of 23 the Department of Labor. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 143 •HR 6637 IH ‘‘(F) The National Institute on Minority 1 Health and Health Disparities. 2 ‘‘(G) The Agency for Healthcare Research 3 and Quality. 4 ‘‘(H) The Institute of Medicine Study 5 Committee for the 2004 workforce diversity re- 6 port. 7 ‘‘(I) The Indian Health Service. 8 ‘‘(J) The Department of Education. 9 ‘‘(K) Minority-serving academic institu- 10 tions. 11 ‘‘(L) Consumer organizations. 12 ‘‘(M) Health professional associations, in- 13 cluding those that represent underrepresented 14 minority populations. 15 ‘‘(N) Researchers in the area of health 16 workforce. 17 ‘‘(O) Health workforce accreditation enti- 18 ties. 19 ‘‘(P) Private (including nonprofit) founda- 20 tions that have sponsored workforce diversity 21 initiatives. 22 ‘‘(Q) Local and State health departments. 23 ‘‘(R) Representatives of community mem- 24 bers to be included on admissions committees 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 144 •HR 6637 IH for health profession schools pursuant to sub- 1 section (c)(9). 2 ‘‘(S) National community-based organiza- 3 tions that serve as a national intermediary to 4 their urban affiliate members and have dem- 5 onstrated capacity to train health care profes- 6 sionals. 7 ‘‘(T) The Veterans Health Administration. 8 ‘‘(U) Other entities determined appropriate 9 by the Secretary. 10 ‘‘(2) The grantee shall ensure that, in addition 11 to the representatives under paragraph (1), the 12 working group has not less than 5 health professions 13 students representing various health profession fields 14 and levels of training. 15 ‘‘(c) ACTIVITIES.—The working group established 16 under subsection (a) shall convene at least twice each year 17 to complete the following activities: 18 ‘‘(1) Review public and private health workforce 19 diversity initiatives. 20 ‘‘(2) Identify successful health workforce diver- 21 sity programs and practices. 22 ‘‘(3) Examine challenges relating to the devel- 23 opment and implementation of health workforce di- 24 versity initiatives. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 145 •HR 6637 IH ‘‘(4) Draft a national strategic work plan for 1 health workforce diversity, including recommenda- 2 tions for public and private sector initiatives. 3 ‘‘(5) Develop a framework and methods for the 4 evaluation of current and future health workforce di- 5 versity initiatives. 6 ‘‘(6) Develop recommended standards for work- 7 force diversity that could be applicable to all health 8 professions programs and programs funded under 9 this Act. 10 ‘‘(7) Develop guidelines to train health profes- 11 sionals to care for a diverse population. 12 ‘‘(8) Develop a workforce data collection or 13 tracking system to identify where racial and ethnic 14 minority health professionals practice. 15 ‘‘(9) Develop a strategy for the inclusion of 16 community members on admissions committees for 17 health profession schools. 18 ‘‘(10) Help with monitoring and implementation 19 of standards for diversity, equity, and inclusion. 20 ‘‘(11) Other activities determined appropriate 21 by the Secretary. 22 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 23 the establishment of the working group under subsection 24 (a), and annually thereafter, the working group shall pre- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 146 •HR 6637 IH pare and make available to the general public for com- 1 ment, an annual report on the activities of the working 2 group. Such report shall include the recommendations of 3 the working group for improving health workforce diver- 4 sity. 5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2021 through 2025. 9 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 10 WORKFORCE DIVERSITY. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Deputy Assistant Secretary for Minority Health, and 13 in collaboration with the Bureau of Health Workforce 14 within the Health Resources and Services Administration 15 and the National Institute on Minority Health and Health 16 Disparities, shall establish a technical clearinghouse on 17 health workforce diversity within the Office of Minority 18 Health and coordinate current and future clearinghouses 19 related to health workforce diversity. 20 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 21 house established under subsection (a) shall offer the fol- 22 lowing information and services: 23 ‘‘(1) Information on the importance of health 24 workforce diversity. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 147 •HR 6637 IH ‘‘(2) Statistical information relating to under- 1 represented minority representation in health and al- 2 lied health professions and occupations. 3 ‘‘(3) Model health workforce diversity practices 4 and programs, including integrated models of care. 5 ‘‘(4) Admissions policies that promote health 6 workforce diversity and are in compliance with Fed- 7 eral and State laws. 8 ‘‘(5) Retainment policies that promote comple- 9 tion of health profession degrees for underserved 10 populations. 11 ‘‘(6) Lists of scholarship, loan repayment, and 12 loan cancellation grants as well as fellowship infor- 13 mation for underserved populations for health pro- 14 fessions schools. 15 ‘‘(7) Foundation and other large organizational 16 initiatives relating to health workforce diversity. 17 ‘‘(c) CONSULTATION.—In carrying out this section, 18 the Secretary shall consult with non-Federal entities which 19 may include minority health professional associations and 20 minority sections of major health professional associations 21 to ensure the adequacy and accuracy of information. 22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 148 •HR 6637 IH such sums as may be necessary for each of fiscal years 1 2021 through 2025. 2 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 3 WORKFORCE DIVERSITY, EQUITY, AND IN- 4 CLUSION. 5 ‘‘(a) IN GENERAL.—The Secretary, acting through 6 the Administrator of the Health Resources and Services 7 Administration and the Centers for Disease Control and 8 Prevention, shall award grants to eligible entities that 9 demonstrate a commitment to health workforce diversity. 10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 11 under subsection (a), an entity shall— 12 ‘‘(1) be an educational institution or entity that 13 historically produces or trains meaningful numbers 14 of underrepresented minority health professionals, 15 including— 16 ‘‘(A) part B institutions, as defined in sec- 17 tion 322 of the Higher Education Act of 1965; 18 ‘‘(B) Hispanic-serving health professions 19 schools; 20 ‘‘(C) Hispanic-serving institutions, as de- 21 fined in section 502 of such Act; 22 ‘‘(D) Tribal Colleges or Universities, as de- 23 fined in section 316 of such Act; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 149 •HR 6637 IH ‘‘(E) Asian American and Native American 1 Pacific Islander-serving institutions, as defined 2 in section 371(c) of such Act; 3 ‘‘(F) institutions that have programs to re- 4 cruit and retain underrepresented minority 5 health professionals, in which a significant 6 number of the enrolled participants are under- 7 represented minorities; 8 ‘‘(G) health professional associations, 9 which may include underrepresented minority 10 health professional associations; and 11 ‘‘(H) institutions, including national and 12 regional community-based organizations with 13 demonstrated commitment to a diversified 14 workforce— 15 ‘‘(i) located in communities with pre- 16 dominantly underrepresented minority pop- 17 ulations; 18 ‘‘(ii) with whom partnerships have 19 been formed for the purpose of increasing 20 workforce diversity; and 21 ‘‘(iii) in which at least 20 percent of 22 the enrolled participants are underrep- 23 resented minorities; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 150 •HR 6637 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.—Amounts received under a 4 grant under subsection (a) shall be used to expand existing 5 workforce diversity programs, implement new workforce 6 diversity programs, or evaluate existing or new workforce 7 diversity programs, including with respect to mental 8 health care professions. Such programs shall enhance di- 9 versity by considering minority status as part of an indi- 10 vidualized consideration of qualifications. Possible activi- 11 ties may include— 12 ‘‘(1) educational outreach programs relating to 13 opportunities in the health professions; 14 ‘‘(2) scholarship, fellowship, grant, loan repay- 15 ment, and loan cancellation programs; 16 ‘‘(3) postbaccalaureate programs; 17 ‘‘(4) academic enrichment programs, particu- 18 larly targeting those who would not be competitive 19 for health professions schools; 20 ‘‘(5) supporting workforce diversity in kinder- 21 garten through 12th grade and other health pipeline 22 programs; 23 ‘‘(6) mentoring programs; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 151 •HR 6637 IH ‘‘(7) internship or rotation programs involving 1 hospitals, health systems, health plans, and other 2 health entities; 3 ‘‘(8) community partnership development for 4 purposes relating to workforce diversity; or 5 ‘‘(9) leadership training. 6 ‘‘(d) REPORTS.—Not later than 1 year after receiving 7 a grant under this section, and annually for the term of 8 the grant, a grantee shall submit to the Secretary a report 9 that summarizes and evaluates all activities conducted 10 under the grant. 11 ‘‘(e) 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 2021 through 2025. 15 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 16 RESEARCHERS. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Director of the National Institutes of Health, the Di- 19 rector of the Centers for Disease Control and Prevention, 20 the Commissioner of Food and Drugs, the Director of the 21 Agency for Healthcare Research and Quality, and the Ad- 22 ministrator of the Health Resources and Services Admin- 23 istration, shall award grants that expand existing opportu- 24 nities for scientists and researchers and promote the inclu- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 152 •HR 6637 IH sion of underrepresented minorities in the health profes- 1 sions. 2 ‘‘(b) RESEARCH FUNDING.—The head of each agency 3 listed in subsection (a) shall establish or expand existing 4 programs to provide research funding to scientists and re- 5 searchers in training. Under such programs, the head of 6 each such entity shall give priority in allocating research 7 funding to support health research in traditionally under- 8 served communities, including underrepresented minority 9 communities, and research classified as community or 10 participatory. 11 ‘‘(c) DATA COLLECTION.—The head of each agency 12 listed in subsection (a) shall collect data on the number 13 (expressed as an absolute number and a percentage) of 14 underrepresented minority and nonminority applicants 15 who receive and are denied agency funding at every stage 16 of review. Such data shall be reported annually to the Sec- 17 retary and the appropriate committees of Congress. 18 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 19 retary shall establish a student loan reimbursement pro- 20 gram to provide student loan reimbursement assistance to 21 researchers who focus on racial and ethnic disparities in 22 health. The Secretary shall promulgate regulations to de- 23 fine the scope and procedures for the program under this 24 subsection. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 153 •HR 6637 IH ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 1 retary shall establish a student loan cancellation program 2 to provide student loan cancellation assistance to research- 3 ers who focus on racial and ethnic disparities in health. 4 Students participating in the program shall make a min- 5 imum 5-year commitment to work at an accredited health 6 profession school. The Secretary shall promulgate addi- 7 tional regulations to define the scope and procedures for 8 the program under this subsection. 9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2021 through 2025. 13 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 14 PROFESSIONALS. 15 ‘‘(a) IN GENERAL.—The Secretary, acting through 16 the Director of the Centers for Disease Control and Pre- 17 vention, the Assistant Secretary for Mental Health and 18 Substance Use, the Administrator of the Health Resources 19 and Services Administration, and the Administrator of the 20 Centers for Medicare & Medicaid Services, shall establish 21 a program to award grants to eligible individuals for ca- 22 reer support in nonresearch-related health and wellness 23 professions. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 154 •HR 6637 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an individual shall— 2 ‘‘(1) be a student in a health professions school, 3 a graduate of such a school who is working in a 4 health profession, an individual working in a health 5 or wellness profession (including mental and behav- 6 ioral health), or a faculty member of such a school; 7 and 8 ‘‘(2) submit to the Secretary an application at 9 such time, in such manner, and containing such in- 10 formation as the Secretary may require. 11 ‘‘(c) USE OF FUNDS.—An individual shall use 12 amounts received under a grant under this section to— 13 ‘‘(1) support the individual’s health activities or 14 projects that involve underserved communities, in- 15 cluding racial and ethnic minority communities; 16 ‘‘(2) support health-related career advancement 17 activities; 18 ‘‘(3) to pay, or as reimbursement for payments 19 of, student loans or training or credentialing costs 20 for individuals who are health professionals and are 21 focused on health issues affecting underserved com- 22 munities, including racial and ethnic minority com- 23 munities; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 155 •HR 6637 IH ‘‘(4) to establish and promote leadership train- 1 ing programs to decrease health disparities and to 2 increase cultural competence with the goal of in- 3 creasing diversity in leadership positions. 4 ‘‘(d) DEFINITION.—In this section, the term ‘career 5 in nonresearch-related health and wellness professions’ 6 means employment or intended employment in the field 7 of public health, health policy, health management, health 8 administration, medicine, nursing, pharmacy, psychology, 9 social work, psychiatry, other mental and behavioral 10 health, allied health, community health, social work, or 11 other fields determined appropriate by the Secretary, 12 other than in a position that involves research. 13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 14 is authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2021 through 2025. 17 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 18 VERSITY ON QUALITY. 19 ‘‘(a) IN GENERAL.—The Director of the Agency for 20 Healthcare Research and Quality, in collaboration with 21 the Deputy Assistant Secretary for Minority Health and 22 the Director of the National Institute on Minority Health 23 and Health Disparities, shall award grants to eligible enti- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 156 •HR 6637 IH ties to expand research on the link between health work- 1 force diversity and quality health care. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 3 under subsection (a), an entity shall— 4 ‘‘(1) be a clinical, public health, or health serv- 5 ices research entity or other entity determined ap- 6 propriate by the Director; and 7 ‘‘(2) submit to the Secretary an application at 8 such time, in such manner, and containing such in- 9 formation as the Secretary may require. 10 ‘‘(c) USE OF FUNDS.—Amounts received under a 11 grant awarded under subsection (a) shall be used to sup- 12 port research that investigates the effect of health work- 13 force diversity on— 14 ‘‘(1) language access; 15 ‘‘(2) cultural competence; 16 ‘‘(3) patient satisfaction; 17 ‘‘(4) timeliness of care; 18 ‘‘(5) safety of care; 19 ‘‘(6) effectiveness of care; 20 ‘‘(7) efficiency of care; 21 ‘‘(8) patient outcomes; 22 ‘‘(9) community engagement; 23 ‘‘(10) resource allocation; 24 ‘‘(11) organizational structure; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 157 •HR 6637 IH ‘‘(12) compliance of care; or 1 ‘‘(13) other topics determined appropriate by 2 the Director. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director shall give individualized consider- 5 ation to all relevant aspects of the applicant’s background. 6 Consideration of prior research experience involving the 7 health of underserved communities shall be such a factor. 8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 9 is authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2021 through 2025. 12 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 13 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 14 through the Office of Minority Health, in collaboration 15 with the National Institute on Minority Health and Health 16 Disparities, the Office for Civil Rights, the Centers for 17 Disease Control and Prevention, the Centers for Medicare 18 & Medicaid Services, the Health Resources and Services 19 Administration, and other appropriate public and private 20 entities, shall establish and coordinate a health and health 21 care disparities education program to support, develop, 22 and implement educational initiatives and outreach strate- 23 gies that inform health care professionals and the public 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 158 •HR 6637 IH about the existence of and methods to reduce racial and 1 ethnic disparities in health and health care. 2 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 3 cation program established under subsection (a), shall, 4 through the use of public awareness and outreach cam- 5 paigns targeting the general public and the medical com- 6 munity at large— 7 ‘‘(1) disseminate scientific evidence for the ex- 8 istence and extent of racial and ethnic disparities in 9 health care, including disparities that are not other- 10 wise attributable to known factors such as access to 11 care, patient preferences, or appropriateness of 12 intervention, as described in the 2002 Institute of 13 Medicine Report entitled ‘Unequal Treatment: Con- 14 fronting Racial and Ethnic Disparities in Health 15 Care’, as well as the impact of disparities related to 16 age, disability status, socioeconomic status, sex, gen- 17 der identity, and sexual orientation on racial and 18 ethnic minorities; 19 ‘‘(2) disseminate new research findings to 20 health care providers and patients to assist them in 21 understanding, reducing, and eliminating health and 22 health care disparities; 23 ‘‘(3) disseminate information about the impact 24 of linguistic and cultural barriers on health care 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 159 •HR 6637 IH quality and the obligation of health providers who 1 receive Federal financial assistance to ensure that 2 individuals with limited English proficiency have ac- 3 cess to language access services; 4 ‘‘(4) disseminate information about the impor- 5 tance and legality of racial, ethnic, disability status, 6 socioeconomic status, sex, gender identity, and sex- 7 ual orientation, and primary language data collec- 8 tion, analysis, and reporting; 9 ‘‘(5) design and implement specific educational 10 initiatives to health care providers relating to health 11 and health care disparities; 12 ‘‘(6) assess the impact of the programs estab- 13 lished under this section in raising awareness of 14 health and health care disparities and providing in- 15 formation on available resources; and 16 ‘‘(7) design and implement specific educational 17 initiatives to educate the health care workforce relat- 18 ing to unconscious bias. 19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2025.’’. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 160 •HR 6637 IH SEC. 302. HISPANIC-SERVING INSTITUTIONS, HISTORI- 1 CALLY BLACK COLLEGES AND UNIVERSITIES, 2 ASIAN AMERICAN AND NATIVE AMERICAN PA- 3 CIFIC ISLANDER-SERVING INSTITUTIONS, 4 TRIBAL COLLEGES, REGIONAL COMMUNITY- 5 BASED ORGANIZATIONS, AND NATIONAL MI- 6 NORITY MEDICAL ASSOCIATIONS. 7 (a) IN GENERAL.—Part B of title VII of the Public 8 Health Service Act (42 U.S.C. 293 et seq.) is amended 9 by adding at the end the following: 10 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 11 CALLY BLACK COLLEGES AND UNIVERSITIES, 12 ASIAN AMERICAN AND NATIVE AMERICAN PA- 13 CIFIC ISLANDER-SERVING INSTITUTIONS, 14 AND TRIBAL COLLEGES. 15 ‘‘(a) IN GENERAL.—The Secretary, acting through 16 the Administrator of the Health Resources and Services 17 Administration and in consultation with the Secretary of 18 Education, shall award grants to Hispanic-serving institu- 19 tions, historically Black colleges and universities, Asian 20 American and Native American Pacific Islander-serving 21 institutions, Tribal Colleges or Universities, regional com- 22 munity-based organizations, and national minority med- 23 ical associations, for counseling, mentoring and providing 24 information on financial assistance to prepare underrep- 25 resented minority individuals to enroll in and graduate 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 161 •HR 6637 IH from health professional schools and to increase services 1 for underrepresented minority students including— 2 ‘‘(1) mentoring with underrepresented health 3 professionals; and 4 ‘‘(2) providing financial assistance information 5 for continued education and applications to health 6 professional schools. 7 ‘‘(b) DEFINITIONS.—In this section: 8 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 9 PACIFIC ISLANDER-SERVING INSTITUTION.—The 10 term ‘Asian American and Native American Pacific 11 Islander-serving institution’ has the meaning given 12 such term in section 320(b) of the Higher Education 13 Act of 1965. 14 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 15 term ‘Hispanic-serving institution’ means an entity 16 that— 17 ‘‘(A) is a school or program for which 18 there is a definition under section 799B; 19 ‘‘(B) has an enrollment of full-time equiva- 20 lent students that is made up of at least 9 per- 21 cent Hispanic students; 22 ‘‘(C) has been effective in carrying out pro- 23 grams to recruit Hispanic individuals to enroll 24 in and graduate from the school; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 162 •HR 6637 IH ‘‘(D) has been effective in recruiting and 1 retaining Hispanic faculty members; 2 ‘‘(E) has a significant number of graduates 3 who are providing health services to medically 4 underserved populations or to individuals in 5 health professional shortage areas; and 6 ‘‘(F) is a Hispanic Center of Excellence in 7 Health Professions Education designated under 8 section 736(d)(2) of the Public Health Service 9 Act (42 U.S.C. 293(d)(2)). 10 ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI- 11 VERSITY.—The term ‘historically Black college and 12 university’ has the meaning given the term ‘part B 13 institution’ as defined in section 322 of the Higher 14 Education Act of 1965. 15 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 16 term ‘Tribal College or University’ has the meaning 17 given such term in section 316(b) of the Higher 18 Education Act of 1965. 19 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 20 carrying out the National Health Service Corps Loan Re- 21 payment Program established under subpart III of part 22 D of title III and the loan repayment program under sec- 23 tion 317F, the Secretary shall ensure, notwithstanding 24 such subpart or section, that loan repayments of not less 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 163 •HR 6637 IH than $50,000 per year per person are awarded for repay- 1 ment of loans incurred for enrollment or participation of 2 underrepresented minority individuals in health profes- 3 sional schools and other health programs described in this 4 section. 5 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2021 through 2026.’’. 9 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 10 DISEASE CONTROL AND PREVENTION. 11 Section 317F(c)(1) of the Public Health Service Act 12 (42 U.S.C. 247b–7(c)(1)) is amended— 13 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 14 (2) by inserting before the period at the end the 15 following: ‘‘, $750,000 for fiscal year 2020, and such 16 sums as may be necessary for each of the fiscal 17 years 2021 through 2025’’. 18 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 19 GREE PROGRAMS AT SCHOOLS OF PUBLIC 20 HEALTH AND SCHOOLS OF ALLIED HEALTH. 21 Part B of title VII of the Public Health Service Act 22 (42 U.S.C. 293 et seq.), as amended by section 302, is 23 further amended by adding at the end the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 164 •HR 6637 IH ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 1 GREE PROGRAMS. 2 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 3 acting through the Administrator of the Health Resources 4 and Services Administration, in consultation with the Di- 5 rector of the Centers for Disease Control and Prevention, 6 the Director of the Agency for Healthcare Research and 7 Quality, and the Deputy Assistant Secretary for Minority 8 Health, shall enter into cooperative agreements with 9 schools of public health and schools of allied health to de- 10 sign and implement online degree programs. 11 ‘‘(b) PRIORITY.—In entering into cooperative agree- 12 ments under this section, the Secretary shall give priority 13 to any school of public health or school of allied health 14 that has an established track record of serving medically 15 underserved communities. 16 ‘‘(c) REQUIREMENTS.—As a condition of entering 17 into a cooperative agreement with the Secretary under this 18 section, a school of public health or school of allied health 19 shall agree to design and implement an online degree pro- 20 gram that meets the following restrictions: 21 ‘‘(1) Enrollment of individuals who have ob- 22 tained a secondary school diploma or its recognized 23 equivalent. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 165 •HR 6637 IH ‘‘(2) Maintaining a significant enrollment of 1 underrepresented minority or disadvantaged stu- 2 dents. 3 ‘‘(3) Achieving a high completion rate of en- 4 rolled underrepresented minority or disadvantaged 5 students. 6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated to carry out this section 8 such sums as may be necessary for each of fiscal years 9 2021 through 2025. 10 ‘‘(e) PERIOD OF GRANTS.—The period during which 11 payments are made under a grant awarded may not exceed 12 3 years.’’. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 166 •HR 6637 IH viduals who are members of multiple minority or special 1 population groups. 2 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 3 Subtitle B 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 Director of the Centers for 9 Disease Control and Prevention, in collaboration with the 10 Administrator of the Health Resources and Services Ad- 11 ministration and the Deputy Assistant Secretary for Mi- 12 nority Health, shall award grants to eligible entities to in- 13 crease awareness among secondary and postsecondary stu- 14 dents 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 167 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 168 •HR 6637 IH ‘‘(15) Other professions determined appropriate 1 by the Director of the Centers for Disease Control 2 and 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.— 18 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 19 an entity receiving a grant under this section may 20 use the funds made available through such grant to 21 award stipends for educational and living expenses 22 to students participating in the internship supported 23 by the grant. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 169 •HR 6637 IH ‘‘(2) LIMITATIONS.—A stipend awarded under 1 paragraph (1) to an individual— 2 ‘‘(A) may not be provided for a period that 3 exceeds 6 months; and 4 ‘‘(B) may not exceed $20 per day for an 5 individual (notwithstanding any other provision 6 of law regarding the amount of a stipend). 7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2021 through 2026. 11 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 12 PROGRAM. 13 ‘‘(a) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention, in collaboration with the 15 Deputy Assistant Secretary for Minority Health, shall 16 award scholarships to eligible individuals under subsection 17 (b) who seek a career in public health. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 19 arship under subsection (a), an individual shall— 20 ‘‘(1) have interest, knowledge, or skill in public 21 health research or public health practice, or other 22 health professions as determined appropriate by the 23 Director of the Centers for Disease Control and Pre- 24 vention; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 170 •HR 6637 IH ‘‘(2) reside in a health professional shortage 1 area as determined by the Secretary; 2 ‘‘(3) demonstrate promise for becoming a leader 3 in public health; 4 ‘‘(4) secure admission to a 4-year institution of 5 higher education; and 6 ‘‘(5) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require. 9 ‘‘(c) USE OF FUNDS.—Amounts received under an 10 award under subsection (a) shall be used to support oppor- 11 tunities for students to become public health professionals. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director shall give priority to those stu- 14 dents that— 15 ‘‘(1) are from disadvantaged backgrounds; 16 ‘‘(2) have secured admissions to a minority- 17 serving institution; and 18 ‘‘(3) have identified a health professional as a 19 mentor at their school or institution and an aca- 20 demic advisor to assist in the completion of their 21 baccalaureate degree. 22 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 23 payment of scholarships under this section for such indi- 24 viduals for any period of education in student under- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 171 •HR 6637 IH graduate tenure, except that such a scholarship may not 1 be provided to an individual for more than 4 years, and 2 such a scholarship may not exceed $10,000 per academic 3 year for an individual (notwithstanding any other provi- 4 sion of law regarding the amount of a scholarship). 5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2021 through 2025. 9 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 10 FELLOWSHIP PROGRAM. 11 ‘‘(a) IN GENERAL.—The Director of the Centers for 12 Disease Control and Prevention, in collaboration with the 13 Deputy Assistant Secretary for Minority Health, the As- 14 sistant Secretary for Mental Health and Substance Use, 15 and the Director of the Indian Health Services, shall 16 award research fellowships to eligible individuals under 17 subsection (b) to conduct research that will examine gen- 18 der and health disparities and to pursue a career in the 19 health professions. 20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 21 ship under subsection (a), an individual shall— 22 ‘‘(1) have experience in health research or pub- 23 lic health practice; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 172 •HR 6637 IH ‘‘(2) reside in a health professional shortage 1 area as designated by the Secretary under section 2 332; 3 ‘‘(3) have expressed an interest in the health 4 professions; 5 ‘‘(4) demonstrate promise for becoming a leader 6 in the field of women’s health; 7 ‘‘(5) secure admission to a health professions 8 school or graduate program with an emphasis in 9 gender studies; and 10 ‘‘(6) submit to the Secretary an application at 11 such time, in such manner, and containing such in- 12 formation as the Secretary may require. 13 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 14 subsection (a) to an eligible individual shall be used to 15 support an opportunity for the individual to become a re- 16 searcher and advance the research base on the intersection 17 between gender and health. 18 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 19 section (a), the Director of the Centers for Disease Con- 20 trol and Prevention shall give priority to those applicants 21 that— 22 ‘‘(1) are from disadvantaged backgrounds; and 23 ‘‘(2) have identified a mentor and academic ad- 24 visor who will assist in the completion of their grad- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 173 •HR 6637 IH uate or professional degree and have secured a re- 1 search assistant position with a researcher working 2 in the area of gender and health. 3 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 4 Disease Control and Prevention may approve fellowships 5 for individuals under this section for any period of edu- 6 cation in the student’s graduate or health profession ten- 7 ure, except that such a fellowship may not be provided 8 to an individual for more than 3 years, and such a fellow- 9 ship may not exceed $18,000 per academic year for an 10 individual (notwithstanding any other provision of law re- 11 garding the amount of a fellowship). 12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 13 is authorized to be appropriated to carry out this section 14 such sums as may be necessary for each of fiscal years 15 2021 through 2025. 16 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 17 HEALTH FELLOWSHIP PROGRAM. 18 ‘‘(a) IN GENERAL.—The Director of the Agency for 19 Healthcare Research and Quality, in collaboration with 20 the Deputy Assistant Secretary for Minority Health, shall 21 award research fellowships to eligible individuals under 22 subsection (b) to advance their understanding of inter- 23 national health. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 174 •HR 6637 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 1 ship under subsection (a), an individual shall— 2 ‘‘(1) have educational experience in the field of 3 international health; 4 ‘‘(2) reside in a health professional shortage 5 area as determined by the Secretary; 6 ‘‘(3) demonstrate promise for becoming a leader 7 in the field of international health; 8 ‘‘(4) be a college senior or recent graduate of 9 a 4-year institution of higher education; and 10 ‘‘(5) submit to the Secretary an application at 11 such time, in such manner, and containing such in- 12 formation as the Secretary may require. 13 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 14 subsection (a) to an eligible individual shall be used to 15 support an opportunity for the individual to become a 16 health professional and to advance the knowledge of the 17 individual about international issues relating to health 18 care access and quality. 19 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 20 section (a), the Director shall give priority to eligible indi- 21 viduals that— 22 ‘‘(1) are from a disadvantaged background; and 23 ‘‘(2) have identified a mentor at a health pro- 24 fessions school or institution, an academic advisor to 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 175 •HR 6637 IH assist in the completion of their graduate or profes- 1 sional degree, and an advisor from an international 2 health non-governmental organization, private volun- 3 teer organization, or other international institution 4 or program that focuses on increasing health care 5 access and quality for residents in developing coun- 6 tries. 7 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 8 this section may not— 9 ‘‘(1) be provided to an eligible individual for 10 more than a period of 6 months; 11 ‘‘(2) be awarded to a graduate of a 4-year insti- 12 tution of higher education that has not been enrolled 13 in such institution for more than 1 year; and 14 ‘‘(3) exceed $4,000 per academic year (notwith- 15 standing any other provision of law regarding the 16 amount of a fellowship). 17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section 19 such sums as may be necessary for each of fiscal years 20 2021 through 2025. 21 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 22 GRAM. 23 ‘‘(a) IN GENERAL.—The Director of the Agency for 24 Healthcare Research and Quality, the Director of the Cen- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 176 •HR 6637 IH ters for Medicare & Medicaid Services, and the Adminis- 1 trator of the Health Resources and Services Administra- 2 tion, in collaboration with the Deputy Assistant Secretary 3 for Minority Health, shall award grants to eligible entities 4 to expose entering graduate students to the health profes- 5 sions. 6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 7 under subsection (a), an entity shall— 8 ‘‘(1) be a clinical, public health, or health serv- 9 ices organization, community-based, academic, or 10 nonprofit entity, or other entity determined appro- 11 priate by the Director of the Agency for Healthcare 12 Research and Quality; 13 ‘‘(2) serve in a health professional shortage 14 area as designated by the Secretary under section 15 332; 16 ‘‘(3) work with students obtaining a degree in 17 the health professions; and 18 ‘‘(4) submit to the Secretary an application at 19 such time, in such manner, and containing such in- 20 formation as the Secretary may require. 21 ‘‘(c) USE OF FUNDS.—Amounts received under a 22 grant awarded under subsection (a) shall be used to sup- 23 port opportunities that expose students to non-research- 24 based health professions, including— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 177 •HR 6637 IH ‘‘(1) public health policy; 1 ‘‘(2) health care and pharmaceutical policy; 2 ‘‘(3) health care administration and manage- 3 ment; 4 ‘‘(4) health economics; and 5 ‘‘(5) other professions determined appropriate 6 by the Director of the Agency for Healthcare Re- 7 search and Quality, the Director of the Centers for 8 Medicare & Medicaid Services, or the Administrator 9 of the Health Resources and Services Administra- 10 tion. 11 ‘‘(d) PRIORITY.—In awarding grants under sub- 12 section (a), the Director of the Agency for Healthcare Re- 13 search and Quality, the Director of the Centers for Medi- 14 care & Medicaid Services, and the Administrator of the 15 Health Resources and Services Administration, in collabo- 16 ration with the Deputy Assistant for Secretary for Minor- 17 ity Health, shall give priority to those entities that— 18 ‘‘(1) have experience with health disparity elimi- 19 nation programs; 20 ‘‘(2) facilitate training in the fields described in 21 subsection (c); and 22 ‘‘(3) provide counseling or other services de- 23 signed to assist students in successfully completing 24 their education at the postsecondary level. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 178 •HR 6637 IH ‘‘(e) STIPENDS.— 1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 2 an entity receiving a grant under this section may 3 use the funds made available through such grant to 4 award stipends for educational and living expenses 5 to students participating in the opportunities sup- 6 ported by the grant. 7 ‘‘(2) LIMITATIONS.—A stipend awarded under 8 paragraph (1) to an individual— 9 ‘‘(A) may not be provided for a period that 10 exceeds 2 months; and 11 ‘‘(B) may not exceed $100 per day (not- 12 withstanding any other provision of law regard- 13 ing the amount of a stipend). 14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of fiscal years 17 2021 through 2025. 18 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 19 ‘‘(a) IN GENERAL.—The Secretary shall award 20 grants to national minority medical or health professional 21 associations to develop leadership fellowship programs for 22 underrepresented health professionals in order to— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 179 •HR 6637 IH ‘‘(1) assist such professionals in becoming fu- 1 ture leaders in public health and health care delivery 2 institutions; and 3 ‘‘(2) increase diversity in decision-making posi- 4 tions that can improve the health of underserved 5 communities. 6 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro- 7 gram supported under this section shall— 8 ‘‘(1) focus on training mid-career physicians 9 and health care executives who have documented 10 leadership experience and a commitment to public 11 health services in underserved communities; and 12 ‘‘(2) support Federal public health policy and 13 budget programs, and priorities that impact health 14 equity, through activities such as didactic lectures 15 and leader site visits. 16 ‘‘(c) PERIOD OF GRANTS.—The period during which 17 payments are made under a grant awarded under sub- 18 section (a) may not exceed 3 years. 19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2026.’’. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 180 •HR 6637 IH SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 1 PROGRAM. 2 Section 402E of the Higher Education Act of 1965 3 (20 U.S.C. 1070a–15) is amended by striking subsection 4 (g) and inserting the following: 5 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 6 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 7 ordinate with the Secretary of Health and Human Serv- 8 ices to ensure that there is collaboration between the goals 9 of the program under this section and programs of the 10 Health Resources and Services Administration that pro- 11 mote health workforce diversity. The Secretary of Edu- 12 cation shall take such measures as may be necessary to 13 encourage students participating in projects assisted 14 under this section to consider health profession careers. 15 ‘‘(h) FUNDING.—From amounts appropriated pursu- 16 ant to the authority of section 402A(g), the Secretary 17 shall, to the extent practicable, allocate funds for projects 18 authorized by this section in an amount which is not less 19 than $31,000,000 for each of the fiscal years 2021 20 through 2026.’’. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 181 •HR 6637 IH SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 1 EQUIVALENT RESIDENTS FOR COST-REPORT- 2 ING PERIODS. 3 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 4 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 5 amended by section 204(a), is amended— 6 (1) in subparagraph (E), by striking ‘‘Subject 7 to subparagraphs (J) and (K), such rules’’ and in- 8 serting ‘‘Subject to subparagraphs (J), (K), and 9 (M), such rules’’; 10 (2) in subparagraph (J), by striking ‘‘Such 11 rules’’ and inserting ‘‘Subject to subparagraph (M), 12 such rules’’; 13 (3) in subparagraph (K), by striking ‘‘In deter- 14 mining’’ and inserting ‘‘Subject to subparagraph 15 (M), in determining’’; and 16 (4) by adding at the end the following new sub- 17 paragraph: 18 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 19 AND INTERNS.—For purposes of cost-reporting 20 periods beginning on or after October 1, 2021, 21 in determining the hospital’s number of full- 22 time equivalent residents for purposes of this 23 paragraph, all the time spent by an intern or 24 resident in an approved medical residency train- 25 ing program shall be counted toward the deter- 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 182 •HR 6637 IH mination of full-time equivalency if the hos- 1 pital— 2 ‘‘(i) is recognized as a subsection (d) 3 hospital; 4 ‘‘(ii) is recognized as a subsection (d) 5 Puerto Rico hospital; 6 ‘‘(iii) is reimbursed under a reim- 7 bursement system authorized under section 8 1814(b)(3); or 9 ‘‘(iv) is a provider-based hospital out- 10 patient department.’’. 11 (b) IME DETERMINATIONS.—Section 12 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 13 1395ww(d)(5)(B)(xi)), as redesignated by section 204(b), 14 is amended— 15 (1) in subclause (II), by striking ‘‘In deter- 16 mining’’ and inserting ‘‘Subject to subclause (IV), in 17 determining’’; 18 (2) in subclause (III), by striking ‘‘In deter- 19 mining’’ and inserting ‘‘Subject to subclause (IV), in 20 determining’’; and 21 (3) by inserting after subclause (III) the fol- 22 lowing new subclause: 23 ‘‘(IV) For purposes of cost-reporting peri- 24 ods beginning on or after October 1, 2021, the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 183 •HR 6637 IH provisions of subparagraph (M) of subsection 1 (h)(4) shall apply under this subparagraph in 2 the same manner as they apply under such sub- 3 section.’’. 4 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 5 FOR LOCAL HEALTH EQUITY. 6 (a) GRANTS.—The Secretary of Health and Human 7 Services, acting jointly with the Secretary of Education 8 and the Secretary of Labor, shall make grants to institu- 9 tions of higher education for the purposes of— 10 (1) in accordance with subsection (b), devel- 11 oping capacity— 12 (A) to build an evidence base for successful 13 strategies for increasing local health equity; and 14 (B) to serve as national models of driving 15 local health equity; 16 (2) in accordance with subsection (c), devel- 17 oping a strategic partnership with the community in 18 which the institution is located; and 19 (3) collecting data on, and periodically evalu- 20 ating, the effectiveness of the institution’s programs 21 funded through this section to enable the institution 22 to adapt accordingly for maximum efficiency and 23 success. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 184 •HR 6637 IH (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 1 HEALTH EQUITY.—As a condition on receipt of a grant 2 under subsection (a), an institution of higher education 3 shall agree to use the grant to build an evidence base for 4 successful strategies for increasing local health equity, and 5 to serve as a national model of driving local health equity, 6 by supporting— 7 (1) resources to strengthen institutional metrics 8 and capacity to execute institution-wide health work- 9 force goals that can serve as models for increasing 10 health equity in communities across the United 11 States; 12 (2) collaborations among a cohort of institu- 13 tions in implementing systemic change, partnership 14 development, and programmatic efforts supportive of 15 health equity goals across disciplines and popu- 16 lations; and 17 (3) enhanced or newly developed data systems 18 and research infrastructure capable of informing 19 current and future workforce efforts and building a 20 foundation for a broader research agenda targeting 21 urban health disparities. 22 (c) STRATEGIC PARTNERSHIPS.—As a condition on 23 receipt of a grant under subsection (a), an institution of 24 higher education shall agree to use the grant to develop 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 185 •HR 6637 IH a strategic partnership with the community in which the 1 institution 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 schools and secondary 16 schools to recruit the next generation of health pro- 17 fessionals earlier in the pipeline to a health care ca- 18 reer. 19 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 20 authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2026. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 186 •HR 6637 IH SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 1 IORAL HEALTH SOCIAL WORKERS. 2 Section 455 of the Higher Education Act of 1965 (20 3 U.S.C. 1087e) is amended by adding at the end the fol- 4 lowing: 5 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV- 6 IORAL HEALTH SOCIAL WORKERS.— 7 ‘‘(1) IN GENERAL.—The Secretary shall cancel 8 the balance of interest and principal due, in accord- 9 ance with paragraph (2), on any eligible Federal Di- 10 rect Loan not in default for a borrower who— 11 ‘‘(A) has made 120 monthly payments on 12 the eligible Federal Direct Loan after October 13 1, 2020, pursuant to any one or a combination 14 of the following— 15 ‘‘(i) payments under an income-based 16 repayment plan under section 493C; 17 ‘‘(ii) payments under a standard re- 18 payment plan under subsection (d)(1)(A), 19 based on a 10-year repayment period; 20 ‘‘(iii) monthly payments under a re- 21 payment plan under subsection (d)(1) or 22 (g) of not less than the monthly amount 23 calculated under subsection (d)(1)(A), 24 based on a 10-year repayment period; or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 187 •HR 6637 IH ‘‘(iv) payments under an income con- 1 tingent repayment plan under subsection 2 (d)(1)(D); and 3 ‘‘(B)(i) is employed as a mental health or 4 behavioral health social worker, as defined by 5 the Secretary by regulation, at the time of such 6 forgiveness; and 7 ‘‘(ii) has been employed as such a mental 8 health or behavioral health social worker during 9 the period in which the borrower makes each of 10 the 120 payments as described in subparagraph 11 (A). 12 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 13 conclusion of the employment period described in 14 paragraph (1), the Secretary shall cancel the obliga- 15 tion to repay the balance of principal and interest 16 due as of the time of such cancellation, on the eligi- 17 ble Federal Direct Loans made to the borrower 18 under this part. 19 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 20 No borrower may, for the same employment as a 21 mental health or behavioral health social worker, re- 22 ceive a reduction of loan obligations under both this 23 subsection and subsection (m), 428J, 428K, 428L, 24 or 460. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 188 •HR 6637 IH ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 1 RECT LOAN.—In this subsection, the term ‘eligible 2 Federal Direct Loan’ means a Federal Direct Staf- 3 ford Loan, Federal Direct PLUS Loan, Federal Di- 4 rect Unsubsidized Stafford Loan, or a Federal Di- 5 rect Consolidation Loan.’’. 6 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 7 (a) ESTABLISHMENT.—There is established in the 8 Health Resources and Services Administration of the De- 9 partment of Health and Human Services a Health Profes- 10 sions Workforce Fund to provide for expanded and sus- 11 tained national investment in the health professions and 12 nursing workforce development programs under title VII 13 and title VIII of the Public Health Service Act (42 U.S.C. 14 292 et seq.; 42 U.S.C. 296 et seq.). 15 (b) FUNDING.— 16 (1) IN GENERAL.—There is authorized to be 17 appropriated, and there is appropriated, out of any 18 monies in the Treasury not otherwise appropriated, 19 to the Health Professions Workforce Fund— 20 (A) $355,000,000 for fiscal year 2021; 21 (B) $375,000,000 for fiscal year 2022; 22 (C) $392,000,000 for fiscal year 2023; 23 (D) $412,000,000 for fiscal year 2024; 24 (E) $432,000,000 for fiscal year 2025; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 189 •HR 6637 IH (F) $454,000,000 for fiscal year 2026; 1 (G) $476,000,000 for fiscal year 2027; 2 (H) $500,000,000 for fiscal year 2028; 3 (I) $525,000,000 for fiscal year 2029; and 4 (J) $552,000,000 for fiscal year 2030. 5 (2) HEALTH PROFESSIONS EDUCATION PRO- 6 GRAMS.—For the purpose of carrying out health 7 professions education programs authorized under 8 title VII of the Public Health Service Act, in addi- 9 tion to any other amounts authorized to be appro- 10 priated for such purpose, there is authorized to be 11 appropriated out of any monies in the Health Pro- 12 fessions Workforce Fund, the following: 13 (A) $240,000,000 for fiscal year 2021. 14 (B) $253,000,000 for fiscal year 2022. 15 (C) $265,000,000 for fiscal year 2023. 16 (D) $278,000,000 for fiscal year 2024. 17 (E) $292,000,000 for fiscal year 2025. 18 (F) $307,000,000 for fiscal year 2026. 19 (G) $322,000,000 for fiscal year 2027. 20 (H) $338,000,000 for fiscal year 2028. 21 (I) $355,000,000 for fiscal year 2029. 22 (J) $373,000,000 for fiscal year 2030. 23 (3) NURSING WORKFORCE DEVELOPMENT PRO- 24 GRAMS.—For the purpose of carrying out nursing 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 190 •HR 6637 IH workforce development programs authorized under 1 Title VIII of the Public Health Service Act, in addi- 2 tion to any other amounts authorized to be appro- 3 priated for such purpose, there is authorized to be 4 appropriated out of any monies in the Health Pro- 5 fessions Workforce Fund, the following: 6 (A) $115,000,000 for fiscal year 2021. 7 (B) $122,000,000 for fiscal year 2022. 8 (C) $127,000,000 for fiscal year 2023. 9 (D) $134,000,000 for fiscal year 2024. 10 (E) $140,000,000 for fiscal year 2025. 11 (F) $147,000,000 for fiscal year 2026. 12 (G) $154,000,000 for fiscal year 2027. 13 (H) $162,000,000 for fiscal year 2028. 14 (I) $170,000,000 for fiscal year 2029. 15 (J) $179,000,000 for fiscal year 2030. 16 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 17 GRADUATE MEDICAL EDUCATION. 18 (a) FINDINGS.—Congress finds the following: 19 (1) Projections by the Association of American 20 Medical Colleges and other expert entities, such as 21 the Health Resources and Services Administration, 22 have indicated a nationwide shortage of up to 23 121,900 physicians, split evenly between primary 24 care and specialists, by 2032. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 191 •HR 6637 IH (2) Primarily due to the growing and aging 1 population, over the next decade, physician demand 2 is expected to grow up to 17 percent. 3 (3) The United States Census Bureau estimates 4 that the United States population will grow from 5 321 million in 2015 to 347 million in 2025. Further, 6 the number of Medicare beneficiaries is estimated to 7 increase from 47,800,000 in 2015 to approximately 8 66,000,000 in 2025. 9 (4) Approximately 36 percent of practicing phy- 10 sicians are over the age of 55 and are likely to retire 11 within the next decade. 12 (5) A nationwide physician shortage will result 13 in many people in the United States waiting longer 14 and traveling farther for health care; seeking non- 15 emergent care in emergency departments; and delay- 16 ing treatment until their health care needs become 17 more serious, complex, and costly. 18 (6) Changing demographics (such as an aging 19 population), new health care delivery models (such 20 as medical homes), and other factors (such as dis- 21 aster preparedness) are contributing to a shortage of 22 both generalist and specialist physicians. 23 (7) These shortages will have the most severe 24 impact on vulnerable and underserved populations, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 192 •HR 6637 IH including racial and ethnic minorities and the ap- 1 proximately 20 percent of people in the United 2 States who live in rural or inner-city locations des- 3 ignated as health professional shortage areas. 4 (8) The health care utilization equity model of 5 the Association of American Medical Colleges esti- 6 mates that if racial and ethnic minorities and indi- 7 viduals from rural areas utilized health care in a 8 similar way to their Caucasian counterparts living in 9 metropolitan areas, the physician shortage would re- 10 quire an additional 96,000 physicians. 11 (9) To address the physician shortage in rural 12 and medically underserved areas, medical education 13 and training need to be accessible to underrep- 14 resented minorities (African American, Hispanic, 15 Native American, and Native Hawaiian), and need 16 to increase pathway programs for underrepresented 17 minorities who make up less than 12 percent as well 18 as for international medical graduates who make up 19 25 percent of graduate medical education. Immigra- 20 tion pathways like student, exchange-visitor, and em- 21 ployment visas, and programs like the National In- 22 terest Waiver and Conrad 30 J–1 Visa Waiver, help 23 improve health access across the United States. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 193 •HR 6637 IH (10) United States medical school enrollment 1 will grow by 30 percent from 2018 to 2019 to help 2 reduce the shortage of quality physicians in the 3 United States. 4 (11) An increase in United States medical 5 school graduates must be accompanied by an in- 6 crease of 4,000 graduate medical education training 7 positions each year. 8 (12) Graduate medical education programs and 9 teaching hospitals provide venues in which the next 10 generation of physicians learns to work collabo- 11 ratively with other physicians and health profes- 12 sionals, adopt more efficient care delivery models 13 (such as care coordination and medical homes), in- 14 corporate health information technology and elec- 15 tronic health records in every aspect of their work, 16 apply new methods of assuring quality and safety, 17 and participate in groundbreaking clinical and public 18 health research. 19 (13) The Medicare program under title XVIII 20 of the Social Security Act (42 U.S.C. 1395 et seq.) 21 (having more beneficiaries than any other health 22 care program), supports its ‘‘fair share’’ of the costs 23 associated with graduate medical education. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 194 •HR 6637 IH (14) In general, the level of support of graduate 1 medical education by the Medicare program has 2 been capped since 1997 and has not been increased 3 to support the expansion of graduate medical edu- 4 cation programs needed to avert the projected physi- 5 cian shortage or to accommodate the increase in 6 United States medical school graduates. 7 (b) SENSE OF CONGRESS.—It is the sense of Con- 8 gress that eliminating the limit of the number of residency 9 positions that receive some level of Medicare support 10 under section 1886(h) of the Social Security Act (42 11 U.S.C. 1395ww(h)), also referred to as the Medical grad- 12 uate medical education cap, is critical to— 13 (1) ensuring an appropriate supply of physi- 14 cians to meet the health care needs in the United 15 States; 16 (2) facilitating equitable access for all who seek 17 health care; and 18 (3) mitigating disparities in health and health 19 care. 20 SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION- 21 ALLY EDUCATED HEALTH PROFESSIONALS. 22 (a) FINDINGS.—Congress finds the following: 23 (1) According to the Association of Schools and 24 Programs of Public Health, projections indicate a 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 195 •HR 6637 IH nationwide shortage of up to 250,000 public health 1 workers needed by 2020. 2 (2) Similar trends are projected for other health 3 professions indicating shortages across disciplines, 4 including within the fields of nursing (500,000 by 5 2025), dentistry (15,000 by 2025), pharmacy 6 (38,000 by 2030), mental and behavioral health, pri- 7 mary care (46,000 by 2025), and community and al- 8 lied health. 9 (3) A nationwide health workforce shortage will 10 result in serious health threats and more severe and 11 costly health care needs, due to, in part, a delayed 12 response to food-borne outbreaks, emerging infec- 13 tious diseases, natural disasters, fewer cancer 14 screenings, and delayed treatment. 15 (4) Vulnerable and underserved populations and 16 health professional shortage areas will be most se- 17 verely impacted by the health workforce shortage. 18 (5) According to the Migration Policy Institute, 19 more than 2,000,000 college-educated immigrants in 20 the United States today are unemployed or under- 21 employed in low- or semi-skilled jobs that fail to 22 draw on their education and expertise. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 196 •HR 6637 IH (6) Approximately 2 out of every 5 internation- 1 ally educated immigrants are unemployed or under- 2 employed. 3 (7) According to the Drexel University Center 4 for Labor Markets and Policy, underemployment for 5 internationally educated immigrant women is 28 per- 6 cent higher than for their male counterparts. 7 (8) According to the Drexel University Center 8 for Labor Markets and Policy, the mean annual 9 earnings of underemployed immigrants were 10 $32,000, or 43 percent less than United States born 11 college graduates employed in the college labor mar- 12 ket. 13 (9) According to Upwardly Global and the Wel- 14 come Back Initiative, with proper guidance and sup- 15 port, underemployed skilled immigrants typically in- 16 crease their income by 215 percent to 900 percent. 17 (10) According to the Brookings Institution and 18 the Partnership for a New American Economy, im- 19 migrants working in the health workforce are, on av- 20 erage, better educated than United States-born 21 workers in the health workforce. 22 (b) GRANTS TO ELIGIBLE ENTITIES.— 23 (1) AUTHORITY TO PROVIDE GRANTS.—The 24 Secretary of Health and Human Services, acting 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 197 •HR 6637 IH through the Bureau of Health Workforce within the 1 Health Resources and Services Administration, the 2 National Institute on Minority Health and Health 3 Disparities, or the Office of Minority Health (in this 4 section referred to as the ‘‘Secretary’’), may award 5 grants to eligible entities to carry out activities de- 6 scribed in subsection (c). 7 (2) ELIGIBILITY.—To be eligible to receive a 8 grant under this section, an entity shall— 9 (A) be a clinical, public health, or health 10 services organization, a community-based or 11 nonprofit entity, an academic institution, a 12 faith-based organization, a State, county, or 13 local government, an area health education cen- 14 ter, or another entity determined appropriate by 15 the Secretary; and 16 (B) submit to the Secretary an application 17 at such time, in such manner, and containing 18 such information as the Secretary may require. 19 (c) AUTHORIZED ACTIVITIES.—A grant awarded 20 under this section shall be used— 21 (1) to provide services to assist unemployed and 22 underemployed skilled immigrants, residing in the 23 United States, who have legal, permanent work au- 24 thorization and who are internationally educated 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 198 •HR 6637 IH health professionals, enter into the health workforce 1 of the United States with employment matching 2 their health professional skills and education, and 3 advance in employment to positions that better 4 match their health professional education and exper- 5 tise; 6 (2) to provide training opportunities to reduce 7 barriers to entry and advancement in the health 8 workforce for skilled, internationally educated immi- 9 grants; 10 (3) to educate employers regarding the abilities 11 and capacities of internationally educated health 12 professionals; 13 (4) to assist in the evaluation of foreign creden- 14 tials; 15 (5) to support preceptorships for international 16 medical graduates in hospital primary care training; 17 and 18 (6) to facilitate access to contextualized and ac- 19 celerated courses on English as a second language. 20 SEC. 314. STUDY AND REPORT ON STRATEGIES FOR IN- 21 CREASING DIVERSITY. 22 (a) STUDY.—The Comptroller General of the United 23 States shall conduct a study on strategies for increasing 24 the diversity of the health professional workforce. Such 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 199 •HR 6637 IH study shall include an analysis of strategies for increasing 1 the number of health professionals from rural, lower in- 2 come, and underrepresented minority communities, includ- 3 ing which strategies are most effective for achieving such 4 goal. 5 (b) REPORT.—Not later than 2 years after the date 6 of enactment of this Act, the Comptroller General shall 7 submit to Congress a report on the study conducted under 8 subsection (a), together with recommendations for such 9 legislation and administrative action as the Comptroller 10 General determines appropriate. 11 SEC. 315. CONRAD STATE 30 AND PHYSICIAN RETENTION. 12 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec- 13 tion 220(c) of the Immigration and Nationality Technical 14 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 15 1182 note) is amended by striking ‘‘September 30, 2015’’ 16 and inserting ‘‘September 30, 2021’’. 17 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED 18 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 19 201(b)(1) of the Immigration and Nationality Act (8 20 U.S.C. 1151(b)(1)) is amended by adding at the end the 21 following: 22 ‘‘(F)(i) Alien physicians who have com- 23 pleted service requirements of a waiver re- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 200 •HR 6637 IH quested under section 203(b)(2)(B)(ii), includ- 1 ing— 2 ‘‘(I) alien physicians who completed 3 such service before the date of the enact- 4 ment of the Conrad State 30 and Physi- 5 cian Access Act; and 6 ‘‘(II) the spouse or children of an 7 alien physician described in subclause (I). 8 ‘‘(ii) Nothing in this subparagraph may be 9 construed— 10 ‘‘(I) to prevent the filing of a petition 11 with the Secretary of Homeland Security 12 for classification under section 204(a) or 13 the filing of an application for adjustment 14 of status under section 245 by an alien 15 physician described in this subparagraph 16 before the date by which such alien physi- 17 cian has completed the service described in 18 section 214(l) or worked full-time as a 19 physician for an aggregate of 5 years at 20 the location identified in the section 214(l) 21 waiver or in an area or areas designated by 22 the Secretary of Health and Human Serv- 23 ices as having a shortage of health care 24 professionals; or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 201 •HR 6637 IH ‘‘(II) to permit the Secretary of 1 Homeland Security to grant a petition or 2 application described in subclause (I) until 3 the alien has satisfied all of the require- 4 ments of the waiver received under section 5 214(l).’’. 6 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 7 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI- 8 DENCY REQUIREMENT.—Section 214(l)(1) of the 9 Immigration and Nationality Act (8 U.S.C. 10 1184(l)(1)) is amended— 11 (A) in the matter preceding subparagraph 12 (A), by striking ‘‘Attorney General’’ and insert- 13 ing ‘‘Secretary of Homeland Security’’; 14 (B) in subparagraph (A), by striking ‘‘Di- 15 rector of the United States Information Agen- 16 cy’’ and inserting ‘‘Secretary of State’’; 17 (C) in subparagraph (B), by inserting ‘‘, 18 except as provided in paragraphs (7) and (8)’’ 19 before the semicolon at the end; 20 (D) in subparagraph (C), by striking 21 clauses (i) and (ii) and inserting the following: 22 ‘‘(i) the alien demonstrates a bona 23 fide offer of full-time employment at a 24 health facility or health care organization, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 202 •HR 6637 IH which employment has been determined by 1 the Secretary of Homeland Security to be 2 in the public interest; 3 ‘‘(ii) the alien— 4 ‘‘(I) has accepted employment 5 with the health facility or health care 6 organization in a geographic area or 7 areas which are designated by the 8 Secretary of Health and Human Serv- 9 ices as having a shortage of health 10 care professionals; 11 ‘‘(II) begins employment by the 12 later of the date that is— 13 ‘‘(aa) 120 days after receiv- 14 ing such waiver; 15 ‘‘(bb) 120 days after com- 16 pleting graduate medical edu- 17 cation or training under a pro- 18 gram approved pursuant to sec- 19 tion 212(j)(1); or 20 ‘‘(cc) 120 days after receiv- 21 ing nonimmigrant status or em- 22 ployment authorization, if the 23 alien or the alien’s employer peti- 24 tions for such nonimmigrant sta- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 203 •HR 6637 IH tus or employment authorization 1 not later than 120 days after the 2 date on which the alien completes 3 his or her graduate medical edu- 4 cation or training under a pro- 5 gram approved pursuant to sec- 6 tion 212(j)(1); and 7 ‘‘(III) agrees to continue to work 8 for a total of not less than 3 years in 9 the status authorized for such employ- 10 ment under this subsection, except as 11 provided in paragraph (8).’’; and 12 (E) in subparagraph (D), in the matter 13 preceding clause (i), by inserting ‘‘(except as 14 provided in paragraph (8)). 15 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS 16 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 17 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 18 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 19 read as follows: 20 ‘‘(A) Upon the request of an interested 21 Federal agency or an interested State agency 22 for recommendation of a waiver under this sec- 23 tion by a physician who is maintaining valid 24 nonimmigrant status under section 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 204 •HR 6637 IH 101(a)(15)(J) and a favorable recommendation 1 by the Secretary of State, the Secretary of 2 Homeland Security may change the status of 3 such physician to any status authorized for em- 4 ployment under this Act. The numerical limita- 5 tions contained in subsection (g)(1)(A) shall not 6 apply to any alien whose status is changed 7 under this subparagraph.’’. 8 (3) VIOLATION OF AGREEMENTS.—Section 9 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 10 amended by inserting ‘‘substantial requirement of 11 an’’ before ‘‘agreement entered into’’. 12 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 13 AREAS.—Section 214(l) of such Act (8 U.S.C. 14 1184(l)), as amended by this section, is further 15 amended by adding at the end the following: 16 ‘‘(4)(A) If an interested State agency denies the 17 application for a waiver under paragraph (1)(B) 18 from a physician pursuing graduate medical edu- 19 cation or training pursuant to section 101(a)(15)(J) 20 because the State has requested the maximum num- 21 ber of waivers permitted for that fiscal year, the 22 physician’s nonimmigrant status shall be extended 23 for up to 6 months if the physician agrees to seek 24 a waiver under this subsection (except for paragraph 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 205 •HR 6637 IH (1)(D)(ii)) to work for an employer described in 1 paragraph (1)(C) in a State that has not yet re- 2 quested the maximum number of waivers. 3 ‘‘(B) Such physician shall be authorized to 4 work only for the employer referred to in subpara- 5 graph (A) from the date on which a new waiver ap- 6 plication is filed with such State until the earlier 7 of— 8 ‘‘(i) the date on which the Secretary of 9 Homeland Security denies such waiver; or 10 ‘‘(ii) the date on which the Secretary ap- 11 proves an application for change of status 12 under paragraph (2)(A) pursuant to the ap- 13 proval of such waiver.’’. 14 (5) CONTRACT REQUIREMENTS.—Section 214(l) 15 of such Act, as amended by this section, is further 16 amended by adding at the end the following: 17 ‘‘(5) An alien granted a waiver under para- 18 graph (1)(C) shall enter into an employment agree- 19 ment with the contracting health facility or health 20 care organization that— 21 ‘‘(A) specifies the maximum number of on- 22 call hours per week (which may be a monthly 23 average) that the alien will be expected to be 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 206 •HR 6637 IH available and the compensation the alien will re- 1 ceive for on-call time; 2 ‘‘(B) specifies— 3 ‘‘(i) whether the contracting facility or 4 organization will pay the alien’s mal- 5 practice insurance premiums; 6 ‘‘(ii) whether the employer will provide 7 malpractice insurance; and 8 ‘‘(iii) the amount of such insurance 9 that will be provided; 10 ‘‘(C) describes all of the work locations 11 that the alien will work and includes a state- 12 ment that the contracting facility or organiza- 13 tion will not add additional work locations with- 14 out the approval of the Federal agency or State 15 agency that requested the waiver; and 16 ‘‘(D) does not include a non-compete provi- 17 sion. 18 ‘‘(6) An alien granted a waiver under this sub- 19 section whose employment relationship with a health 20 facility or health care organization terminates under 21 paragraph (1)(C)(ii) during the 3-year service period 22 required under paragraph (1) shall be considered to 23 be maintaining lawful status in an authorized period 24 of stay during the 120-day period referred to in 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 207 •HR 6637 IH items (aa) and (bb) of subclause (III) of paragraph 1 (1)(C)(ii) or the 45-day period referred to in sub- 2 clause (III)(cc) of such paragraph.’’. 3 (6) RECAPTURING WAIVER SLOTS LOST TO 4 OTHER STATES.—Section 214(l) of such Act, as 5 amended by this section, is further amended by add- 6 ing at the end the following: 7 ‘‘(7) If a recipient of a waiver under this sub- 8 section terminates the recipient’s employment with a 9 health facility or health care organization pursuant 10 to paragraph (1)(C)(ii), including termination of em- 11 ployment because of circumstances described in 12 paragraph (1)(C)(ii)(III), and accepts new employ- 13 ment with such a facility or organization in a dif- 14 ferent State, the State from which the alien is de- 15 parting may be accorded an additional waiver by the 16 Secretary of State for use in the fiscal year in which 17 the alien’s employment was terminated.’’. 18 (7) EXCEPTION TO 3–YEAR WORK REQUIRE- 19 MENT.—Section 214(l) of such Act, as amended by 20 this section, is further amended by adding at the 21 end the following: 22 ‘‘(8) The 3-year work requirement set forth in 23 subparagraphs (C) and (D) of paragraph (1) shall 24 not apply if— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 208 •HR 6637 IH ‘‘(A)(i) the Secretary of Homeland Secu- 1 rity determines that extenuating circumstances, 2 including violations by the employer of the em- 3 ployment agreement with the alien or of labor 4 and employment laws, exist that justify a lesser 5 period of employment at such facility or organi- 6 zation; and 7 ‘‘(ii) the alien demonstrates, not later than 8 120 days after the employment termination 9 date (unless the Secretary determines that ex- 10 tenuating circumstances would justify an exten- 11 sion), another bona fide offer of employment at 12 a health facility or health care organization in 13 a geographic area or areas which are designated 14 by the Secretary of Health and Human Services 15 as having a shortage of health care profes- 16 sionals, for the remainder of such 3-year period; 17 ‘‘(B)(i) the interested State agency that re- 18 quested the waiver attests that extenuating cir- 19 cumstances, including violations by the em- 20 ployer of the employment agreement with the 21 alien or of labor and employment laws, exist 22 that justify a lesser period of employment at 23 such facility or organization; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 209 •HR 6637 IH ‘‘(ii) the alien demonstrates, not later than 1 120 days after the employment termination 2 date (unless the Secretary determines that ex- 3 tenuating circumstances would justify an exten- 4 sion), another bona fide offer of employment at 5 a health facility or health care organization in 6 a geographic area or areas which are designated 7 by the Secretary of Health and Human Services 8 as having a shortage of health care profes- 9 sionals, for the remainder of such 3-year period; 10 or 11 ‘‘(C) the alien— 12 ‘‘(i) elects not to pursue a determina- 13 tion of extenuating circumstances pursuant 14 to subclause (A) or (B); 15 ‘‘(ii) terminates the alien’s employ- 16 ment relationship with the health facility 17 or health care organization at which the 18 alien was employed; 19 ‘‘(iii) demonstrates, not later than 45 20 days after the employment termination 21 date, another bona fide offer of employ- 22 ment at a health facility or health care or- 23 ganization in a geographic area or areas, 24 in the State that requested the alien’s 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 210 •HR 6637 IH waiver, which are designated by the Sec- 1 retary of Health and Human Services as 2 having a shortage of health care profes- 3 sionals; and 4 ‘‘(iv) agrees to be employed for the re- 5 mainder of such 3-year period, and 1 addi- 6 tional year for each termination under 7 clause (ii).’’. 8 (d) ALLOTMENT OF CONRAD 30 WAIVERS.— 9 (1) IN GENERAL.—Section 214(l) of the Immi- 10 gration and Nationality Act (8 U.S.C. 1184(l)), as 11 amended by subsection (d), is further amended by 12 adding at the end the following: 13 ‘‘(8)(A)(i) All States shall be allotted a total of 35 14 waivers under paragraph (1)(B) for a fiscal year if 90 per- 15 cent of the waivers available to the States receiving at 16 least 5 waivers were used in the previous fiscal year. 17 ‘‘(ii) When an allotment occurs under clause (i), all 18 States shall be allotted an additional 5 waivers under 19 paragraph (1)(B) for each subsequent fiscal year if 90 20 percent of the waivers available to the States receiving at 21 least 5 waivers were used in the previous fiscal year. If 22 the States are allotted 45 or more waivers for a fiscal year, 23 the States will only receive an additional increase of 5 24 waivers the following fiscal year if 95 percent of the waiv- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 211 •HR 6637 IH ers available to the States receiving at least 1 waiver were 1 used in the previous fiscal year. 2 ‘‘(B) Any increase in allotments under subparagraph 3 (A) shall be maintained indefinitely, unless in a fiscal year, 4 the total number of such waivers granted is 5 percent 5 lower than in the last year in which there was an increase 6 in the number of waivers allotted pursuant to this para- 7 graph, in which case— 8 ‘‘(i) the number of waivers allotted shall be de- 9 creased by five for all States beginning in the next 10 fiscal year; and 11 ‘‘(ii) each additional 5 percent decrease in such 12 waivers granted from the last year in which there 13 was an increase in the allotment, shall result in an 14 additional decrease of 5 waivers allotted for all 15 States, provided that the number of waivers allotted 16 for all States shall not drop below 30.’’. 17 (2) ACADEMIC MEDICAL CENTERS.—Section 18 214(l)(1)(D) of such Act is amended— 19 (A) in clause (ii), by striking ‘‘and’’ at the 20 end; 21 (B) in clause (iii), by striking the period at 22 the end and inserting ‘‘; and’’; and 23 (C) by adding at the end the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 212 •HR 6637 IH ‘‘(iv) in the case of a request by an inter- 1 ested State agency— 2 ‘‘(I) the head of such agency deter- 3 mines that the alien is to practice medicine 4 in, or be on the faculty of a residency pro- 5 gram at, an academic medical center (as 6 that term is defined in section 7 411.355(e)(2) of title 42, Code of Federal 8 Regulations, or similar successor regula- 9 tion), without regard to whether such facil- 10 ity is located within an area designated by 11 the Secretary of Health and Human Serv- 12 ices as having a shortage of health care 13 professionals; and 14 ‘‘(II) the head of such agency deter- 15 mines that— 16 ‘‘(aa) the alien physician’s work 17 is in the public interest; and 18 ‘‘(bb) the grant of such waiver 19 would not cause the number of the 20 waivers granted on behalf of aliens for 21 such State for a fiscal year (within 22 the limitation in subparagraph (B) 23 and subject to paragraph (6)) in ac- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 213 •HR 6637 IH cordance with the conditions of this 1 clause to exceed 3.’’. 2 (e) AMENDMENTS TO THE PROCEDURES, DEFINI- 3 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 4 IMMIGRATION.— 5 (1) DUAL INTENT FOR PHYSICIANS SEEKING 6 GRADUATE MEDICAL TRAINING.—Section 214(b) of 7 the Immigration and Nationality Act (8 U.S.C. 8 1184(b)) is amended by striking ‘‘(other than a non- 9 immigrant described in subparagraph (L) or (V) of 10 section 101(a)(15), and other than a nonimmigrant 11 described in any provision of section 12 101(a)(15)(H)(i) except subclause (b1) of such sec- 13 tion)’’ and inserting ‘‘(other than a nonimmigrant 14 described in subparagraph (L) or (V) of section 15 101(a)(15), a nonimmigrant described in any provi- 16 sion of section 101(a)(15)(H)(i) (except subclause 17 (b1) of such section), and an alien coming to the 18 United States to receive graduate medical education 19 or training as described in section 212(j) or to take 20 examinations required to receive graduate medical 21 education or training as described in section 22 212(j))’’. 23 (2) PHYSICIAN NATIONAL INTEREST WAIVER 24 CLARIFICATIONS.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 214 •HR 6637 IH (A) PRACTICE AND GEOGRAPHIC AREA.— 1 Section 203(b)(2)(B)(ii)(I) of the Immigration 2 and Nationality Act (8 U.S.C. 3 1153(b)(2)(B)(ii)(I)) is amended by striking 4 items (aa) and (bb) and inserting the following: 5 ‘‘(aa) the alien physician agrees to 6 work on a full-time basis practicing pri- 7 mary care, specialty medicine, or a com- 8 bination thereof, in an area or areas des- 9 ignated by the Secretary of Health and 10 Human Services as having a shortage of 11 health care professionals, or at a health 12 care facility under the jurisdiction of the 13 Secretary of Veterans Affairs; or 14 ‘‘(bb) the alien physician is pursuing 15 such waiver based upon service at a facility 16 or facilities that serve patients who reside 17 in a geographic area or areas designated 18 by the Secretary of Health and Human 19 Services as having a shortage of health 20 care professionals (without regard to 21 whether such facility or facilities are lo- 22 cated within such an area) and a Federal 23 agency, or a local, county, regional, or 24 State department of public health deter- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 215 •HR 6637 IH mines the alien physician’s work was or 1 will be in the public interest.’’. 2 (B) FIVE-YEAR SERVICE REQUIREMENT.— 3 Section 203(b)(2)(B)(ii) of the Immigration 4 and Nationality Act (8 U.S.C. 1153(B)(ii)) is 5 amended— 6 (i) by moving subclauses (II), (III), 7 and (IV) 4 ems to the left; and 8 (ii) in subclause (II)— 9 (I) by inserting ‘‘(aa)’’ after 10 ‘‘(II)’’; and 11 (II) by adding at the end the fol- 12 lowing: 13 ‘‘(bb) The 5-year service requirement 14 under item (aa) shall begin on the date on 15 which the alien physician begins work in 16 the shortage area in any legal status and 17 not on the date on which an immigrant 18 visa petition is filed or approved. Such 19 service shall be aggregated without regard 20 to when such service began and without re- 21 gard to whether such service began during 22 or in conjunction with a course of graduate 23 medical education. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 216 •HR 6637 IH ‘‘(cc) An alien physician shall not be 1 required to submit an employment contract 2 with a term exceeding the balance of the 5- 3 year commitment yet to be served or an 4 employment contract dated within a min- 5 imum time period before filing a visa peti- 6 tion under this subsection. 7 ‘‘(dd) An alien physician shall not be 8 required to file additional immigrant visa 9 petitions upon a change of work location 10 from the location approved in the original 11 national interest immigrant petition.’’. 12 (3) TECHNICAL CLARIFICATION REGARDING AD- 13 VANCED DEGREE FOR PHYSICIANS.—Section 14 203(b)(2)(A) of the Immigration and Nationality 15 Act (8 U.S.C. 1153(b)(2)(A)) is amended by adding 16 at the end the following: ‘‘An alien physician holding 17 a foreign medical degree that has been deemed suffi- 18 cient for acceptance by an accredited United States 19 medical residency or fellowship program is a member 20 of the professions holding an advanced degree or its 21 equivalent.’’. 22 (4) SHORT-TERM WORK AUTHORIZATION FOR 23 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 217 •HR 6637 IH (A) IN GENERAL.—A physician completing 1 graduate medical education or training de- 2 scribed in section 212(j) of the Immigration 3 and Nationality Act (8 U.S.C. 1182(j)) as a 4 nonimmigrant described in section 5 101(a)(15)(H)(i) of such Act (8 U.S.C. 6 1101(a)(15)(H)(i))— 7 (i) shall have such nonimmigrant sta- 8 tus automatically extended until October 1 9 of the fiscal year for which a petition for 10 a continuation of such nonimmigrant sta- 11 tus has been submitted in a timely manner 12 and the employment start date for the ben- 13 eficiary of such petition is October 1 of 14 that fiscal year; and 15 (ii) shall be authorized to be employed 16 incident to status during the period be- 17 tween the filing of such petition and Octo- 18 ber 1 of such fiscal year. 19 (B) TERMINATION.—The physician’s sta- 20 tus and employment authorization shall termi- 21 nate on the date that is 30 days after the date 22 on which a petition described in clause (i)(I) is 23 rejected, denied or revoked. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 218 •HR 6637 IH (C) AUTOMATIC EXTENSION.—A physi- 1 cian’s status and employment authorization will 2 automatically extend to October 1 of the next 3 fiscal year if all of the visas described in section 4 101(a)(15)(H)(i) of such Act that were author- 5 ized to be issued for the fiscal year have been 6 issued. 7 (5) APPLICABILITY OF SECTION 212(e) TO 8 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI- 9 TORS.—A spouse or child of an exchange visitor de- 10 scribed in section 101(a)(15)(J) of the Immigration 11 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 12 not be subject to the requirements under section 13 212(e) of such Act (8 U.S.C. 1182(e)). 14 TITLE IV—IMPROVING HEALTH 15 CARE ACCESS AND QUALITY 16 Subtitle A—Improvement of 17 Coverage 18 SEC. 401. REPEAL OF REQUIREMENT FOR DOCUMENTA- 19 TION EVIDENCING CITIZENSHIP OR NATION- 20 ALITY UNDER THE MEDICAID PROGRAM. 21 (a) REPEAL.—Subsections (i)(22) and (x) of section 22 1903 of the Social Security Act (42 U.S.C. 1396b) are 23 each repealed. 24 (b) CONFORMING AMENDMENTS.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 219 •HR 6637 IH (1) STATE PAYMENTS FOR MEDICAL ASSIST- 1 ANCE.—Section 1902 of the Social Security Act (42 2 U.S.C. 1396a) is amended— 3 (A) by amending paragraph (46) of sub- 4 section (a) to read as follows: 5 ‘‘(46) provide that information is requested and 6 exchanged for purposes of income and eligibility 7 verification in accordance with a State system which 8 meets the requirements of section 1137 of this 9 Act;’’; 10 (B) in subsection (e)(13)(A)(i)— 11 (i) in the matter preceding subclause 12 (I), by striking ‘‘sections 1902(a)(46)(B) 13 and 1137(d)’’ and inserting ‘‘section 14 1137(d)’’; and 15 (ii) in subclause (IV), by striking 16 ‘‘1902(a)(46)(B) or’’; and 17 (C) by striking subsection (ee). 18 (2) PAYMENT TO STATES.—Section 1903 of the 19 Social Security Act (42 U.S.C. 1396b) is amended— 20 (A) in subsection (i), by redesignating 21 paragraphs (23) through (26) as paragraphs 22 (22) through (25), respectively; and 23 (B) by redesignating subsections (y) and 24 (z) as subsections (x) and (y), respectively. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 220 •HR 6637 IH (3) REPEAL.—Subsection (c) of section 6036 of 1 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 2 note) is repealed. 3 (c) EFFECTIVE DATE.—The amendments made by 4 this section shall take effect as if included in the enact- 5 ment of the Deficit Reduction Act of 2005. 6 SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 7 RIERS TO ACCESS TO AFFORDABLE HEALTH 8 CARE UNDER ACA. 9 (a) IN GENERAL.— 10 (1) PREMIUM TAX CREDITS.—Section 36B of 11 the Internal Revenue Code of 1986 is amended— 12 (A) in subsection (c)(1)(B)— 13 (i) by amending the heading to read 14 as follows: ‘‘SPECIAL RULE FOR CERTAIN 15 INDIVIDUALS INELIGIBLE FOR MEDICAID 16 DUE TO STATUS’’, and 17 (ii) in clause (ii), by striking ‘‘lawfully 18 present in the United States, but’’ and in- 19 serting ‘‘who’’, and 20 (B) by striking subsection (e). 21 (2) COST-SHARING REDUCTIONS.—Section 1402 22 of the Patient Protection and Affordable Care Act 23 (42 U.S.C. 18071) is amended by striking sub- 24 section (e). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 221 •HR 6637 IH (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 1 Section 1331(e)(1)(B) of the Patient Protection and 2 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 3 amended by striking ‘‘lawfully present in the United 4 States’’. 5 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 6 Section 1412 of the Patient Protection and Afford- 7 able Care Act (42 U.S.C. 18082) is amended by 8 striking subsection (d). 9 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 10 SENTIAL COVERAGE.—Section 5000A(d) of the In- 11 ternal Revenue Code of 1986 is amended by striking 12 paragraph (3) and by redesignating paragraph (4) 13 as paragraph (3). 14 (b) CONFORMING AMENDMENTS.— 15 (1) Section 1411(a) of the Patient Protection 16 and Affordable Care Act (42 U.S.C. 18081(a)) is 17 amended by striking paragraph (1) and redesig- 18 nating paragraphs (2), (3), and (4) as paragraphs 19 (1), (2), and (3), respectively. 20 (2) Section 1312(f) of the Patient Protection 21 and Affordable Care Act (42 U.S.C. 18032(f)) is 22 amended— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 222 •HR 6637 IH (A) in the heading, by striking ‘‘; ACCESS 1 LIMITED TO CITIZENS AND LAWFUL RESI- 2 DENTS’’; and 3 (B) by striking paragraph (3). 4 SEC. 403. STUDY ON THE UNINSURED. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services (in this section referred to as the ‘‘Sec- 7 retary’’) shall— 8 (1) conduct a study, in accordance with the 9 standards under section 3101 of the Public Health 10 Service Act (42 U.S.C. 300kk), on the demographic 11 characteristics of the population of individuals who 12 do not have health insurance coverage or oral health 13 coverage; and 14 (2) predict, based on such study, the demo- 15 graphic characteristics of the population of individ- 16 uals who would remain without health insurance cov- 17 erage after the end of any annual open enrollment 18 or any special enrollment period or upon enactment 19 and implementation of any legislative changes to the 20 Patient Protection and Affordable Care Act (Public 21 Law 111–148) that affect the number of persons eli- 22 gible for coverage. 23 (b) REPORTING REQUIREMENTS.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 223 •HR 6637 IH (1) IN GENERAL.—Not later than 12 months 1 after the date of the enactment of this Act, the Sec- 2 retary shall submit to the Congress the results of 3 the study under subsection (a)(1) and the prediction 4 made under subsection (a)(2). 5 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 6 ISTICS.—The Secretary shall— 7 (A) report the demographic characteristics 8 under paragraphs (1) and (2) of subsection (a) 9 on the basis of racial and ethnic group, and 10 shall stratify the reporting on each racial and 11 ethnic group by other demographic characteris- 12 tics that can impact access to health insurance 13 coverage, such as sexual orientation, gender 14 identity, primary language, disability status, 15 sex, socioeconomic status, age group, and citi- 16 zenship and immigration status, in a manner 17 consistent with title I of this Act, including the 18 amendments made by such title; 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 224 •HR 6637 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 pre- 6 ceding paragraph (1), by striking ‘‘subsection 7 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 8 (B) in subsection (g)(2), in the matter pre- 9 ceding subparagraph (A), by inserting ‘‘and 10 subsection (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 2020.’’. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 225 •HR 6637 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 2021. 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 2020’’ 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 226 •HR 6637 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 12 subsection the requirement of subsection 13 (a)(10)(A)(i)(IX) (relating to coverage of adults for- 14 merly under foster care) with respect to any terri- 15 tory.’’. 16 (2) EFFECTIVE DATE.—The amendments made 17 by this section shall apply beginning October 1, 18 2021. 19 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR 20 TERRITORIES.—Section 1923(f) of the Social Security Act 21 (42 U.S.C. 1396r–4) is amended— 22 (1) in paragraph (6), by adding at the end the 23 following new subparagraph: 24 ‘‘(C) TERRITORIES.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 227 •HR 6637 IH ‘‘(i) FISCAL YEAR 2020.—For fiscal 1 year 2020, 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 $300,000,000 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 2021, Puerto Rico, the Virgin 20 Islands of the United States, Guam, the Northern 21 Mariana Islands, and American Samoa’’. 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 228 •HR 6637 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, 2021’’ 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, 2021 (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.’’. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 229 •HR 6637 IH SEC. 406. INDIAN DEFINED IN TITLE I OF THE PATIENT 1 PROTECTION AND AFFORDABLE CARE ACT. 2 (a) DEFINITION OF INDIAN.—Section 1304 of the 3 Patient Protection and Affordable Care Act (42 U.S.C. 4 18024) is amended by adding at the end the following: 5 ‘‘(f) INDIAN.— 6 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 7 dian’ means any individual— 8 ‘‘(A) described in paragraph (13) or (28) 9 of section 4 of the Indian Health Care Improve- 10 ment Act (25 U.S.C. 1603); 11 ‘‘(B) who is eligible for health services pro- 12 vided by the Indian Health Service under sec- 13 tion 809 of the Indian Health Care Improve- 14 ment Act (25 U.S.C. 1679); 15 ‘‘(C) who is of Indian descent and belongs 16 to the Indian community served by the local fa- 17 cilities and program of the Indian Health Serv- 18 ice; or 19 ‘‘(D) who is described in paragraph (2). 20 ‘‘(2) INCLUSIONS.—An individual is described 21 in this paragraph if the individual is any of the fol- 22 lowing: 23 ‘‘(A) A member of a federally recognized 24 Indian Tribe. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 230 •HR 6637 IH ‘‘(B) A resident of an urban center who 1 meets any of the following criteria: 2 ‘‘(i) Membership in a Tribe, band, or 3 other organized group of Indians, including 4 those Tribes, bands, or groups terminated 5 since 1940 and those recognized as of the 6 date of enactment of the Health Equity 7 and Accountability Act of 2018 or later by 8 the State in which they reside, or being a 9 descendant, in the first or second degree, 10 of any such member. 11 ‘‘(ii) Is an Eskimo or Aleut or other 12 Alaska Native. 13 ‘‘(iii) Is considered by the Secretary of 14 the Interior to be an Indian for any pur- 15 pose. 16 ‘‘(iv) Is determined to be an Indian 17 under regulations promulgated by the Sec- 18 retary. 19 ‘‘(C) An individual who is considered by 20 the Secretary of the Interior to be an Indian for 21 any purpose. 22 ‘‘(D) An individual who is considered by 23 the Secretary to be an Indian for purposes of 24 eligibility for Indian health care services, includ- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 231 •HR 6637 IH ing as a California Indian, Eskimo, Aleut, or 1 other Alaska Native.’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) AFFORDABLE CHOICES HEALTH BENEFIT 4 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 5 tection and Affordable Care Act (42 U.S.C. 6 18031(c)(6)(D)) is amended by striking ‘‘(as defined 7 in section 4 of the Indian Health Care Improvement 8 Act)’’. 9 (2) REDUCED COST-SHARING FOR INDIVIDUALS 10 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 11 1402(d) of the Patient Protection and Affordable 12 Care Act (42 U.S.C. 18071(d)) is amended— 13 (A) in paragraph (1), in the matter pre- 14 ceding subparagraph (A), by striking ‘‘(as de- 15 fined in section 4(d) of the Indian Self-Deter- 16 mination and Education Assistance Act (25 17 U.S.C. 450b(d))’’; and 18 (B) in paragraph (2), in the matter pre- 19 ceding subparagraph (A), by striking ‘‘(as so 20 defined)’’. 21 (3) EXEMPTION FROM PENALTY FOR NOT 22 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 23 Section 5000A(e) of the Internal Revenue Code of 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 232 •HR 6637 IH 1986 is amended by striking paragraph (3) and in- 1 serting the following: 2 ‘‘(3) INDIANS.—Any applicable individual who 3 is an Indian (as defined in section 1304(f) of the 4 Patient Protection and Affordable Care Act).’’. 5 SEC. 407. REMOVING MEDICARE BARRIER TO HEALTH 6 CARE. 7 (a) PART A.—Section 1818(a)(3) of the Social Secu- 8 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 9 ‘‘an alien’’ and all that follows through ‘‘under this sec- 10 tion’’ and inserting ‘‘an individual who is lawfully present 11 in the United States’’. 12 (b) PART B.—Section 1836(2) of the Social Security 13 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 14 alien’’ and all that follows through ‘‘under this part’’ and 15 inserting ‘‘an individual who is lawfully present in the 16 United States’’. 17 SEC. 408. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 18 PROVIDED BY URBAN INDIAN HEALTH CEN- 19 TERS. 20 (a) IN GENERAL.—The third sentence of section 21 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 22 is amended by inserting ‘‘or are received through a pro- 23 gram operated by an urban Indian organization through 24 a grant or contract under title V of such Act’’ after ‘‘(as 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 233 •HR 6637 IH defined in section 4 of the Indian Health Care Improve- 1 ment Act)’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 this section shall apply to medical assistance provided on 4 or after the date of enactment of this Act. 5 SEC. 409. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 6 PROVIDED TO A NATIVE HAWAIIAN THROUGH 7 A FEDERALLY QUALIFIED HEALTH CENTER 8 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 9 TEM UNDER THE MEDICAID PROGRAM. 10 (a) IN GENERAL.—The third sentence of section 11 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 12 as amended by section 408(a), is amended by inserting 13 before the period the following: ‘‘, and with respect to 14 medical assistance provided to a Native Hawaiian (as de- 15 fined in section 12(2) of the Native Hawaiian Health Care 16 Improvement Act) through a federally qualified health 17 center or a Native Hawaiian health care system (as de- 18 fined in section 12(6) of such Act), whether directly, by 19 referral, or under contract or other arrangement between 20 such federally qualified health center or Native Hawaiian 21 health care system and another health care provider’’. 22 (b) EFFECTIVE DATE.—The amendment made by 23 this section shall apply to medical assistance provided on 24 or after the date of enactment of this Act. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 234 •HR 6637 IH SEC. 410. MEDICAID COVERAGE FOR CITIZENS OF FREELY 1 ASSOCIATED STATES. 2 (a) IN GENERAL.—Section 402(b)(2) of the Personal 3 Responsibility and Work Opportunity Reconciliation Act 4 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 5 the end the following new subparagraph: 6 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 7 OF FREELY ASSOCIATED STATES.—With respect 8 to eligibility for benefits for the designated Fed- 9 eral program described in paragraph (3)(C), 10 section 401(a) and paragraph (1) shall not 11 apply to any individual who lawfully resides in 12 1 of the 50 States or the District of Columbia 13 in accordance with the Compacts of Free Asso- 14 ciation between the Government of the United 15 States and the Governments of the Federated 16 States of Micronesia, the Republic of the Mar- 17 shall Islands, and the Republic of Palau and 18 shall not apply, at the option of the Governors 19 of Puerto Rico, the Virgin Islands, Guam, the 20 Northern Mariana Islands, or American Samoa, 21 respectively, as communicated to the Secretary 22 of Health and Human Services in writing, to 23 any individual who lawfully resides in the re- 24 spective territory in accordance with such Com- 25 pacts.’’. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 235 •HR 6637 IH (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 1 Section 403(d) of the Personal Responsibility and Work 2 Opportunity Reconciliation Act of 1996 (8 U.S.C. 3 1613(d)) is amended— 4 (1) in paragraph (1), by striking ‘‘or’’ at the 5 end; 6 (2) in paragraph (2), by striking the period at 7 the end and inserting ‘‘; or’’; and 8 (3) by adding at the end the following new 9 paragraph: 10 ‘‘(3) an individual described in section 11 402(b)(2)(G), but only with respect to the des- 12 ignated Federal program described in section 13 402(b)(3)(C).’’. 14 (c) DEFINITION OF QUALIFIED ALIEN.—Section 15 431(b) of the Personal Responsibility and Work Oppor- 16 tunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is 17 amended— 18 (1) in paragraph (6), by striking ‘‘; or’’ at the 19 end and inserting a comma; 20 (2) in paragraph (7), by striking the period at 21 the end and inserting ‘‘, or’’; and 22 (3) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 236 •HR 6637 IH ‘‘(8) an individual who lawfully resides in the 1 United States in accordance with a Compact of Free 2 Association referred to in section 402(b)(2)(G), but 3 only with respect to the designated Federal program 4 described in section 402(b)(3)(C) (relating to the 5 Medicaid program).’’. 6 (d) EFFECTIVE DATE.—The amendments made by 7 this section take effect on October 1, 2021. 8 SEC. 411. AT-RISK YOUTH MEDICAID PROTECTION. 9 (a) IN GENERAL.—Section 1902 of the Social Secu- 10 rity Act (42 U.S.C. 1396a) is amended— 11 (1) in subsection (a)— 12 (A) by striking ‘‘and’’ at the end of para- 13 graph (83); 14 (B) by striking the period at the end of 15 paragraph (84) and inserting ‘‘; and’’; and 16 (C) by inserting after paragraph (84) the 17 following new paragraph: 18 ‘‘(85) provide that— 19 ‘‘(A) the State shall not terminate eligi- 20 bility for medical assistance under a State plan 21 for an individual who is an eligible juvenile (as 22 defined in subsection (nn)(2)) because the juve- 23 nile is an inmate of a public institution (as de- 24 fined in subsection (nn)(3)), but may suspend 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 237 •HR 6637 IH coverage during the period the juvenile is such 1 an inmate; 2 ‘‘(B) the State shall restore coverage for 3 such medical assistance to such an individual 4 upon the individual’s release from any such 5 public institution, without requiring a new ap- 6 plication from the individual, unless (and until 7 such date as) there is a determination that the 8 individual no longer meets the eligibility re- 9 quirements for such medical assistance; and 10 ‘‘(C) the State shall process any applica- 11 tion for medical assistance submitted by, or on 12 behalf of, a juvenile who is an inmate of a pub- 13 lic institution notwithstanding that the juvenile 14 is such an inmate.’’; and 15 (2) by adding at the end the following new sub- 16 section: 17 ‘‘(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC IN- 18 STITUTION.—For purposes of subsection (a)(84) and this 19 subsection: 20 ‘‘(1) JUVENILE.—The term ‘juvenile’ means an 21 individual who is— 22 ‘‘(A) under 21 years of age; or 23 ‘‘(B) is described in subsection 24 (a)(10)(A)(i)(IX). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 238 •HR 6637 IH ‘‘(2) ELIGIBLE JUVENILE.—The term ‘eligible 1 juvenile’ means a juvenile who is an inmate of a 2 public institution and was eligible for medical assist- 3 ance under the State plan immediately before be- 4 coming an inmate of such a public institution or who 5 becomes eligible for such medical assistance while an 6 inmate of a public institution. 7 ‘‘(3) INMATE OF A PUBLIC INSTITUTION.—The 8 term ‘inmate of a public institution’ has the meaning 9 given such term for purposes of applying the sub- 10 division (A) following paragraph (30) of section 11 1905(a), taking into account the exception in such 12 subdivision for a patient of a medical institution.’’. 13 (b) NO CHANGE IN EXCLUSION FROM MEDICAL AS- 14 SISTANCE FOR INMATES OF PUBLIC INSTITUTIONS.— 15 Nothing in this section shall be construed as changing the 16 exclusion from medical assistance under the subdivision 17 (A) following paragraph (30) of section 1905(a) of the So- 18 cial Security Act (42 U.S.C. 1396d(a)), including any ap- 19 plicable restrictions on a State submitting claims for Fed- 20 eral financial participation under title XIX of such Act 21 for such assistance. 22 (c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BE- 23 FORE ADJUDICATION OR SENTENCING.—Nothing in this 24 section shall be construed to mandate, encourage, or sug- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 239 •HR 6637 IH gest that a State suspend or terminate coverage for indi- 1 viduals before they have been adjudicated or sentenced. 2 (d) EFFECTIVE DATE.— 3 (1) IN GENERAL.—Except as provided in para- 4 graph (2), the amendments made by subsection (a) 5 shall apply to eligibility for medical assistance under 6 a State plan under title XIX of the Social Security 7 Act of juveniles who become inmates of public insti- 8 tutions on or after the date that is 1 year after the 9 date of the enactment of this Act. 10 (2) RULE FOR CHANGES REQUIRING STATE 11 LEGISLATION.—In the case of a State plan for med- 12 ical assistance under title XIX of the Social Security 13 Act which the Secretary of Health and Human Serv- 14 ices determines requires State legislation (other than 15 legislation appropriating funds) in order for the plan 16 to meet the additional requirements imposed by the 17 amendments made by subsection (a), the State plan 18 shall not be regarded as failing to comply with the 19 requirements of such title solely on the basis of its 20 failure to meet these additional requirements before 21 the first day of the first calendar quarter beginning 22 after the close of the first regular session of the 23 State legislature that begins after the date of the en- 24 actment of this Act. For purposes of the previous 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 240 •HR 6637 IH sentence, in the case of a State that has a 2-year 1 legislative session, each year of such session shall be 2 deemed to be a separate regular session of the State 3 legislature. 4 Subtitle B—Expansion of Access 5 SEC. 412. AMENDMENT TO THE PUBLIC HEALTH SERVICE 6 ACT. 7 Title XXXIV of the Public Health Service Act, as 8 amended by titles I, II, III, and IX of this Act, is further 9 amended by inserting after subtitle D the following: 10 ‘‘Subtitle E—Reconstruction and 11 Improvement Grants for Public 12 Health Care Facilities Serving 13 Pacific Islanders and the Insu- 14 lar Areas 15 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 16 INITIATIVES. 17 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 18 with the Administrator of the Health Resources and Serv- 19 ices Administration, the Director of the Agency for 20 Healthcare Research and Quality, and the Administrator 21 of the Centers for Medicare & Medicaid Services, shall 22 award grants to eligible entities for the conduct of dem- 23 onstration projects to improve the quality of and access 24 to health care. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 241 •HR 6637 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an entity shall— 2 ‘‘(1) be a health center, hospital, health plan, 3 health system, community clinic, or other health en- 4 tity determined appropriate by the Secretary— 5 ‘‘(A) that, by legal mandate or explicitly 6 adopted mission, provides patients with access 7 to services regardless of their ability to pay; 8 ‘‘(B) that provides care or treatment for a 9 substantial number of patients who are unin- 10 sured, are receiving assistance under a State 11 plan under title XIX of the Social Security Act 12 (or under a waiver of such plan), or are mem- 13 bers of vulnerable populations, as determined 14 by the Secretary; and 15 ‘‘(C)(i) with respect to which, not less than 16 50 percent of the entity’s patient population is 17 made up of racial and ethnic minority groups; 18 or 19 ‘‘(ii) that— 20 ‘‘(I) serves a disproportionate percent- 21 age of local patients that are from a racial 22 and ethnic minority group, or that has a 23 patient population, at least 50 percent of 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 242 •HR 6637 IH which is composed of individuals with lim- 1 ited English proficiency; 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 minority 6 population 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 243 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 244 •HR 6637 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 2021 through 2026. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 245 •HR 6637 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 2021 through 2026. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 246 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 247 •HR 6637 IH ‘‘(2)(A) provides care or treatment for a sub- 1 stantial number of patients who are uninsured, re- 2 ceiving assistance under title XVIII of the Social Se- 3 curity Act, or a State plan under title XIX of such 4 Act (or under a waiver of such plan), 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 patients that are from a racial and ethnic mi- 9 nority group. 10 ‘‘(c) REPORT.—Not later than 180 days after the 11 date of enactment of this title and annually thereafter, the 12 Secretary shall submit to the Congress and the President 13 a report that includes an assessment of health resources 14 and facilities serving populations in American Samoa, 15 Guam, the Commonwealth of the Northern Mariana Is- 16 lands, the United States Virgin Islands, Puerto Rico, and 17 Hawaii. In preparing such report, the Secretary shall— 18 ‘‘(1) consult with and obtain information on all 19 health care facilities needs from the entities receiv- 20 ing direct financial assistance under subsection (a); 21 ‘‘(2) include all amounts of Federal assistance 22 received by each such entity in the preceding fiscal 23 year; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 248 •HR 6637 IH ‘‘(3) review the total unmet needs of health care 1 facilities serving American Samoa, Guam, the Com- 2 monwealth of the Northern Mariana Islands, the 3 United States Virgin Islands, Puerto Rico, and Ha- 4 waii, including needs for renovation and expansion 5 of existing facilities; 6 ‘‘(4) include a strategic plan for addressing the 7 needs of each such population identified in the re- 8 port; and 9 ‘‘(5) evaluate the effectiveness of the care pro- 10 vided by measuring patient outcomes and cost meas- 11 ures. 12 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated such sums as necessary 14 to carry out this section.’’. 15 SEC. 413. PROTECTING SENSITIVE LOCATIONS. 16 Section 287 of the Immigration and Nationality Act 17 (8 U.S.C. 1357) is amended— 18 (1) by striking ‘‘Service’’ each place such term 19 appears and inserting ‘‘Department of Homeland 20 Security’’; 21 (2) by striking ‘‘Attorney General’’ each place 22 such term appears and inserting ‘‘Secretary of 23 Homeland Security’’; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 249 •HR 6637 IH (3) in subsection (f)(1), by striking ‘‘Commis- 1 sioner’’ and inserting ‘‘Director of U.S. Citizenship 2 and Immigration Services’’; 3 (4) in subsection (h)— 4 (A) by striking ‘‘of the Immigration and 5 Nationality Act’’; and 6 (B) by striking ‘‘of such Act’’; and 7 (5) by adding at the end the following: 8 ‘‘(i)(1) In this subsection: 9 ‘‘(A) The term ‘appropriate committees of Con- 10 gress’ means— 11 ‘‘(i) the Committee on Homeland Security 12 and Governmental Affairs of the Senate; 13 ‘‘(ii) the Committee on the Judiciary of the 14 Senate; 15 ‘‘(iii) the Committee on Homeland Security 16 of the House of Representatives; and 17 ‘‘(iv) the Committee on the Judiciary of 18 the House of Representatives. 19 ‘‘(B) The term ‘enforcement action’— 20 ‘‘(i) means an apprehension, arrest, inter- 21 view, request for identification, search, or sur- 22 veillance for the purposes of immigration en- 23 forcement; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 250 •HR 6637 IH ‘‘(ii) includes an enforcement action at, or 1 focused on, a sensitive location that is part of 2 a joint case led by another law enforcement 3 agency. 4 ‘‘(C) The term ‘exigent circumstances’ means a 5 situation involving— 6 ‘‘(i) the imminent risk of death, violence, 7 or physical harm to any person or property, in- 8 cluding a situation implicating terrorism or the 9 national security of the United States; 10 ‘‘(ii) the immediate arrest or pursuit of a 11 dangerous felon, terrorist suspect, or other indi- 12 vidual presenting an imminent danger; or 13 ‘‘(iii) the imminent risk of destruction of 14 evidence that is material to an ongoing criminal 15 case. 16 ‘‘(D) The term ‘prior approval’ means— 17 ‘‘(i) in the case of officers and agents of 18 U.S. Immigration and Customs Enforcement, 19 prior written approval to carry out an enforce- 20 ment action involving a specific individual or in- 21 dividuals authorized by— 22 ‘‘(I) the Assistant Director of Oper- 23 ations, Homeland Security Investigations; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 251 •HR 6637 IH ‘‘(II) the Executive Associate Direc- 1 tor, Homeland Security Investigations; 2 ‘‘(III) the Assistant Director for Field 3 Operations, Enforcement and Removal Op- 4 erations; or 5 ‘‘(IV) the Executive Associate Direc- 6 tor for Field Operations, Enforcement and 7 Removal Operations; 8 ‘‘(ii) in the case of officers and agents of 9 U.S. Customs and Border Protection, prior 10 written approval to carry out an enforcement 11 action involving a specific individual or individ- 12 uals authorized by— 13 ‘‘(I) a Chief Patrol Agent; 14 ‘‘(II) the Director of Field Operations; 15 ‘‘(III) the Director of Air and Marine 16 Operations; or 17 ‘‘(IV) the Internal Affairs Special 18 Agent in Charge; and 19 ‘‘(iii) in the case of other Federal, State, 20 or local law enforcement officers, to carry out 21 an enforcement action involving a specific indi- 22 vidual or individuals authorized by— 23 ‘‘(I) the head of the Federal agency 24 carrying out the enforcement action; or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 252 •HR 6637 IH ‘‘(II) the head of the State or local 1 law enforcement agency carrying out the 2 enforcement action. 3 ‘‘(E) The term ‘sensitive location’ includes all of 4 the physical space located within 1,000 feet of— 5 ‘‘(i) any medical treatment or health care 6 facility, including any hospital, doctor’s office, 7 accredited health clinic, alcohol or drug treat- 8 ment center, or emergent or urgent care facil- 9 ity; 10 ‘‘(ii) any public or private school, including 11 any known and licensed day care facility, pre- 12 school, other early learning program facility, 13 primary school, secondary school, postsecondary 14 school (including colleges and universities), or 15 other institution of learning (including voca- 16 tional or trade schools); 17 ‘‘(iii) any scholastic or education-related 18 activity or event, including field trips and inter- 19 scholastic events; 20 ‘‘(iv) any school bus or school bus stop 21 during periods when school children are present 22 on the bus or at the stop; 23 ‘‘(v) any organization or subdivision of 24 government that— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 253 •HR 6637 IH ‘‘(I) assists children, pregnant women, 1 victims of crime or abuse, or individuals 2 with significant mental or physical disabil- 3 ities; or 4 ‘‘(II) provides social services and as- 5 sistance, including emergency and disaster 6 services or assistance with food and nutri- 7 tion, housing affordability and income or 8 other services funded by State or local gov- 9 ernment, charitable giving, the Special 10 Supplemental Nutrition Program for 11 Women, Infants, and Children (WIC), 12 Supplemental Nutrition Assistance Pro- 13 gram (SNAP), Temporary Assistance for 14 Needy Families (TANF), or the United 15 States Housing Act; 16 ‘‘(vi) any church, synagogue, mosque, or 17 other place of worship, including buildings 18 rented for the purpose of religious services, re- 19 treats, counseling, workshops, instruction, and 20 education; 21 ‘‘(vii) any Federal, State, or local court- 22 house, including the office of an individual’s 23 legal counsel or representative, and a probation, 24 parole, or supervised release office; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 254 •HR 6637 IH ‘‘(viii) the site of a funeral, wedding, or 1 other religious ceremony or observance; 2 ‘‘(ix) any public demonstration, such as a 3 march, rally, or parade; 4 ‘‘(x) any domestic violence shelter, rape 5 crisis center, supervised visitation center, family 6 justice center, or victim services provider; or 7 ‘‘(xi) any other location specified by the 8 Secretary of Homeland Security for purposes of 9 this subsection. 10 ‘‘(2)(A) An enforcement action may not take place 11 at, or be focused on, a sensitive location unless— 12 ‘‘(i) the action involves exigent circumstances; 13 and 14 ‘‘(ii) prior approval for the enforcement action 15 was obtained from the appropriate official. 16 ‘‘(B) If an enforcement action is initiated pursuant 17 to subparagraph (A) and the exigent circumstances per- 18 mitting the enforcement action cease, the enforcement ac- 19 tion shall be discontinued until such exigent circumstances 20 reemerge. 21 ‘‘(C) If an enforcement action is carried out in viola- 22 tion of this subsection— 23 ‘‘(i) no information resulting from the enforce- 24 ment action may be entered into the record or re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 255 •HR 6637 IH ceived into evidence in a removal proceeding result- 1 ing from the enforcement action; and 2 ‘‘(ii) the alien who is the subject of such re- 3 moval proceeding may file a motion for the imme- 4 diate termination of the removal proceeding. 5 ‘‘(3)(A) This subsection shall apply to any enforce- 6 ment action by officers or agents of the Department of 7 Homeland Security, including— 8 ‘‘(i) officers or agents of U.S. Immigration and 9 Customs Enforcement; 10 ‘‘(ii) officers or agents of U.S. Customs and 11 Border Protection; and 12 ‘‘(iii) any individual designated to perform im- 13 migration enforcement functions pursuant to sub- 14 section (g). 15 ‘‘(B) While carrying out an enforcement action at a 16 sensitive location, officers and agents referred to in sub- 17 paragraph (A) shall make every effort— 18 ‘‘(i) to limit the time spent at the sensitive loca- 19 tion; 20 ‘‘(ii) to limit the enforcement action at the sen- 21 sitive location to the person or persons for whom 22 prior approval was obtained; and 23 ‘‘(iii) to conduct themselves discreetly. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 256 •HR 6637 IH ‘‘(C) If, while carrying out an enforcement action 1 that is not initiated at or focused on a sensitive location, 2 officers or agents are led to a sensitive location, and no 3 exigent circumstance and prior approval with respect to 4 the sensitive location exists, such officers or agents shall— 5 ‘‘(i) cease before taking any further enforce- 6 ment action; 7 ‘‘(ii) conduct themselves in a discreet manner; 8 ‘‘(iii) maintain surveillance; and 9 ‘‘(iv) immediately consult their supervisor in 10 order to determine whether such enforcement action 11 should be discontinued. 12 ‘‘(D) The limitations under this paragraph shall not 13 apply to the transportation of an individual apprehended 14 at or near a land or sea border to a hospital or health 15 care provider for the purpose of providing medical care 16 to such individual. 17 ‘‘(4)(A) Each official specified in subparagraph (B) 18 shall ensure that the employees under his or her super- 19 vision receive annual training on compliance with— 20 ‘‘(i) the requirements under this subsection in 21 enforcement actions at or focused on sensitive loca- 22 tions and enforcement actions that lead officers or 23 agents to a sensitive location; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 257 •HR 6637 IH ‘‘(ii) the requirements under section 239 of this 1 Act and section 384 of the Illegal Immigration Re- 2 form and Immigrant Responsibility Act of 1996 (8 3 U.S.C. 1367). 4 ‘‘(B) The officials specified in this subparagraph 5 are— 6 ‘‘(i) the Chief Counsel of U.S. Immigration and 7 Customs Enforcement; 8 ‘‘(ii) the Field Office Directors of U.S. Immi- 9 gration and Customs Enforcement; 10 ‘‘(iii) each Special Agent in Charge of U.S. Im- 11 migration and Customs Enforcement; 12 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 13 and Border Protection; 14 ‘‘(v) the Director of Field Operations of U.S. 15 Customs and Border Protection; 16 ‘‘(vi) the Director of Air and Marine Operations 17 of U.S. Customs and Border Protection; 18 ‘‘(vii) the Internal Affairs Special Agent in 19 Charge of U.S. Customs and Border Protection; and 20 ‘‘(viii) the chief law enforcement officer of each 21 State or local law enforcement agency that enters 22 into a written agreement with the Department of 23 Homeland Security pursuant to subsection (g). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 258 •HR 6637 IH ‘‘(5) The Secretary of Homeland Security shall mod- 1 ify the Notice to Appear form (I–862)— 2 ‘‘(A) to provide the subjects of an enforcement 3 action with information, written in plain language, 4 summarizing the restrictions against enforcement 5 actions at sensitive locations set forth in this sub- 6 section and the remedies available to the alien if 7 such action violates such restrictions; 8 ‘‘(B) so that the information described in sub- 9 paragraph (A) is accessible to individuals with lim- 10 ited English proficiency; and 11 ‘‘(C) so that subjects of an enforcement action 12 are not permitted to verify that the officers or 13 agents that carried out such action complied with 14 the restrictions set forth in this subsection. 15 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 16 toms Enforcement and the Commissioner of U.S. Customs 17 and Border Protection shall each submit an annual report 18 to the appropriate committees of Congress that includes 19 the information set forth in subparagraph (B) with respect 20 to the respective agency. 21 ‘‘(B) Each report submitted under subparagraph (A) 22 shall include, with respect to the submitting agency during 23 the reporting period— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 259 •HR 6637 IH ‘‘(i) the number of enforcement actions that 1 were carried out at, or focused on, a sensitive loca- 2 tion; 3 ‘‘(ii) the number of enforcement actions in 4 which officers or agents were subsequently led to a 5 sensitive location; and 6 ‘‘(iii) for each enforcement action described in 7 clause (i) or (ii)— 8 ‘‘(I) the date on which it occurred; 9 ‘‘(II) the specific site, city, county, and 10 State in which it occurred; 11 ‘‘(III) the components of the agency in- 12 volved in the enforcement action; 13 ‘‘(IV) a description of the enforcement ac- 14 tion, including the nature of the criminal activ- 15 ity of its intended target; 16 ‘‘(V) the number of individuals, if any, ar- 17 rested or taken into custody; 18 ‘‘(VI) the number of collateral arrests, if 19 any, and the reasons for each such arrest; 20 ‘‘(VII) a certification whether the location 21 administrator was contacted before, during, or 22 after the enforcement action; and 23 ‘‘(VIII) the percentage of all of the staff 24 members and supervisors reporting to the offi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 260 •HR 6637 IH cials listed in paragraph (4)(B) who completed 1 the training required under paragraph (4)(A). 2 ‘‘(7) Nothing in the subsection may be construed— 3 ‘‘(A) to affect the authority of Federal, State, 4 or local law enforcement agencies— 5 ‘‘(i) to enforce generally applicable Federal 6 or State criminal laws unrelated to immigra- 7 tion; or 8 ‘‘(ii) to protect residents from imminent 9 threats to public safety; or 10 ‘‘(B) to limit or override the protections pro- 11 vided in— 12 ‘‘(i) section 239; or 13 ‘‘(ii) section 384 of the Illegal Immigration 14 Reform and Immigrant Responsibility Act of 15 1996 (8 U.S.C. 1367).’’. 16 SEC. 414. GRANTS FOR RACIAL AND ETHNIC APPROACHES 17 TO COMMUNITY HEALTH. 18 (a) PURPOSE.—It is the purpose of this section to 19 award grants to assist communities in mobilizing and or- 20 ganizing resources in support of effective and sustainable 21 programs that will reduce or eliminate disparities in health 22 and health care experienced by racial and ethnic minority 23 individuals. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 261 •HR 6637 IH (b) AUTHORITY TO AWARD GRANTS.—The Secretary 1 of Health and Human Services, acting through the Ad- 2 ministrator of the Health Resources and Services Admin- 3 istration (referred to in this section as the ‘‘Secretary’’), 4 shall award grants to eligible entities to assist in design- 5 ing, implementing, and evaluating culturally and linguis- 6 tically appropriate, science-based, and community-driven 7 sustainable strategies to eliminate racial and ethnic health 8 and health care disparities. 9 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 10 grant under this section, an entity shall— 11 (1) represent a coalition— 12 (A) whose principal purpose is to develop 13 and implement interventions to reduce or elimi- 14 nate a health or health care disparity in a tar- 15 geted racial or ethnic minority group in the 16 community served by the coalition; and 17 (B) that includes— 18 (i) members selected from among— 19 (I) public health departments; 20 (II) community-based organiza- 21 tions; 22 (III) university and research or- 23 ganizations; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 262 •HR 6637 IH (IV) Indian tribes or tribal orga- 1 nizations (as such terms are defined 2 in section 4 of the Indian Self-Deter- 3 mination and Education Assistance 4 Act (25 U.S.C. 5304)), the Indian 5 Health Service, or any other organiza- 6 tion that serves Alaska Natives; and 7 (V) interested public or private 8 health care providers or organizations 9 as determined appropriate by the Sec- 10 retary; and 11 (ii) at least 1 member from a commu- 12 nity-based organization that represents the 13 targeted racial or ethnic minority group; 14 and 15 (2) submit to the Secretary an application at 16 such time, in such manner, and containing such in- 17 formation as the Secretary may require, which shall 18 include— 19 (A) a description of the targeted racial or 20 ethnic populations in the community to be 21 served under the grant; 22 (B) a description of at least 1 health dis- 23 parity that exists in the racial or ethnic tar- 24 geted populations, including health issues such 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 263 •HR 6637 IH as infant mortality, breast and cervical cancer 1 screening and management, musculoskeletal 2 diseases and obesity, prostate cancer screening 3 and management, cardiovascular disease, diabe- 4 tes, child and adult immunization levels, oral 5 disease, or other health priority areas as des- 6 ignated by the Secretary; and 7 (C) a demonstration of a proven record of 8 accomplishment of the coalition members in 9 serving and working with the targeted commu- 10 nity. 11 (d) SUSTAINABILITY.—The Secretary shall give pri- 12 ority to an eligible entity under this section if the entity 13 agrees that, with respect to the costs to be incurred by 14 the entity in carrying out the activities for which the grant 15 was awarded, the entity (and each of the participating 16 partners in the coalition represented by the entity) will 17 maintain its expenditures of non-Federal funds for such 18 activities at a level that is not less than the level of such 19 expenditures during the fiscal year immediately preceding 20 the first fiscal year for which the grant is awarded. 21 (e) NONDUPLICATION.—Any funds provided to an eli- 22 gible entity through a grant under this section shall— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 264 •HR 6637 IH (1) supplement, not supplant, any other Federal 1 funds made available to the entity for the purposes 2 of this section; and 3 (2) not be used to duplicate the activities of any 4 other health disparity grant program under this Act, 5 including an amendment made by this Act. 6 (f) TECHNICAL ASSISTANCE.—The Secretary may, 7 either directly or by grant or contract, provide any entity 8 that receives a grant under this section with technical and 9 other nonfinancial assistance necessary to meet the re- 10 quirements of this section. 11 (g) DISSEMINATION.—The Secretary shall encourage 12 and enable eligible entities receiving grants under this sec- 13 tion to share best practices, evaluation results, and reports 14 with communities not affiliated with such entities, by 15 using the internet, conferences, and other pertinent infor- 16 mation regarding the projects funded by this section, in- 17 cluding through using outreach efforts of the Office of Mi- 18 nority Health and the Centers for Disease Control and 19 Prevention. 20 (h) ADMINISTRATIVE BURDENS.—The Secretary 21 shall make every effort to minimize duplicative or unneces- 22 sary administrative burdens on eligible entities receiving 23 grants under this section. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 265 •HR 6637 IH (i) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated such sums as may be 2 necessary to carry out this section. 3 SEC. 415. BORDER HEALTH GRANTS. 4 (a) DEFINITIONS.—In this section: 5 (1) BORDER AREA.—The term ‘‘border area’’ 6 means the United States-Mexico Border Area, as de- 7 fined in section 8 of the United States-Mexico Bor- 8 der Health Commission Act (22 U.S.C. 290n–6). 9 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 10 ty’’ means an entity that is located in the border 11 area and is any of the following: 12 (A) A State, local government, or Tribal 13 government. 14 (B) A public institution of higher edu- 15 cation. 16 (C) A nonprofit health organization. 17 (D) A community health center. 18 (E) A community clinic that is a health 19 center receiving assistance under section 330 of 20 the Public Health Service Act (42 U.S.C. 21 254b). 22 (b) AUTHORIZATION.—From funds appropriated 23 under subsection (f), the Secretary of Health and Human 24 Services (in this section referred to as the ‘‘Secretary’’), 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 266 •HR 6637 IH acting through the United States members of the United 1 States-Mexico Border Health Commission, shall award 2 grants to eligible entities to address priorities and rec- 3 ommendations to improve the health of border area resi- 4 dents that are established by— 5 (1) the United States members of the United 6 States-Mexico Border Health Commission; 7 (2) the State border health offices; and 8 (3) the Secretary. 9 (c) APPLICATION.—An eligible entity that desires a 10 grant under subsection (b) shall submit an application to 11 the Secretary at such time, in such manner, and con- 12 taining such information as the Secretary may require. 13 (d) USE OF FUNDS.—An eligible entity that receives 14 a grant under subsection (b) shall use the grant funds 15 for— 16 (1) programs relating to— 17 (A) maternal and child health; 18 (B) primary care and preventative health; 19 (C) public health and public health infra- 20 structure; 21 (D) musculoskeletal health and obesity; 22 (E) health education and promotion; 23 (F) oral health; 24 (G) mental and behavioral health; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 267 •HR 6637 IH (H) substance use disorders; 1 (I) health conditions that have a high prev- 2 alence in the border area; 3 (J) medical and health services research; 4 (K) workforce training and development; 5 (L) community health workers, patient 6 navigators, and promotores; 7 (M) health care infrastructure problems in 8 the border area (including planning and con- 9 struction grants); 10 (N) health disparities in the border area; 11 (O) environmental health; and 12 (P) outreach and enrollment services with 13 respect to Federal programs (including pro- 14 grams authorized under titles XIX and XXI of 15 the Social Security Act (42 U.S.C. 1396 et seq.; 16 42 U.S.C. 1397aa et seq.)); and 17 (2) other programs determined appropriate by 18 the Secretary. 19 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 20 vided to an eligible entity awarded a grant under sub- 21 section (b) shall be used to supplement and not supplant 22 other funds available to the eligible entity to carry out the 23 activities described in subsection (d). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 268 •HR 6637 IH (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 $200,000,000 for fiscal year 2021 and such sums as may 3 be necessary for each succeeding fiscal year. 4 SEC. 416. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 5 (a) ELIMINATION OF ISOLATION TEST FOR COST- 6 BASED AMBULANCE REIMBURSEMENT.— 7 (1) IN GENERAL.—Section 1834(l)(8) of the 8 Social Security Act (42 U.S.C. 1395m(l)(8)) is 9 amended— 10 (A) in subparagraph (B)— 11 (i) by striking ‘‘owned and’’; and 12 (ii) by inserting ‘‘(including when 13 such services are provided by the entity 14 under an arrangement with the hospital)’’ 15 after ‘‘hospital’’; and 16 (B) by striking the comma at the end of 17 subparagraph (B) and all that follows and in- 18 serting a period. 19 (2) EFFECTIVE DATE.—The amendments made 20 by this subsection shall apply to services furnished 21 on or after January 1, 2021. 22 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 23 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 24 REQUIREMENT.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 269 •HR 6637 IH (1) IN GENERAL.—Section 1820(c)(2) of the 1 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 2 amended— 3 (A) in subparagraph (B)(iii), by striking 4 ‘‘provides not more than’’ and inserting ‘‘sub- 5 ject to subparagraph (F), provides not more 6 than’’; and 7 (B) by adding at the end the following new 8 subparagraph: 9 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 10 LIMIT REQUIREMENT.— 11 ‘‘(i) IN GENERAL.—A State may elect 12 to treat a facility, with respect to the des- 13 ignation of the facility for a cost-reporting 14 period, as satisfying the requirement of 15 subparagraph (B)(iii) relating to a max- 16 imum number of acute care inpatient beds 17 if the facility elects, in accordance with a 18 method specified by the Secretary and be- 19 fore the beginning of the cost-reporting pe- 20 riod, to meet the requirement under clause 21 (ii). 22 ‘‘(ii) ALTERNATE REQUIREMENT.— 23 The requirement under this clause, with 24 respect to a facility and a cost-reporting 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 270 •HR 6637 IH period, is that the total number of inpa- 1 tient bed days described in subparagraph 2 (B)(iii) during such period will not exceed 3 7,300. For purposes of this subparagraph, 4 an individual who is an inpatient in a bed 5 in the facility for a single day shall be 6 counted as one inpatient bed day. 7 ‘‘(iii) WITHDRAWAL OF ELECTION.— 8 The option described in clause (i) shall not 9 apply to a facility for a cost-reporting pe- 10 riod if the facility (for any two consecutive 11 cost-reporting periods during the previous 12 5 cost-reporting periods) was treated under 13 such option and had a total number of in- 14 patient bed days for each of such two cost- 15 reporting periods that exceeded the num- 16 ber specified in such clause.’’. 17 (2) EFFECTIVE DATE.—The amendments made 18 by paragraph (1) shall apply to cost-reporting peri- 19 ods beginning on or after the date of the enactment 20 of this Act. 21 SEC. 417. ESTABLISHMENT OF RURAL COMMUNITY HOS- 22 PITAL (RCH) PROGRAM. 23 (a) IN GENERAL.—Section 1861 of the Social Secu- 24 rity Act (42 U.S.C. 1395x), as amended by section 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 271 •HR 6637 IH 205(b)(1), is amended by adding at the end of the fol- 1 lowing new subsection: 2 ‘‘Rural Community Hospital; Rural Community Hospital 3 Services 4 ‘‘(kkk)(1) The term ‘rural community hospital’ 5 means a hospital (as defined in subsection (e)) that— 6 ‘‘(A) is located in a rural area (as defined in 7 section 1886(d)(2)(D)) or treated as being so lo- 8 cated pursuant to section 1886(d)(8)(E); 9 ‘‘(B) subject to paragraph (2), has less than 51 10 acute care inpatient beds, as reported in its most re- 11 cent cost report; 12 ‘‘(C) makes available 24-hour emergency care 13 services; 14 ‘‘(D) subject to paragraph (3), has a provider 15 agreement in effect with the Secretary and is open 16 to the public as of January 1, 2010; and 17 ‘‘(E) applies to the Secretary for such designa- 18 tion. 19 ‘‘(2) For purposes of paragraph (1)(B), beds in a 20 psychiatric or rehabilitation unit of the hospital which is 21 a distinct part of the hospital shall not be counted. 22 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 23 hibit any of the following from qualifying as a rural com- 24 munity hospital: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 272 •HR 6637 IH ‘‘(A) A replacement facility (as defined by the 1 Secretary in regulations in effect on January 1, 2 2012) with the same service area (as defined by the 3 Secretary in regulations in effect on such date). 4 ‘‘(B) A facility obtaining a new provider num- 5 ber pursuant to a change of ownership. 6 ‘‘(C) A facility which has a binding written 7 agreement with an outside, unrelated party for the 8 construction, reconstruction, lease, rental, or financ- 9 ing of a building as of January 1, 2012. 10 ‘‘(4) Nothing in this subsection shall be construed as 11 prohibiting a critical access hospital from qualifying as a 12 rural community hospital if the critical access hospital 13 meets the conditions otherwise applicable to hospitals 14 under subsection (e) and section 1866. 15 ‘‘(5) Nothing in this subsection shall be construed as 16 prohibiting a rural community hospital participating in 17 the demonstration program under section 410A of the 18 Medicare Prescription Drug, Improvement, and Mod- 19 ernization Act of 2003 (Public Law 108–173; 117 Stat. 20 2313) from qualifying as a rural community hospital if 21 the rural community hospital meets the conditions other- 22 wise applicable to hospitals under subsection (e) and sec- 23 tion 1866.’’. 24 (b) PAYMENT.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 273 •HR 6637 IH (1) INPATIENT HOSPITAL SERVICES.—Section 1 1814 of the Social Security Act (42 U.S.C. 1395f) 2 is amended by adding at the end the following new 3 subsection: 4 ‘‘Payment for Inpatient Services Furnished in Rural 5 Community Hospitals 6 ‘‘(m) The amount of payment under this part for in- 7 patient hospital services furnished in a rural community 8 hospital, other than such services furnished in a psy- 9 chiatric or rehabilitation unit of the hospital which is a 10 distinct part, is, at the election of the hospital in the appli- 11 cation referred to in section 1861(kkk)(1)(E)— 12 ‘‘(1) 101 percent of the reasonable costs of pro- 13 viding such services, without regard to the amount 14 of the customary or other charge, or 15 ‘‘(2) the amount of payment provided for under 16 the prospective payment system for inpatient hos- 17 pital services under section 1886(d).’’. 18 (2) OUTPATIENT SERVICES.—Section 1834 of 19 such Act (42 U.S.C. 1395m) is amended by adding 20 at the end the following new subsection: 21 ‘‘(j) PAYMENT FOR OUTPATIENT SERVICES FUR- 22 NISHED IN RURAL COMMUNITY HOSPITALS.—The 23 amount of payment under this part for outpatient services 24 furnished in a rural community hospital is, at the election 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 274 •HR 6637 IH of the hospital in the application referred to in section 1 1861(kkk)(1)(E)— 2 ‘‘(1) 101 percent of the reasonable costs of pro- 3 viding such services, without regard to the amount 4 of the customary or other charge and any limitation 5 under section 1861(v)(1)(U), or 6 ‘‘(2) the amount of payment provided for under 7 the prospective payment system for covered OPD 8 services under section 1833(t).’’. 9 (3) EXEMPTION FROM 30-PERCENT REDUCTION 10 IN REIMBURSEMENT FOR BAD DEBT.—Section 11 1861(v)(1)(T) of such Act (42 U.S.C. 12 1395x(v)(1)(T)) is amended by inserting ‘‘(other 13 than for a rural community hospital)’’ after ‘‘In de- 14 termining such reasonable costs for hospitals’’. 15 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 16 SERVICES.—Section 1834(j) of such Act (as added by sub- 17 section (b)(2)) is amended— 18 (1) by redesignating paragraphs (1) and (2) as 19 subparagraphs (A) and (B), respectively; 20 (2) by inserting ‘‘(1)’’ after ‘‘(j)’’; and 21 (3) by adding at the end the following: 22 ‘‘(2) The amounts of beneficiary cost-sharing for out- 23 patient services furnished in a rural community hospital 24 under this part shall be as follows: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 275 •HR 6637 IH ‘‘(A) For items and services that would have 1 been paid under section 1833(t) if furnished by a 2 hospital, the amount of cost-sharing determined 3 under paragraph (8) of such section. 4 ‘‘(B) For items and services that would have 5 been paid under section 1833(h) if furnished by a 6 provider of services or supplier, no cost-sharing shall 7 apply. 8 ‘‘(C) For all other items and services, the 9 amount of cost-sharing that would apply to the item 10 or service under the methodology that would be used 11 to determine payment for such item or service if pro- 12 vided by a physician, provider of services, or sup- 13 plier, as the case may be.’’. 14 (d) CONFORMING AMENDMENTS.— 15 (1) PART A PAYMENT.—Section 1814(b) of 16 such Act (42 U.S.C. 1395f(b)) is amended in the 17 matter preceding paragraph (1) by inserting ‘‘other 18 than inpatient hospital services furnished by a rural 19 community hospital,’’ after ‘‘critical access hospital 20 services,’’. 21 (2) PART B PAYMENT.—Section 1833(a) of 22 such Act (42 U.S.C. 1395l(a)), as amended by sec- 23 tion 205(b)(3), is amended— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 276 •HR 6637 IH (A) in paragraph (2), in the matter before 1 subparagraph (A), by striking ‘‘and (I)’’ and in- 2 serting ‘‘(I), and (K)’’; 3 (B) by striking ‘‘and’’ at the end of para- 4 graph (8); 5 (C) by striking the period at the end of 6 paragraph (9) and inserting ‘‘; and’’; and 7 (D) by adding at the end the following: 8 ‘‘(10) in the case of outpatient services fur- 9 nished by a rural community hospital, the amounts 10 described in section 1834(j).’’. 11 (3) TECHNICAL AMENDMENTS.— 12 (A) CONSULTATION WITH STATE AGEN- 13 CIES.—Section 1863 of such Act (42 U.S.C. 14 1395z) is amended by striking ‘‘and (dd)(2)’’ 15 and inserting ‘‘(dd)(2), and (kkk)(1)’’. 16 (B) PROVIDER AGREEMENTS.—Section 17 1866(a)(2)(A) of such Act (42 U.S.C. 18 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 19 tion 1834(j)(2),’’ after ‘‘section 1833(b),’’. 20 (e) EFFECTIVE DATE.—The amendments made by 21 this section shall apply to items and services furnished on 22 or after October 1, 2021. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 277 •HR 6637 IH SEC. 418. MEDICARE REMOTE MONITORING PILOT 1 PROJECTS. 2 (a) PILOT PROJECTS.— 3 (1) IN GENERAL.—Not later than 9 months 4 after the date of enactment of this Act, the Sec- 5 retary of Health and Human Services (in this sec- 6 tion referred to as the ‘‘Secretary’’) shall conduct 7 pilot projects under title XVIII of the Social Secu- 8 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 9 providing incentives to home health agencies to uti- 10 lize home monitoring and communications tech- 11 nologies that— 12 (A) enhance health outcomes for Medicare 13 beneficiaries; and 14 (B) reduce expenditures under such title. 15 (2) SITE REQUIREMENTS.— 16 (A) URBAN AND RURAL.—The Secretary 17 shall conduct the pilot projects under this sec- 18 tion in both urban and rural areas. 19 (B) SITE IN A SMALL STATE.—The Sec- 20 retary shall conduct at least 3 of the pilot 21 projects in a State with a population of less 22 than 1,000,000. 23 (3) DEFINITION OF HOME HEALTH AGENCY.— 24 In this section, the term ‘‘home health agency’’ has 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 278 •HR 6637 IH the meaning given that term in section 1861(o) of 1 the Social Security Act (42 U.S.C. 1395x(o)). 2 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 3 OF PROJECTS.—The Secretary shall specify the criteria 4 for identifying those Medicare beneficiaries who shall be 5 considered within the scope of the pilot projects under this 6 section for purposes of the application of subsection (c) 7 and for the assessment of the effectiveness of the home 8 health agency in achieving the objectives of this section. 9 Such criteria may provide for the inclusion in the projects 10 of Medicare beneficiaries who begin receiving home health 11 services under title XVIII of the Social Security Act (42 12 U.S.C. 1395 et seq.) after the date of the implementation 13 of the projects. 14 (c) INCENTIVES.— 15 (1) PERFORMANCE TARGETS.—The Secretary 16 shall establish for each home health agency partici- 17 pating in a pilot project under this section a per- 18 formance target using one of the following meth- 19 odologies, as determined appropriate by the Sec- 20 retary: 21 (A) ADJUSTED HISTORICAL PERFORMANCE 22 TARGET.—The Secretary shall establish for the 23 agency— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 279 •HR 6637 IH (i) a base expenditure amount equal 1 to the average total payments made to the 2 agency under parts A and B of title XVIII 3 of the Social Security Act (42 U.S.C. 1395 4 et seq.) for Medicare beneficiaries deter- 5 mined to be within the scope of the pilot 6 project in a base period determined by the 7 Secretary; and 8 (ii) an annual per capita expenditure 9 target for such beneficiaries, reflecting the 10 base expenditure amount adjusted for risk 11 and adjusted growth rates. 12 (B) COMPARATIVE PERFORMANCE TAR- 13 GET.—The Secretary shall establish for the 14 agency a comparative performance target equal 15 to the average total payments under such parts 16 A and B during the pilot project for comparable 17 individuals in the same geographic area that 18 are not determined to be within the scope of the 19 pilot project. 20 (2) INCENTIVE.—Subject to paragraph (3), the 21 Secretary shall pay to each participating home care 22 agency an incentive payment for each year under the 23 pilot project equal to a portion of the Medicare sav- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 280 •HR 6637 IH ings realized for such year relative to the perform- 1 ance target under paragraph (1). 2 (3) LIMITATION ON EXPENDITURES.—The Sec- 3 retary shall limit incentive payments under this sec- 4 tion in order to ensure that the aggregate expendi- 5 tures under title XVIII of the Social Security Act 6 (42 U.S.C. 1395 et seq.) (including incentive pay- 7 ments under this subsection) do not exceed the 8 amount that the Secretary estimates would have 9 been expended if the pilot projects under this section 10 had not been implemented. 11 (d) WAIVER AUTHORITY.—The Secretary may waive 12 such provisions of titles XI and XVIII of the Social Secu- 13 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 14 as the Secretary determines to be appropriate for the con- 15 duct of the pilot projects under this section. 16 (e) REPORT TO CONGRESS.—Not later than 5 years 17 after the date that the first pilot project under this section 18 is implemented, the Secretary shall submit to Congress a 19 report on the pilot projects. Such report shall contain a 20 detailed description of issues related to the expansion of 21 the projects under subsection (f) and recommendations for 22 such legislation and administrative actions as the Sec- 23 retary considers appropriate. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 281 •HR 6637 IH (f) EXPANSION.—If the Secretary determines that 1 any of the pilot projects under this section enhance health 2 outcomes for Medicare beneficiaries and reduce expendi- 3 tures under title XVIII of the Social Security Act (42 4 U.S.C. 1395 et seq.), the Secretary may initiate com- 5 parable projects in additional areas. 6 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 7 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 8 tive payment under this section— 9 (1) shall be in addition to the payments that a 10 home health agency would otherwise receive under 11 title XVIII of the Social Security Act for the provi- 12 sion of home health services; and 13 (2) shall have no effect on the amount of such 14 payments. 15 SEC. 419. RURAL HEALTH QUALITY ADVISORY COMMISSION 16 AND DEMONSTRATION PROJECTS. 17 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 18 SION.— 19 (1) ESTABLISHMENT.—Not later than 6 20 months after the date of the enactment of this sec- 21 tion, the Secretary of Health and Human Services 22 (in this section referred to as the ‘‘Secretary’’) shall 23 establish a commission to be known as the Rural 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 282 •HR 6637 IH Health Quality Advisory Commission (in this section 1 referred to as the ‘‘Commission’’). 2 (2) DUTIES OF COMMISSION.— 3 (A) NATIONAL PLAN.—The Commission 4 shall develop, coordinate, and facilitate imple- 5 mentation of a national plan for rural health 6 quality improvement. The national plan shall— 7 (i) identify objectives for rural health 8 quality improvement; 9 (ii) identify strategies to eliminate 10 known gaps in rural health system capacity 11 and improve rural health quality; and 12 (iii) provide recommendations for 13 Federal programs to identify opportunities 14 for strengthening and aligning policies and 15 programs to improve rural health quality. 16 (B) DEMONSTRATION PROJECTS.—The 17 Commission shall design demonstration projects 18 to recommend to the Secretary to test alter- 19 native models for rural health quality improve- 20 ment, including with respect to both personal 21 and population health. 22 (C) MONITORING.—The Commission shall 23 monitor progress toward the objectives identi- 24 fied pursuant to paragraph (1)(A). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 283 •HR 6637 IH (3) MEMBERSHIP.— 1 (A) NUMBER.—The Commission shall be 2 composed of 11 members appointed by the Sec- 3 retary. 4 (B) SELECTION.—The Secretary shall se- 5 lect the members of the Commission from 6 among individuals with significant rural health 7 care and health care quality expertise, including 8 expertise in clinical health care, health care 9 quality research, population or public health, or 10 purchaser organizations. 11 (4) CONTRACTING AUTHORITY.—Subject to the 12 availability of funds, the Commission may enter into 13 contracts and make other arrangements, as may be 14 necessary to carry out the duties described in para- 15 graph (2). 16 (5) STAFF.—Upon the request of the Commis- 17 sion, the Secretary may detail, on a reimbursable 18 basis, any of the personnel of the Office of Rural 19 Health Policy of the Health Resources and Services 20 Administration, the Agency for Healthcare Research 21 and Quality, or the Centers for Medicare & Medicaid 22 Services to the Commission to assist in carrying out 23 this subsection. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 284 •HR 6637 IH (6) REPORTS TO CONGRESS.—Not later than 1 1 year after the establishment of the Commission, and 2 annually thereafter, the Commission shall submit a 3 report to the Congress on rural health quality. Each 4 such report shall include the following: 5 (A) An inventory of relevant programs and 6 recommendations for improved coordination and 7 integration of policy and programs. 8 (B) An assessment of achievement of the 9 objectives identified in the national plan devel- 10 oped under paragraph (2) and recommenda- 11 tions for realizing such objectives. 12 (C) Recommendations on Federal legisla- 13 tion, regulations, or administrative policies to 14 enhance rural health quality and outcomes. 15 (b) RURAL HEALTH QUALITY DEMONSTRATION 16 PROJECTS.— 17 (1) IN GENERAL.—Not later than 270 days 18 after the date of the enactment of this section, the 19 Secretary, in consultation with the Rural Health 20 Quality Advisory Commission, the Office of Rural 21 Health Policy of the Health Resources and Services 22 Administration, the Agency for Healthcare Research 23 and Quality, and the Centers for Medicare & Med- 24 icaid Services, shall make grants to eligible entities 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 285 •HR 6637 IH for a total of 5 demonstration projects to implement 1 and evaluate methods for improving the quality of 2 health care in rural communities. Each such dem- 3 onstration project shall include— 4 (A) alternative community models that— 5 (i) will achieve greater integration of 6 personal and population health services; 7 and 8 (ii) address safety, effectiveness, 9 patient- or community-centeredness, timeli- 10 ness, efficiency, and equity (the 6 aims 11 identified by the Institute of Medicine of 12 the National Academy of Sciences in its re- 13 port entitled ‘‘Crossing the Quality Chasm: 14 A New Health System for the 21st Cen- 15 tury’’ released on March 1, 2001); 16 (B) innovative approaches to the financing 17 and delivery of health services to achieve rural 18 health quality goals; and 19 (C) development of quality improvement 20 support structures to assist rural health sys- 21 tems and professionals (such as workforce sup- 22 port structures, quality monitoring and report- 23 ing, clinical care protocols, and information 24 technology applications). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 286 •HR 6637 IH (2) ELIGIBLE ENTITIES.—In this subsection, 1 the term ‘‘eligible entity’’ means a consortium 2 that— 3 (A) shall include— 4 (i) at least one health care provider or 5 health care delivery system located in a 6 rural area; and 7 (ii) at least one organization rep- 8 resenting multiple community stakeholders; 9 and 10 (B) may include other partners such as 11 rural research centers. 12 (3) CONSULTATION.—In developing the pro- 13 gram for awarding grants under this subsection, the 14 Secretary shall consult with the Administrator of the 15 Agency for Healthcare Research and Quality, rural 16 health care providers, rural health care researchers, 17 and private and nonprofit groups (including national 18 associations) which are undertaking similar efforts. 19 (4) EXPEDITED WAIVERS.—The Secretary shall 20 expedite the processing of any waiver that— 21 (A) is authorized under title XVIII or XIX 22 of the Social Security Act (42 U.S.C. 1395 et 23 seq.; 42 U.S.C. 1396 et seq.); and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 287 •HR 6637 IH (B) is necessary to carry out a demonstra- 1 tion project under this subsection. 2 (5) DEMONSTRATION PROJECT SITES.—The 3 Secretary shall ensure that the 5 demonstration 4 projects funded under this subsection are conducted 5 at a variety of sites representing the diversity of 6 rural communities in the United States. 7 (6) DURATION.—Each demonstration project 8 under this subsection shall be for a period of 4 9 years. 10 (7) INDEPENDENT EVALUATION.—The Sec- 11 retary shall enter into an arrangement with an enti- 12 ty that has experience working directly with rural 13 health systems for the conduct of an independent 14 evaluation of the program carried out under this 15 subsection. 16 (8) REPORT.—Not later than 1 year after the 17 conclusion of all of the demonstration projects fund- 18 ed under this subsection, the Secretary shall submit 19 a report to the Congress on the results of such 20 projects. The report shall include— 21 (A) an evaluation of patient access to care, 22 patient outcomes, and an analysis of the cost 23 effectiveness of each such project; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 288 •HR 6637 IH (B) recommendations on Federal legisla- 1 tion, regulations, or administrative policies to 2 enhance rural health quality and outcomes. 3 (c) APPROPRIATION.— 4 (1) IN GENERAL.—Out of funds in the Treas- 5 ury not otherwise appropriated, there are appro- 6 priated to the Secretary to carry out this section 7 $30,000,000 for the period of fiscal years 2021 8 through 2025. 9 (2) AVAILABILITY.— 10 (A) IN GENERAL.—Funds appropriated 11 under paragraph (1) shall remain available for 12 expenditure through fiscal year 2025. 13 (B) REPORT.—For purposes of carrying 14 out subsection (b)(8), funds appropriated under 15 paragraph (1) shall remain available for ex- 16 penditure through fiscal year 2026. 17 (3) RESERVATION.—Of the amount appro- 18 priated under paragraph (1), the Secretary shall re- 19 serve— 20 (A) $5,000,000 to carry out subsection (a); 21 and 22 (B) $25,000,000 to carry out subsection 23 (b), of which— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 289 •HR 6637 IH (i) 2 percent shall be for the provision 1 of technical assistance to grant recipients; 2 and 3 (ii) 5 percent shall be for independent 4 evaluation under subsection (b)(7). 5 SEC. 420. RURAL HEALTH CARE SERVICES. 6 Section 330A of the Public Health Service Act (42 7 U.S.C. 254c) is amended to read as follows: 8 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 9 RURAL HEALTH NETWORK DEVELOPMENT, 10 DELTA RURAL DISPARITIES AND HEALTH 11 SYSTEMS DEVELOPMENT, AND SMALL RURAL 12 HEALTH CARE PROVIDER QUALITY IMPROVE- 13 MENT GRANT PROGRAMS. 14 ‘‘(a) PURPOSE.—The purpose of this section is to 15 provide for grants— 16 ‘‘(1) under subsection (b), to promote rural 17 health care services outreach; 18 ‘‘(2) under subsection (c), to provide for the 19 planning and implementation of integrated health 20 care networks in rural areas; 21 ‘‘(3) under subsection (d), to assist rural com- 22 munities in the Delta Region to reduce health dis- 23 parities and to promote and enhance health system 24 development; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 290 •HR 6637 IH ‘‘(4) under subsection (e), to provide for the 1 planning and implementation of small rural health 2 care provider quality improvement activities. 3 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 4 GRANTS.— 5 ‘‘(1) GRANTS.—The Director of the Office of 6 Rural Health Policy of the Health Resources and 7 Services Administration (referred to in this section 8 as the ‘Director’) may award grants to eligible enti- 9 ties to promote rural health care services outreach 10 by expanding the delivery of health care services to 11 include new and enhanced services in rural areas. 12 The Director may award the grants for periods of 13 not more than 3 years. 14 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 15 grant under this subsection for a project, an enti- 16 ty— 17 ‘‘(A) shall be a rural public or rural non- 18 profit private entity, a facility that qualifies as 19 a rural health clinic under title XVIII of the 20 Social Security Act, a public or nonprofit entity 21 existing exclusively to provide services to mi- 22 grant and seasonal farm workers in rural areas, 23 or a Tribal government whose grant-funded ac- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 291 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 292 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 293 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 294 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 295 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 296 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 297 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 298 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 299 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 300 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 301 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 302 •HR 6637 IH similar grant programs, to maximize the effect of 1 public dollars in funding meritorious proposals. 2 ‘‘(g) REPORT.—Not later than September 30, 2022, 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) DEFINITION OF DELTA REGION.—In this sec- 8 tion, the term ‘Delta Region’ has the meaning given to 9 the term ‘region’ in section 382A of the Consolidated 10 Farm and Rural Development Act (7 U.S.C. 2009aa). 11 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 $40,000,000 for fiscal year 2021 and such sums as may 14 be necessary for each of fiscal years 2022 through 2025.’’. 15 SEC. 421. COMMUNITY HEALTH CENTER COLLABORATIVE 16 ACCESS EXPANSION. 17 Section 330(r)(4) of the Public Health Service Act 18 (42 U.S.C. 254b(r)(4)) is amended— 19 (1) in subparagraph (A), by striking ‘‘primary 20 health care services’’ each place it appears and in- 21 serting ‘‘primary health care and other mental, den- 22 tal, and physical health services’’; and 23 (2) in subparagraph (B)— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 303 •HR 6637 IH (A) in clause (i), by striking ‘‘and’’ at the 1 end; 2 (B) in clause (ii), by striking the period at 3 the end and inserting ‘‘; and’’; and 4 (C) by adding at the end the following: 5 ‘‘(iii) in the case of a rural health 6 clinic described in such subparagraph— 7 ‘‘(I) that such clinic provides, to 8 the extent possible, enabling services, 9 such as transportation and language 10 assistance (including translation and 11 interpretation); and 12 ‘‘(II) that the primary health 13 care and other services described in 14 such subparagraph are subject to full 15 reimbursement according to the pro- 16 spective payment system for Federally 17 qualified health center services under 18 section 1834(o) of the Social Security 19 Act.’’. 20 SEC. 422. FACILITATING THE PROVISION OF TELEHEALTH 21 SERVICES ACROSS STATE LINES. 22 (a) IN GENERAL.—For purposes of expediting the 23 provision of telehealth services, for which payment is made 24 under the Medicare Program, across State lines, the Sec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 304 •HR 6637 IH retary of Health and Human Services shall, in consulta- 1 tion with representatives of States, physicians, health care 2 practitioners, and patient advocates, encourage and facili- 3 tate the adoption of provisions allowing for multistate 4 practitioner practice across State lines. 5 (b) DEFINITIONS.—In subsection (a): 6 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 7 health service’’ has the meaning given that term in 8 subparagraph (F) of section 1834(m)(4) of the So- 9 cial Security Act (42 U.S.C. 1395m(m)(4)). 10 (2) PHYSICIAN, PRACTITIONER.—The terms 11 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 12 given those terms in subparagraphs (D) and (E), re- 13 spectively, of such section. 14 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 15 Program’’ means the program of health insurance 16 administered by the Secretary of Health and Human 17 Services under title XVIII of the Social Security Act 18 (42 U.S.C. 1395 et seq.). 19 SEC. 423. SCORING OF PREVENTIVE HEALTH SAVINGS. 20 Section 202 of the Congressional Budget and Im- 21 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 22 ed by adding at the end the following: 23 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 305 •HR 6637 IH ‘‘(1) DETERMINATION BY THE DIRECTOR.— 1 Upon a request by the chairman or ranking minority 2 member of the Committee on the Budget of the Sen- 3 ate, or by the chairman or ranking minority member 4 of the Committee on the Budget of the House of 5 Representatives, the Director shall determine if a 6 proposed measure would result in reductions in 7 budget outlays in budgetary outyears through the 8 use of preventive health and preventive health serv- 9 ices. 10 ‘‘(2) PROJECTIONS.—If the Director determines 11 that a measure would result in substantial reduc- 12 tions in budget outlays as described in paragraph 13 (1), the Director— 14 ‘‘(A) shall include, in any projection pre- 15 pared by the Director, a description and esti- 16 mate of the reductions in budget outlays in the 17 budgetary outyears and a description of the 18 basis for such conclusions; and 19 ‘‘(B) may prepare a budget projection that 20 includes some or all of the budgetary outyears, 21 notwithstanding the time periods for projections 22 described in subsection (e) and sections 308, 23 402, and 424. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 306 •HR 6637 IH ‘‘(3) DEFINITIONS.—As used in this sub- 1 section— 2 ‘‘(A) 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; and 8 ‘‘(B) the term ‘preventive health’ means an 9 action that focuses on the health of the public, 10 individuals, and defined populations in order to 11 protect, promote, and maintain health, wellness, 12 and functional ability, and prevent disease, dis- 13 ability, and premature death that is dem- 14 onstrated by credible and publicly available epi- 15 demiological projection models, incorporating 16 clinical trials or observational studies in hu- 17 mans, to avoid future health care costs.’’. 18 SEC. 424. SENSE OF CONGRESS ON MAINTENANCE OF EF- 19 FORT PROVISIONS REGARDING CHILDREN’S 20 HEALTH. 21 It is the sense of the Congress that— 22 (1) the maintenance of effort provisions added 23 to sections 1902 and 2105(d) of the Social Security 24 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 307 •HR 6637 IH tions 2001(b) and 2101(b) of the Patient Protection 1 and Affordable Care Act were intended to maintain 2 the eligibility standards for the Medicaid program 3 under title XIX of the Social Security Act (42 4 U.S.C. 1396 et seq.) and Children’s Health Insur- 5 ance Program under title XXI of such Act (42 6 U.S.C. 1397aa et seq.) until the American Health 7 Benefit Exchanges in the States are fully oper- 8 ational; 9 (2) it is imperative that the maintenance of ef- 10 fort provisions are enforced to the strict standard in- 11 tended by the Congress through September 30, 12 2027; 13 (3) waiving the maintenance of effort provisions 14 should not be permitted; 15 (4) the maintenance of effort provisions ensure 16 the continued success of the Medicaid program and 17 Children’s Health Insurance Program and were in- 18 tended to specifically protect vulnerable and disabled 19 adults, children, and senior citizens, many of whom 20 are also members of communities of color; and 21 (5) the maintenance of effort provisions must 22 be strictly enforced and proposals to weaken the 23 maintenance of effort provisions must not be consid- 24 ered. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 308 •HR 6637 IH SEC. 425. PROTECTION OF THE HHS OFFICES OF MINORITY 1 HEALTH. 2 (a) IN GENERAL.—Pursuant to section 1707A of the 3 Public Health Service Act (42 U.S.C. 300u–6a), the Of- 4 fices of Minority Health established within the Centers for 5 Disease Control and Prevention, the Health Resources 6 and Services Administration, the Substance Abuse and 7 Mental Health Services Administration, the Agency for 8 Healthcare Research and Quality, the Food and Drug Ad- 9 ministration, and the Centers for Medicare & Medicaid 10 Services, are offices that, regardless of change in the 11 structure of the Department of Health and Human Serv- 12 ices, shall report to the Secretary of Health and Human 13 Services. 14 (b) SENSE OF CONGRESS.—It is the sense of the 15 Congress that any effort to eliminate or consolidate such 16 Offices of Minority Health undermines the progress 17 achieved so far. 18 SEC. 426. OFFICE OF MINORITY HEALTH IN VETERANS 19 HEALTH ADMINISTRATION OF DEPARTMENT 20 OF VETERANS AFFAIRS. 21 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 22 I of chapter 73 of title 38, United States Code, is amended 23 by adding at the end the following new section: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 309 •HR 6637 IH ‘‘§ 7310. Office of Minority Health 1 ‘‘(a) ESTABLISHMENT.—There is established in the 2 Department within the Office of the Under Secretary for 3 Health an office to be known as the ‘Office of Minority 4 Health’ (in this section referred to as the ‘Office’). 5 ‘‘(b) HEAD.—The Director of the Office of Minority 6 Health shall be the head of the Office. The Director of 7 the Office of Minority Health shall be appointed by the 8 Under Secretary for Health from among individuals quali- 9 fied to perform the duties of the position. 10 ‘‘(c) FUNCTIONS.—The functions of the Office are as 11 follows: 12 ‘‘(1) To establish short-range and long-range 13 goals and objectives and coordinate all other activi- 14 ties within the Veterans Health Administration that 15 relate to disease prevention, health promotion, health 16 care services delivery, and health care research con- 17 cerning veterans who are members of a racial or eth- 18 nic minority group. 19 ‘‘(2) To support research, demonstrations, and 20 evaluations to test new and innovative models for 21 the discharge of activities described in paragraph 22 (1). 23 ‘‘(3) To increase knowledge and understanding 24 of health risk factors for veterans who are members 25 of a racial or ethnic minority group. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 310 •HR 6637 IH ‘‘(4) To develop mechanisms that support bet- 1 ter health care information dissemination, education, 2 prevention, and services delivery to veterans from 3 disadvantaged backgrounds, including veterans who 4 are members of a racial or ethnic minority group. 5 ‘‘(5) To enter into contracts or agreements with 6 appropriate public and nonprofit private entities to 7 develop and carry out programs to provide bilingual 8 or interpretive services to assist veterans who are 9 members of a racial or ethnic minority group and 10 who lack proficiency in speaking the English lan- 11 guage in accessing and receiving health care services 12 through the Veterans Health Administration. 13 ‘‘(6) To carry out programs to improve access 14 to health care services through the Veterans Health 15 Administration for veterans with limited proficiency 16 in speaking the English language, including the de- 17 velopment and evaluation of demonstration and pilot 18 projects for that purpose. 19 ‘‘(7) To advise the Under Secretary for Health 20 on matters relating to the development, implementa- 21 tion, and evaluation of health professions education 22 in decreasing disparities in health care outcomes be- 23 tween veterans who are members of a racial or eth- 24 nic minority group and other veterans, including cul- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 311 •HR 6637 IH tural competency as a method of eliminating such 1 health disparities. 2 ‘‘(8) To perform such other functions and du- 3 ties as the Secretary or the Under Secretary for 4 Health considers appropriate. 5 ‘‘(d) DEFINITIONS.—In this section: 6 ‘‘(1) The term ‘racial or ethnic minority group’ 7 means any of the following: 8 ‘‘(A) American Indians (including Alaska 9 Natives, Eskimos, and Aleuts). 10 ‘‘(B) Asian Americans. 11 ‘‘(C) Native Hawaiians and other Pacific 12 Islanders. 13 ‘‘(D) Blacks. 14 ‘‘(E) Hispanics. 15 ‘‘(2) The term ‘Hispanic’ means individuals 16 whose origin is Mexican, Puerto Rican, Cuban, Cen- 17 tral or South American, or any other Spanish-speak- 18 ing country.’’. 19 (b) CLERICAL AMENDMENT.—The table of sections 20 at the beginning of such chapter is amended by inserting 21 after the item relating to section 7309A the following new 22 item: 23 ‘‘7310. Office of Minority Health.’’. VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6211 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 312 •HR 6637 IH SEC. 427. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 1 ACCESS FOR LOW-INCOME PATIENTS. 2 (a) IN GENERAL.—Not later than January 1, 2021, 3 the Comptroller General of the United States shall con- 4 duct a study on how amendments made by the Patient 5 Protection and Affordable Care Act (Public Law 111– 6 148) and the Health Care and Education Reconciliation 7 Act of 2010 (Public Law 111–152) to titles XVIII and 8 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 9 42 U.S.C. 1396 et seq.) relating to disproportionate share 10 hospital adjustment payments under Medicare and Med- 11 icaid (and subsequent amendments made with respect to 12 such payments) affect the timely access to health care 13 services for low-income patients. Such study shall— 14 (1) evaluate and examine whether States elect- 15 ing to make medical assistance available under sec- 16 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 17 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 18 States making such an election through a waiver of 19 the State plan) to individuals described in such sec- 20 tion mitigate the need for payments to dispropor- 21 tionate share hospitals under section 1886(d)(5)(F) 22 of the Social Security Act (42 U.S.C. 23 1395ww(d)(5)(F)) and section 1923 of such Act (42 24 U.S.C. 1396r–4), including the impact of such 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 313 •HR 6637 IH States electing to make medical assistance available 1 to such individuals on— 2 (A) the number of individuals in the 3 United States who are without health insurance 4 and the distribution of such individuals in rela- 5 tion to areas primarily served by dispropor- 6 tionate share hospitals; and 7 (B) the low-income utilization rate of such 8 hospitals and the resulting fiscal sustainability 9 of such hospitals; 10 (2) evaluate the appropriate level and distribu- 11 tion of such payments among such disproportionate 12 share hospitals for purposes of— 13 (A) sufficiently accounting for the level of 14 uncompensated care provided by such hospitals 15 to low-income patients; and 16 (B) providing timely access to health serv- 17 ices for individuals in medically underserved 18 areas; and 19 (3) assess, with respect to such disproportionate 20 share hospitals— 21 (A) the role played by such hospitals in 22 providing critical access to emergency, inpa- 23 tient, and outpatient health services, as well as 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 314 •HR 6637 IH the location of such hospitals in relation to 1 medically underserved areas; and 2 (B) the extent to which such hospitals sat- 3 isfy the requirements established for charitable 4 hospital organizations under section 501(r) of 5 the Internal Revenue Code of 1986 with respect 6 to community health needs assessments, finan- 7 cial assistance policy requirements, limitations 8 on charges, and billing and collection require- 9 ments. 10 (b) REPORTS.— 11 (1) REPORT TO CONGRESS.—Not later than 12 180 days after the date on which the study under 13 subsection (a) is completed, the Comptroller General 14 of the United States shall submit to the Committee 15 on Energy and Commerce of the House of Rep- 16 resentatives and the Committee on Finance of the 17 Senate a report that contains— 18 (A) the results of the study; 19 (B) recommendations to Congress for any 20 legislative changes to the payments to dis- 21 proportionate share hospitals under section 22 1886(d)(5)(F) of the Social Security Act (42 23 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 24 such Act (42 U.S.C. 1396r–4) that are needed 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 315 •HR 6637 IH to ensure access to health services for low-in- 1 come patients that— 2 (i) are based on the number of indi- 3 viduals without health insurance, the 4 amount of uncompensated care provided by 5 such hospitals, and the impact of reduced 6 payment levels on low-income communities; 7 and 8 (ii) takes into account any reports 9 submitted by the Secretary of the Treas- 10 ury, in consultation with the Secretary of 11 Health and Human Services, to Congres- 12 sional committees regarding the costs in- 13 curred by charitable hospital organizations 14 for charity care, bad debt, nonreimbursed 15 expenses for services provided to individ- 16 uals under the Medicare program under 17 title XVIII of the Social Security Act and 18 the Medicaid program under title XIX of 19 such Act, and any community benefit ac- 20 tivities provided by such organizations. 21 (2) REPORT TO THE SECRETARY OF HEALTH 22 AND HUMAN SERVICES.—Not later than 180 days 23 after the date on which the study under subsection 24 (a) is completed, the Comptroller General of the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 316 •HR 6637 IH United States shall submit to the Secretary of 1 Health and Human Services a report that con- 2 tains— 3 (A) the results of the study; and 4 (B) any recommendations for purposes of 5 assisting in the development of the methodology 6 for the adjustment of payments to dispropor- 7 tionate share hospitals, as required under sec- 8 tion 1886(r) of the Social Security Act (42 9 U.S.C. 1395ww(r)) and the reduction of such 10 payments under section 1923(f)(7) of such Act 11 (42 U.S.C. 1396r–4(f)(7)), taking into account 12 the reports referred to in paragraph (1)(B)(ii). 13 SEC. 428. ASSISTANT SECRETARY OF THE INDIAN HEALTH 14 SERVICE. 15 (a) REFERENCES.—Any reference in a law, regula- 16 tion, document, paper, or other record of the United 17 States to the Director of the Indian Health Service shall 18 be deemed to be a reference to the Assistant Secretary 19 of the Indian Health Service. 20 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 21 United States Code, is amended in the matter relating to 22 the Assistant Secretaries of Health and Human Services 23 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 24 the Assistant Secretary of the Indian Health Service’’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 317 •HR 6637 IH (c) CONFORMING AMENDMENT.—Section 5316 of 1 title 5, United States Code, is amended by striking ‘‘Direc- 2 tor, Indian Health Service, Department of Health and 3 Human Services.’’. 4 SEC. 429. REAUTHORIZATION OF THE NATIVE HAWAIIAN 5 HEALTH CARE IMPROVEMENT ACT. 6 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 7 Section 6(h)(1) of the Native Hawaiian Health Care Im- 8 provement Act (42 U.S.C. 11705(h)(1)) is amended by 9 striking ‘‘may be necessary for fiscal years 1993 through 10 2019’’ and inserting ‘‘are necessary’’. 11 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 12 LOKAHI.—Section 7(b) of the Native Hawaiian Health 13 Care Improvement Act (42 U.S.C. 11706(b)) is amended 14 by striking ‘‘may be necessary for fiscal years 1993 15 through 2019’’ and inserting ‘‘are necessary’’. 16 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 17 Section 10(c) of the Native Hawaiian Health Care Im- 18 provement Act (42 U.S.C. 11709(c)) is amended by strik- 19 ing ‘‘may be necessary for fiscal years 1993 through 20 2019’’ and inserting ‘‘are necessary’’. 21 SEC. 430. AVAILABILITY OF NON-ENGLISH LANGUAGE 22 SPEAKING PROVIDERS. 23 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 24 tient Protection and Affordable Care Act (42 U.S.C. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 318 •HR 6637 IH 18031(c)(1)(B)) is amended by inserting before the semi- 1 colon the following: ‘‘and the ability of such provider to 2 provide care in a language other than English either 3 through the provider speaking such language or by the 4 provider having a qualified interpreter for an individual 5 with limited English proficiency (as defined in section 6 3400 of such Act) who speaks such language available 7 during office hours’’. 8 (b) EFFECTIVE DATE.—The amendment made by 9 subsection (a) shall not apply to any plan beginning on 10 or prior to the date that is 1 year after the date of the 11 enactment of this Act. 12 SEC. 431. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 13 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 14 1311(c)(1)(C) of the Patient Protection and Affordable 15 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 16 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 17 (2) by adding at the end the following new 18 clauses: 19 ‘‘(ii) not later than January 1, 2020, in- 20 crease the percentage of essential community 21 providers as described in clause (i) included in 22 its network by 10 percent annually (based on 23 the level in the plan for 2016) until 90 percent 24 of all federally-qualified health centers and 75 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 319 •HR 6637 IH percent of all other such essential community 1 providers in the contract service area are in-net- 2 work; and 3 ‘‘(iii) include at least one essential commu- 4 nity provider in each of the essential community 5 provider categories described in section 6 156.235(a)(2)(ii)(B) of title 45, Code of Fed- 7 eral Regulations (as in effect on the date of en- 8 actment of the Health Equity and Account- 9 ability Act of 2020) in each county in the serv- 10 ice area, where available;’’. 11 (b) REPORTING REQUIREMENTS.—Section 12 1311(e)(3) of the Patient Protection and Affordable Care 13 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 14 end the following new subparagraph: 15 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 16 PROVIDERS.—The Secretary shall require quali- 17 fied health plans to submit annually to the Sec- 18 retary data on the percentage of essential com- 19 munity providers as described in clause (ii) of 20 subsection (c)(1)(C), by county, that contract 21 with each qualified health plan offered in that 22 county and the percentage of such essential 23 community providers, by category as described 24 in clause (iii) of such subsection, that contract 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 320 •HR 6637 IH with each qualified health plan offered in that 1 county. Such data shall be made available to 2 the general public.’’. 3 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 4 APPLIED UNDER MEDICARE AND MEDICAID.— 5 (1) MEDICARE.—Section 1852(d)(1) of the So- 6 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 7 amended— 8 (A) by striking ‘‘and’’ at the end of sub- 9 paragraph (D); 10 (B) by striking the period at the end of 11 subparagraph (E) and inserting ‘‘; and’’; and 12 (C) by adding at the end the following new 13 subparagraph: 14 ‘‘(F) the plan meets the requirements of 15 clauses (ii) and (iii) of section 1311(c)(1)(C) of 16 the Patient Protection and Affordable Care Act 17 (relating to inclusion in networks of essential 18 community providers).’’. 19 (2) MEDICAID.—Section 1932(b)(5) of the So- 20 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 21 amended— 22 (A) by striking ‘‘and’’ at the end of sub- 23 paragraph (A); 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 321 •HR 6637 IH (B) by striking the period at the end of 1 subparagraph (B) and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(C) meets the requirements of clauses (ii) 5 and (iii) of section 1311(c)(1)(C) of the Patient 6 Protection and Affordable Care Act (relating to 7 inclusion in networks of essential community 8 providers) with respect to services offered in the 9 service area involved.’’. 10 SEC. 432. PROVIDER NETWORK ADEQUACY IN COMMU- 11 NITIES OF COLOR. 12 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 13 tient Protection and Affordable Care Act (42 U.S.C. 14 18031(c)(1)(B)), as amended by section 428(a), is further 15 amended— 16 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 17 (2) by adding at the end the following new 18 clauses: 19 ‘‘(ii) meet such network adequacy 20 standards as the Secretary may establish 21 with regard to— 22 ‘‘(I) appointment wait time; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 322 •HR 6637 IH ‘‘(II) travel time and distance to 1 health care provider facilities and pro- 2 viders by public and private transit; 3 ‘‘(III) hours of operation to ac- 4 commodate individuals who cannot 5 come to provider appointments during 6 standard business hours; and 7 ‘‘(IV) other network adequacy 8 standards to ensure that care through 9 these plans is accessible to diverse 10 communities, including individuals 11 with limited English proficiency as de- 12 fined in section 3400 of such Act; and 13 ‘‘(iii) provide coverage for services for 14 enrollees through out-of-network providers 15 at no additional cost to the enrollees in 16 cases where in-network providers are un- 17 able to comply with the standards estab- 18 lished under subclause (III) or (IV) of 19 clause (ii) for such services and the out-of- 20 network providers can deliver such services 21 in compliance with such standards. 22 ‘‘(b) EFFECTIVE DATE.—The amendments made by 23 subsection (a) shall not apply to plans beginning on or 24 prior to the date that is 1 year after the date of the enact- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 323 •HR 6637 IH ment of the Health Equity and Accountability Act of 1 2020.’’. 2 SEC. 433. IMPROVING ACCESS TO DENTAL CARE. 3 (a) REPORTS TO CONGRESS.— 4 (1) GAO REPORTS.—Not later than 1 year 5 after the date of the enactment of this Act, the 6 Comptroller General of the United States shall sub- 7 mit to Congress— 8 (A) a report on the Alaska Dental Health 9 Aide Therapists program and the Dental Ther- 10 apist and Advanced Dental Therapist programs 11 in Minnesota, to assess the effectiveness of den- 12 tal therapists in— 13 (i) improving access to timely dental 14 care among communities of color; 15 (ii) providing high-quality care; and 16 (iii) providing culturally competent 17 care; and 18 (iv) providing accessible care to people 19 with disabilities; 20 (B) a report on State variations in the use 21 of dental hygienists and the effectiveness of ex- 22 panding the scope of practice for dental hygien- 23 ists in— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 324 •HR 6637 IH (i) improving access to timely dental 1 care among communities of color; 2 (ii) providing high-quality care; 3 (iii) providing culturally competent 4 care; and 5 (iv) providing accessible care to people 6 with disabilities; and 7 (C) the reports shall also explain how tele- 8 health service is used to enhance services pro- 9 vided by dental hygienists and therapists and 10 shall recommend any modifications in Medicare 11 and Medicaid to better provide for telehealth 12 consultations in conjunction with therapists’ 13 and hygienists’ care. 14 (2) HRSA REPORT ON DENTAL SHORTAGE 15 AREAS.—Not later than 1 year after the date of the 16 enactment of this Act, the Secretary of Health and 17 Human Services, acting through the Administrator 18 of the Health Resources and Services Administra- 19 tion, shall submit to Congress a report which details 20 geographic dental access shortages and the pre- 21 paredness of dental providers to offer culturally and 22 linguistically appropriate, affordable, accessible, and 23 timely services. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 325 •HR 6637 IH (b) EXPANSION OF DENTAL HEALTH AID THERA- 1 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 2 Indian Health Care Improvement Act (25 U.S.C. 3 1616l(d)) is amended— 4 (1) in paragraph (2), by striking ‘‘Subject to’’ 5 and all that follows and inserting ‘‘Subject to para- 6 graph (3), in establishing a national program under 7 paragraph (1), the Secretary shall not reduce the 8 amounts provided for the Community Health Aide 9 Program described in subsections (a) and (b).’’; 10 (2) by striking paragraph (3); and 11 (3) by redesignating paragraph (4) as para- 12 graph (3). 13 (c) COVERAGE OF DENTAL SERVICES UNDER THE 14 MEDICARE PROGRAM.— 15 (1) COVERAGE.—Section 1861(s)(2) of the So- 16 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 17 ed— 18 (A) in subparagraph (GG), by striking 19 ‘‘and’’ at the end; 20 (B) in subparagraph (HH), by adding 21 ‘‘and’’ after the semicolon at the end; and 22 (C) by adding at the end the following new 23 subparagraph: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 326 •HR 6637 IH ‘‘(II) oral health services (as defined in sub- 1 section (kkk));’’. 2 (2) ORAL HEALTH SERVICES DEFINED.—Sec- 3 tion 1861 of the Social Security Act (42 U.S.C. 4 1395x), as amended by sections 205(b) and 413(a), 5 is amended by adding at the end the following new 6 subsection: 7 ‘‘Oral Health Services 8 ‘‘(kkk)(1) The term ‘oral health services’ means serv- 9 ices (as defined by the Secretary) that are necessary to 10 prevent disease and promote oral health, restore oral 11 structures to health and function, and treat emergency 12 conditions. 13 ‘‘(2) For purposes of paragraph (1), such term shall 14 include mobile and portable oral health services (as de- 15 fined by the Secretary) that— 16 ‘‘(A) are provided for the purpose of over- 17 coming mobility, transportation, and access barriers 18 for individuals; and 19 ‘‘(B) satisfy the standards and certification re- 20 quirements established under section 1902(a)(82)(B) 21 for the State in which the services are provided.’’. 22 (3) PAYMENT AND COINSURANCE.—Section 23 1833(a)(1) of the Social Security Act (42 U.S.C. 24 1395l(a)(1)) is amended— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 327 •HR 6637 IH (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 1 (B) by inserting before the semicolon at 2 the end the following: ‘‘, and (DD) with respect 3 to oral health services (as defined in section 4 1861(kkk)), the amount paid shall be (i) in the 5 case of such services that are preventive, 100 6 percent of the lesser of the actual charge for 7 the services or the amount determined under 8 the payment basis determined under section 9 1848, and (ii) in the case of all other such serv- 10 ices, 80 percent of the lesser of the actual 11 charge for the services or the amount deter- 12 mined under the payment basis determined 13 under section 1848’’. 14 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 15 ULE.—Section 1848(j)(3) of the Social Security Act 16 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 17 ‘‘(2)(II),’’ after ‘‘risk assessment),’’. 18 (5) DENTURES.—Section 1861(s)(8) of the So- 19 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 20 ed— 21 (A) by striking ‘‘(other than dental)’’ and 22 inserting ‘‘(including dentures)’’; and 23 (B) by striking ‘‘internal body’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 328 •HR 6637 IH (6) REPEAL OF GROUND FOR EXCLUSION.— 1 Section 1862(a) of the Social Security Act (42 2 U.S.C. 1395y) is amended by striking paragraph 3 (12). 4 (7) EFFECTIVE DATE.—The amendments made 5 by this section shall apply to services furnished on 6 or after January 1, 2021. 7 (d) COVERAGE OF DENTAL SERVICES UNDER THE 8 MEDICAID PROGRAM.— 9 (1) IN GENERAL.—Section 1905 of the Social 10 Security Act (42 U.S.C. 1396d) is amended— 11 (A) in subsection (a)(10), by striking ‘‘den- 12 tal services’’ and inserting ‘‘oral health services 13 (as defined in subsection (ff)(1))’’; and 14 (B) by adding at the end the following new 15 subsection: 16 ‘‘(ff)(1) Subject to paragraphs (2) and (3), for pur- 17 poses of this title, the term ‘oral health services’ means 18 services (as defined by the Secretary) that are necessary 19 to prevent disease and promote oral health, restore oral 20 structures to health and function, and treat emergency 21 conditions. These services shall include, in the case of 22 pregnant or postpartum women, such services as are nec- 23 essary to address oral health conditions that exist or are 24 exacerbated by pregnancy or childbirth or which, if left 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 329 •HR 6637 IH untreated, could adversely affect fetal or child develop- 1 ment. 2 ‘‘(2) For purposes of paragraph (1), such term shall 3 include— 4 ‘‘(A) dentures; and 5 ‘‘(B) mobile and portable oral health services 6 (as defined by the Secretary) that— 7 ‘‘(i) are provided for the purpose of over- 8 coming mobility, transportation, and access bar- 9 riers for individuals; and 10 ‘‘(ii) satisfy the standards and certification 11 requirements established under section 12 1902(a)(84)(C) for the State in which the serv- 13 ices are provided. 14 ‘‘(3) For purposes of paragraph (1), such term shall 15 not include dental care or services provided to individuals 16 under the age of 21 under subsection (r)(3).’’. 17 (2) CONFORMING AMENDMENTS.— 18 (A) STATE PLAN REQUIREMENTS.—Section 19 1902(a) of the Social Security Act (42 U.S.C. 20 1396a(a)) is amended— 21 (i) in paragraph (10)(A), in the mat- 22 ter preceding clause (i), by inserting 23 ‘‘(10),’’ after ‘‘(5),’’; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 330 •HR 6637 IH (ii) in paragraph (82), by striking 1 ‘‘and’’ at the end; 2 (iii) in paragraph (83), by striking the 3 period at the end and inserting ‘‘; and’’; 4 and 5 (iv) by inserting after paragraph (83) 6 the following: 7 ‘‘(84) provide for— 8 ‘‘(A) informing, in writing, all individuals 9 who have been determined to be eligible for 10 medical assistance of the availability of oral 11 health services (as defined in section 1905(ff)); 12 ‘‘(B) conducting targeted outreach to preg- 13 nant women who have been determined to be el- 14 igible for medical assistance about the avail- 15 ability of medical assistance for such dental 16 services and the importance of receiving dental 17 care while pregnant; and 18 ‘‘(C) establishing and maintaining stand- 19 ards for and certification of mobile and portable 20 oral health services (as described in subsections 21 (r)(3)(C) and (ff)(2)(B) of section 1905).’’. 22 (B) DEFINITION OF MEDICAL ASSIST- 23 ANCE.—Section 1905(a)(12) of the Social Secu- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 331 •HR 6637 IH rity Act (42 U.S.C. 1396d(a)(12)) is amended 1 by striking ‘‘, dentures,’’. 2 (3) MOBILE AND PORTABLE ORAL HEALTH 3 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 4 Social Security Act (42 U.S.C. 1396d(r)(3)) is 5 amended— 6 (A) in subparagraph (A)(ii), by striking ‘‘; 7 and’’ and inserting a semicolon; 8 (B) in subparagraph (B), by striking the 9 period at the end and inserting ‘‘; and’’; and 10 (C) by adding at the end the following new 11 subparagraph: 12 ‘‘(C) which shall include mobile and port- 13 able oral health services (as defined by the Sec- 14 retary) that— 15 ‘‘(i) are provided for the purpose of 16 overcoming mobility, transportation, or ac- 17 cess barriers for children; and 18 ‘‘(ii) satisfy the standards and certifi- 19 cation requirements established under sec- 20 tion 1902(a)(82)(C) for the State in which 21 the services are provided.’’. 22 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 23 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 332 •HR 6637 IH tection and Affordable Care Act (42 U.S.C. 18022(b)) is 1 amended— 2 (1) in paragraph (1)— 3 (A) in subparagraph (J), by striking ‘‘oral 4 and’’; and 5 (B) by adding at the end the following: 6 ‘‘(K) Oral health services for children and 7 adults.’’; and 8 (2) by adding at the end the following: 9 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 10 of paragraph (1)(K), the term ‘oral health services’ 11 means services (as defined by the Secretary), that 12 are necessary to prevent any oral disease and pro- 13 mote oral health, restore oral structures to health 14 and function, and treat emergency oral conditions.’’. 15 (f) DEMONSTRATION PROGRAM ON TRAINING AND 16 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 17 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 18 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 19 MUNITIES.— 20 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 21 The Secretary of Veterans Affairs may carry out a 22 demonstration program to establish programs to 23 train and employ alternative dental health care pro- 24 viders in order to increase access to dental health 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 333 •HR 6637 IH care services for veterans who are entitled to such 1 services from the Department of Veterans Affairs 2 and reside in rural and other underserved commu- 3 nities. 4 (2) TELEHEALTH.—For purposes of alternative 5 dental health care providers and other dental care 6 providers who are licensed to provide clinical care, 7 dental services provided under the demonstration 8 program under this subsection may be administered 9 by such providers through telehealth-enabled collabo- 10 ration and supervision when appropriate and fea- 11 sible. 12 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 13 VIDERS DEFINED.—In this subsection, the term ‘‘al- 14 ternative dental health care providers’’ has the 15 meaning given that term in section 340G–1(a)(2) of 16 the Public Health Service Act (42 U.S.C. 256g– 17 1(a)(2)). 18 (4) AUTHORIZATION OF APPROPRIATIONS.— 19 There are authorized to be appropriated such sums 20 as are necessary to carry out the demonstration pro- 21 gram under this subsection. 22 (g) DEMONSTRATION PROGRAM ON TRAINING AND 23 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 24 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 334 •HR 6637 IH MEMBERS OF THE ARMED FORCES AND DEPENDENTS 1 LACKING READY ACCESS TO SUCH SERVICES.— 2 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 3 The Secretary of Defense may carry out a dem- 4 onstration program to establish programs to train 5 and employ alternative dental health care providers 6 in order to increase access to dental health care 7 services for members of the Armed Forces and their 8 dependents who lack ready access to such services, 9 including the following: 10 (A) Members and dependents who reside in 11 rural areas or areas otherwise underserved by 12 dental health care providers. 13 (B) Members of the National Guard and 14 Reserves in active status who are potentially 15 deployable. 16 (2) TELEHEALTH.—For purposes of alternative 17 dental health care providers and other dental care 18 providers who are licensed to provide clinical care, 19 dental services provided under the demonstration 20 program under this subsection may be administered 21 by such providers through telehealth-enabled collabo- 22 ration and supervision when appropriate and fea- 23 sible. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 335 •HR 6637 IH (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 1 VIDERS DEFINED.—In this subsection, the term ‘‘al- 2 ternative dental health care providers’’ has the 3 meaning given that term in section 340G–1(a)(2) of 4 the Public Health Service Act (42 U.S.C. 256g– 5 1(a)(2)). 6 (4) AUTHORIZATION OF APPROPRIATIONS.— 7 There are authorized to be appropriated such sums 8 as are necessary to carry out the demonstration pro- 9 gram under this subsection. 10 (h) DEMONSTRATION PROGRAM ON TRAINING AND 11 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 12 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 13 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 14 PRISONS.— 15 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 16 The Attorney General, acting through the Director 17 of the Bureau of Prisons, may carry out a dem- 18 onstration program to establish programs to train 19 and employ alternative dental health care providers 20 in order to increase access to dental health services 21 for prisoners within the custody of the Bureau of 22 Prisons. 23 (2) TELEHEALTH.—For purposes of alternative 24 dental health care providers and other dental care 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 336 •HR 6637 IH providers who are licensed to provide clinical care, 1 dental services provided under the demonstration 2 program under this subsection may be administered 3 by such providers through telehealth-enabled collabo- 4 ration and supervision when appropriate and fea- 5 sible. 6 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 7 VIDERS DEFINED.—In this subsection and sub- 8 section (i), the term ‘‘alternative dental health care 9 providers’’ has the meaning given that term in sec- 10 tion 340G–1(a)(2) of the Public Health Service Act 11 (42 U.S.C. 256g–1(a)(2)). 12 (4) AUTHORIZATION OF APPROPRIATIONS.— 13 There are authorized to be appropriated such sums 14 as are necessary to carry out the demonstration pro- 15 gram under this subsection. 16 (i) DEMONSTRATION PROGRAM ON TRAINING AND 17 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 18 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 19 UNDER THE INDIAN HEALTH SERVICE.— 20 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 21 The Secretary of Health and Human Services, act- 22 ing through the Indian Health Service, may carry 23 out a demonstration program to establish programs 24 to train and employ alternative dental health care 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 337 •HR 6637 IH providers in order to help eliminate oral health dis- 1 parities and increase access to dental services 2 through health programs operated by the Indian 3 Health Service, Indian tribes, tribal organizations, 4 and urban Indian organizations (as the preceding 3 5 terms are defined in section 4 of the Indian Health 6 Care Improvement Act (25 U.S.C. 1603)). 7 (2) TELEHEALTH.—For purposes of alternative 8 dental health care providers and other dental care 9 providers who are licensed to provide clinical care, 10 dental services provided under the demonstration 11 program under this subsection may be administered 12 by such providers through telehealth-enabled collabo- 13 ration and supervision when appropriate and fea- 14 sible. 15 (3) AUTHORIZATION OF APPROPRIATIONS.— 16 There are authorized to be appropriated such sums 17 as are necessary to carry out the demonstration pro- 18 gram under this subsection. 19 SEC. 434. PROVIDING FOR A SPECIAL ENROLLMENT PE- 20 RIOD FOR PREGNANT INDIVIDUALS. 21 (a) PUBLIC HEALTH SERVICE ACT.—Section 22 2702(b)(2) of the Public Health Service Act (42 U.S.C. 23 300gg–1(b)(2)) is amended by inserting ‘‘including a spe- 24 cial enrollment period for pregnant individuals, beginning 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 338 •HR 6637 IH on the date on which the pregnancy is reported to the 1 health insurance issuer’’ before the period at the end. 2 (b) PATIENT PROTECTION AND AFFORDABLE CARE 3 ACT.—Section 1311(c)(6) of the Patient Protection and 4 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend- 5 ed— 6 (1) in subparagraph (C), by striking ‘‘and’’ at 7 the end; 8 (2) by redesignating subparagraph (D) as sub- 9 paragraph (E); and 10 (3) by inserting after subparagraph (C) the fol- 11 lowing new subparagraph: 12 ‘‘(D) a special enrollment period for preg- 13 nant individuals, beginning on the date on 14 which the pregnancy is reported to the Ex- 15 change; and’’. 16 (c) SPECIAL ENROLLMENT PERIODS.— 17 (1) INTERNAL REVENUE CODE.—Section 18 9801(f) of the Internal Revenue Code of 1986 (26 19 U.S.C. 9801(f)) is amended by adding at the end 20 the following new paragraph: 21 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 22 ‘‘(A) A group health plan shall permit an 23 employee who is eligible, but not enrolled, for 24 coverage under the terms of the plan (or a de- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 339 •HR 6637 IH pendent of such an employee if the dependent 1 is eligible, but not enrolled, for coverage under 2 such terms) to enroll for coverage under the 3 terms of the plan upon pregnancy, with the spe- 4 cial enrollment period beginning on the date on 5 which the pregnancy is reported to the group 6 health plan or the pregnancy is confirmed by a 7 health care provider. 8 ‘‘(B) The Secretary shall promulgate regu- 9 lations with respect to the special enrollment 10 period under subparagraph (A), including es- 11 tablishing a time period for pregnant individ- 12 uals to enroll in coverage and effective date of 13 such coverage.’’. 14 (2) ERISA.—Section 701(f) of the Employee 15 Retirement Income Security Act of 1974 (29 U.S.C. 16 1181(f)) is amended by adding at the end the fol- 17 lowing: 18 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 19 ‘‘(A) A group health plan or health insur- 20 ance issuer in connection with a group health 21 plan shall permit an employee who is eligible, 22 but not enrolled, for coverage under the terms 23 of the plan (or a dependent of such an employee 24 if the dependent is eligible, but not enrolled, for 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 340 •HR 6637 IH coverage under such terms) to enroll for cov- 1 erage under the terms of the plan upon preg- 2 nancy, with the special enrollment period begin- 3 ning on the date on which the pregnancy is re- 4 ported to the group health plan or health insur- 5 ance issuer or the pregnancy is confirmed by a 6 health care provider. 7 ‘‘(B) The Secretary shall promulgate regu- 8 lations with respect to the special enrollment 9 period under subparagraph (A), including es- 10 tablishing a time period for pregnant individ- 11 uals to enroll in coverage and effective date of 12 such coverage.’’. 13 (d) EFFECTIVE DATE.—The amendments made by 14 this section shall apply with respect to plan years begin- 15 ning after the 2021 plan year. 16 SEC. 435. COVERAGE OF MATERNITY CARE FOR DEPEND- 17 ENT CHILDREN. 18 Section 2719A of the Public Health Service Act (42 19 U.S.C. 300gg–19a) is amended by adding at the end the 20 following: 21 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 22 health plan, or health insurance issuer offering group or 23 individual health insurance coverage, that provides cov- 24 erage for dependants shall ensure that such plan or cov- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 341 •HR 6637 IH erage includes coverage for maternity care associated with 1 pregnancy, childbirth, and postpartum care for all partici- 2 pants, beneficiaries, or enrollees, including dependants, in- 3 cluding coverage of labor and delivery. Such coverage shall 4 be provided to all pregnant dependents regardless of age.’’. 5 SEC. 436. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 6 (a) COVERAGE OF PREGNANCY.— 7 (1) IN GENERAL.—The Director of the Office of 8 Personnel Management shall issue such regulations 9 as are necessary to ensure that pregnancy is consid- 10 ered a change in family status and a qualifying life 11 event for an individual who is eligible to enroll, but 12 is not enrolled, in a health benefit plan under chap- 13 ter 89 title 5, United States Code. 14 (2) EFFECTIVE DATE.—The requirement in 15 paragraph (1) shall apply with respect to any con- 16 tract entered into under section 8902 of such title 17 beginning 12 months after the date of enactment of 18 this Act. 19 (b) DESIGNATING CERTAIN FEHBP-RELATED 20 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI- 21 DEFICIENCY ACT.— 22 (1) IN GENERAL.—Section 8905 of title 5, 23 United States Code, is amended by adding at the 24 end the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 342 •HR 6637 IH ‘‘(i) Any services by an officer or em- 1 ployee under this chapter relating to en- 2 rolling individuals in a health benefits plan 3 under this chapter, or changing the enroll- 4 ment of an individual already so enrolled 5 due to an event described in section 6 5(a)(1) of the Healthy MOM Act, shall be 7 deemed, for purposes of section 1342 of 8 title 31, services for emergencies involving 9 the safety of human life or the protection 10 of property.’’. 11 (2) APPLICATION.—The amendment made by 12 paragraph (1) shall apply to any lapse in appropria- 13 tions beginning on or after the date of enactment of 14 this Act. 15 SEC. 437. CONTINUATION OF MEDICAID INCOME ELIGI- 16 BILITY STANDARD FOR PREGNANT INDIVID- 17 UALS AND INFANTS. 18 Section 1902(l)(2)(A) of the Social Security Act (42 19 U.S.C. 1396a(l)(2)(A)) is amended— 20 (1) in clause (i), by striking ‘‘and not more 21 than 185 percent’’; 22 (2) in clause (ii)— 23 (A) in subclause (I), by striking ‘‘and’’ 24 after the comma; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 343 •HR 6637 IH (B) in subclause (II), by striking the pe- 1 riod at the end and inserting ‘‘, and’’; and 2 (C) by adding at the end the following: 3 ‘‘(III) January 1, 2020, is the 4 percentage provided under clause 5 (v).’’; and 6 (3) by adding at the end the following new 7 clause: 8 ‘‘(v) The percentage provided under 9 clause (ii) for medical assistance provided 10 on or after January 1, 2020, with respect 11 to individuals described in subparagraph 12 (A) or (B) of paragraph (1) shall not be 13 less than— 14 ‘‘(I) the percentage specified for 15 such individuals by the State in an 16 amendment to its State plan (whether 17 approved or not) as of January 1, 18 2014; or 19 ‘‘(II) if no such percentage is 20 specified as of January 1, 2014, the 21 percentage established for such indi- 22 viduals under the State’s authorizing 23 legislation or provided for under the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 344 •HR 6637 IH State’s appropriations as of that 1 date.’’. 2 Subtitle C—Advancing Health Eq- 3 uity Through Payment and De- 4 livery Reform 5 SEC. 441. SENSE OF CONGRESS. 6 It is the sense of Congress that— 7 (1) the sustainability of the health care system 8 in the United States hinges on restructuring how 9 health care is paid for, shifting away from paying 10 for the volume of services provided to the value the 11 services provide; 12 (2) high-value care is care that provides higher- 13 quality care more efficiently, achieving greater 14 health improvement and better health outcomes at 15 lower cost (per patient and overall); 16 (3) a high-value health care system must deliver 17 timely, accessible, well-coordinated, high-quality, cul- 18 turally centered, and language-appropriate care to 19 everyone; 20 (4) eliminating health disparities and achieving 21 health equity must be central to efforts to achieve a 22 high-value health care system; 23 (5) eliminating such disparities and achieving 24 such equity will require tailored interventions and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 345 •HR 6637 IH targeted investments to address inequities in health 1 and health care to make sure that health care deliv- 2 ery and payment efforts are responsive to and inclu- 3 sive of the needs of communities of color and other 4 communities experiencing disparities; and 5 (6) new models of value-based payment and 6 care delivery should consider the holistic needs of 7 the patient population and behavioral health, oral 8 health, their history of adverse childhood experiences 9 and adverse community environments, social deter- 10 minants of health, social risk factors, unmet social 11 needs, and the burden of intergenerational racial 12 and other inequities. 13 SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 14 REPORTING AND VALUE-BASED PROGRAMS. 15 (a) ADVANCING HEALTH EQUITY IN REPORTING AND 16 VALUE-BASED PAYMENT PROGRAMS.— 17 (1) IN GENERAL.—The Administrator shall re- 18 quire that a clinician or other professional partici- 19 pating in any pay-for-reporting or value-based pay- 20 ment program stratify clinical quality measures by 21 disparity variables, including race, ethnicity, sex, pri- 22 mary language, disability status, sexual orientation, 23 gender identity, and socioeconomic status. A clini- 24 cian or other professional may use existing demo- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 346 •HR 6637 IH graphic data collection fields in certified electronic 1 health record technology (as defined in section 2 1848(o)(4) of the Social Security Act (42 U.S.C. 3 1395w–4(o)(4)) to carry out such data stratification 4 under the preceding sentence. Such stratified data 5 will assist clinicians and other professionals in the 6 identification of disparities obscured in aggregated 7 data and assist with the provision of interventions 8 that target reducing those disparities. 9 (2) CLINICIAN.—In assessing performance in 10 any value-based payment program, the Adminis- 11 trator shall incorporate a clinician or other profes- 12 sional’s performance in reducing disparities across 13 race, ethnicity, sex, primary language, disability sta- 14 tus, sexual orientation, gender identity, and socio- 15 economic status. Linking performance payments to 16 the reduction of health care disparities across such 17 variables will assist in holding clinicians and other 18 professionals accountable for providing quality care 19 that can lead to decreased health inequities. 20 (3) REQUIREMENT OF ADOPTION OF CERT.—All 21 entities, clinicians, or other professionals partici- 22 pating in the Quality Payment Program shall be re- 23 quired to adopt 2015 certified electronic health 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 347 •HR 6637 IH record technology (as so defined) as a condition of 1 participating in the Quality Payment Program. 2 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad- 3 ministrator, upon yearly review of the Quality Payment 4 Program, shall add quality improvement activities that im- 5 plement the Culturally and Linguistically Accessible 6 Standards (CLAS) standards as Improvement Activities 7 under the Quality Payment Program. 8 SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE- 9 DUCING DELIVERY AND PAYMENT MODELS. 10 (a) IN GENERAL.—The Center for Medicare and 11 Medicaid Innovation established under section 1115A of 12 the Social Security Act (42 U.S.C. 1315a) (in this section 13 referred to as the ‘‘CMI’’) shall establish a dedicated fund 14 to identify, test, evaluate, and scale delivery and payment 15 models under the applicable titles (as defined in subsection 16 (a)(4)(B) of such section) that target health disparities 17 among racial and ethnic minorities, including models that 18 support high-value non-medical services that address so- 19 cially determined barriers to health, including English pro- 20 ficiency status, low health literacy, case management, 21 transportation, enrollment assistance needs, stable and af- 22 fordable housing, utility assistance, employment and ca- 23 reer development, and nutrition and food security which 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 348 •HR 6637 IH will help to reduce disparities and impact the overall cost 1 of care. 2 (b) AMENDMENT TO SOCIAL SECURITY ACT.—Sec- 3 tion 1115A(a)(1) of the Social Security Act (42 U.S.C. 4 1315a(a)(1)) is amended as follows: 5 ‘‘(1) The purpose of the CMI is to test innova- 6 tive payment and service delivery models to reduce 7 program expenditures and improve health equity 8 under the applicable titles while preserving or en- 9 hancing the quality of care furnished to individuals 10 under such titles.’’. 11 (c) PILOT PROGRAMS.—The CMI shall prioritize the 12 testing of models under such section 1115A that include 13 partnerships with entities, including community-based or- 14 ganizations or other nonprofit entities, to help address so- 15 cially determined barriers to health and health care. 16 (d) ALTERNATIVES.—Any model tested by the CMI 17 under such 1115A shall include measures to assess and 18 track the impact of the model on health disparities, using 19 existing measures such as the Healthcare Disparities and 20 Cultural Competency Measures endorsed by the entity 21 with a contract under section 1890(a) of the Social Secu- 22 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 23 ethnicity, English proficiency, gender identity, sexual ori- 24 entation, and disability status. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 349 •HR 6637 IH SEC. 444. DIVERSITY IN CENTERS FOR MEDICARE & MED- 1 ICAID CONSULTATION. 2 (a) IN GENERAL.—In carrying out the duties under 3 this section, the CMI shall consult representatives of rel- 4 evant Federal agencies, and clinical and analytical experts 5 with expertise in medicine and health care management, 6 specifically such experts with expertise in— 7 (1) the health care needs of minority, rural, and 8 underserved populations; and 9 (2) the financial needs of safety net, commu- 10 nity-based, rural, and critical access providers, in- 11 cluding federally qualified health centers. 12 (b) OPEN DOOR FORUMS.—The CMI shall use open 13 door forums or other mechanisms to seek external feed- 14 back from interested parties and incorporate that feedback 15 into the development of models. 16 SEC. 445. SUPPORTING SAFETY NET AND COMMUNITY- 17 BASED PROVIDERS TO COMPETE IN VALUE- 18 BASED PAYMENT SYSTEMS. 19 (a) IN GENERAL.—Any pay-for-performance or alter- 20 native payment model that is developed and tested by the 21 Center for Medicare and Medicaid Innovation established 22 under section 1115A of the Social Security Act (42 U.S.C. 23 1315a), or any other agency of the Department of Health 24 and Human Services with respect to the programs under 25 titles XVIII, XIX, or XXI of such Act, shall be assessed 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 350 •HR 6637 IH for potential impact on safety net, community-based, and 1 critical access providers, including federally qualified 2 health centers. 3 (b) NEW MODELS.—The rollout of any such models 4 shall include training and additional up front resources for 5 community-based and safety net providers to enable those 6 providers to participate in the model. 7 Subtitle D—Health Empowerment 8 Zones 9 SEC. 451. SHORT TITLE. 10 This subtitle may be cited as the ‘‘Health Empower- 11 ment Zone Act of 2020’’. 12 SEC. 452. FINDINGS. 13 Congress finds the following: 14 (1) Numerous studies and reports, including 15 the 2015 National Healthcare Quality and Dispari- 16 ties Report of the Agency for Healthcare Research 17 and Quality and the 2002 report of the Institute of 18 Medicine entitled ‘‘Unequal Treatment: Confronting 19 Racial and Ethnic Disparities in Health Care’’, doc- 20 ument the extensiveness to which health disparities 21 exist across the country. 22 (2) These studies have found that, on average, 23 racial and ethnic minorities are disproportionately 24 afflicted with chronic and acute conditions—such as 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 351 •HR 6637 IH cancer, diabetes, musculoskeletal disease, obesity, 1 and hypertension—and suffer worse health out- 2 comes, worse health status, and higher mortality 3 rates than their White counterparts. 4 (3) Several recent studies also show that health 5 disparities are a function of not only access to health 6 care, but also the social determinants of health—in- 7 cluding the environment, the physical structure of 8 communities, nutrition and food options, educational 9 attainment and health literacy, employment, race, 10 ethnicity, immigration status, geography, and lan- 11 guage preference—that directly and indirectly affect 12 the health, health care, and wellness of individuals 13 and communities. 14 (4) Integrally involving and fully supporting the 15 communities most affected by health inequities in 16 the assessment, planning, launch, and evaluation of 17 health disparity elimination efforts are among the 18 leading recommendations made to adequately ad- 19 dress and ultimately reduce health disparities. 20 (5) Recommendations also include supporting 21 the efforts of community stakeholders from a broad 22 cross section—including local businesses, local de- 23 partments of commerce, education, labor, urban 24 planning, and transportation, and community-based 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 352 •HR 6637 IH and other nonprofit organizations, including national 1 and regional intermediaries with demonstrated ca- 2 pacity to serve low-income urban communities—to 3 find areas of common ground around health dis- 4 parity elimination and collaborate to improve the 5 overall health and wellness of a community and its 6 residents. 7 SEC. 453. DESIGNATION OF HEALTH EMPOWERMENT 8 ZONES. 9 (a) IN GENERAL.—The Secretary may, at the request 10 of an eligible community partnership described in sub- 11 section (b)(1), designate an eligible area described in sub- 12 section (b)(2) as a health empowerment zone for the pur- 13 pose of eligibility for a grant under section 455. 14 (b) ELIGIBILITY CRITERIA.— 15 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 16 community partnership is eligible to submit a re- 17 quest under this section if the partnership— 18 (A) demonstrates widespread public sup- 19 port from key individuals and entities in the eli- 20 gible area, including members of the target 21 community, State and local governments, non- 22 profit organizations including national and re- 23 gional intermediaries with demonstrated capac- 24 ity to serve low-income urban communities, and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 353 •HR 6637 IH community and industry leaders, for designa- 1 tion of the eligible area as a health empower- 2 ment zone; and 3 (B) includes representatives of— 4 (i) a broad cross section of stake- 5 holders and residents from communities in 6 the eligible area experiencing dispropor- 7 tionate disparities in health status and 8 health care; and 9 (ii) organizations, facilities, and insti- 10 tutions that have a history of working 11 within and serving such communities. 12 (2) ELIGIBLE AREA.—An area is eligible to be 13 designated as a health empowerment zone under this 14 section if one or more communities in the area expe- 15 rience disproportionate disparities in health status 16 and health care. In determining whether a commu- 17 nity experiences such disparities, the Secretary shall 18 consider data collected by the Department of Health 19 and Human Services focusing on the following areas: 20 (A) Access to affordable, high-quality 21 health services. 22 (B) The prevalence of disproportionate 23 rates of certain illnesses or diseases including 24 the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 354 •HR 6637 IH (i) Arthritis, osteoporosis, chronic 1 back conditions, and other musculoskeletal 2 diseases. 3 (ii) Cancer. 4 (iii) Chronic kidney disease. 5 (iv) Diabetes. 6 (v) Injury (intentional and uninten- 7 tional). 8 (vi) Violence (intimate and non- 9 intimate). 10 (vii) Maternal and paternal illnesses 11 and diseases. 12 (viii) Infant mortality. 13 (ix) Mental illness and other disabil- 14 ities. 15 (x) Substance use disorder treatment 16 and prevention, including underage drink- 17 ing. 18 (xi) Nutrition, obesity, and overweight 19 conditions. 20 (xii) Heart disease. 21 (xiii) Hypertension. 22 (xiv) Cerebrovascular disease or 23 stroke. 24 (xv) Tuberculosis. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 355 •HR 6637 IH (xvi) HIV/AIDS and other sexually 1 transmitted infections. 2 (xvii) Viral hepatitis. 3 (xviii) Asthma. 4 (xix) Tooth decay and other oral 5 health issues. 6 (C) Within the community, the historical 7 and persistent presence of conditions that have 8 been found to contribute to health disparities 9 including any such conditions respecting any of 10 the following: 11 (i) Poverty. 12 (ii) Educational status and the quality 13 of community schools. 14 (iii) Income. 15 (iv) Access to high-quality affordable 16 health care. 17 (v) Work and work environment. 18 (vi) Environmental conditions in the 19 community, including with respect to clean 20 water, clean air, and the presence or ab- 21 sence of pollutants. 22 (vii) Language and English pro- 23 ficiency. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 356 •HR 6637 IH (viii) Access to affordable healthy 1 food. 2 (ix) Access to ethnically and culturally 3 diverse health and human service providers 4 and practitioners. 5 (x) Access to culturally and linguis- 6 tically competent health and human serv- 7 ices and health and human service pro- 8 viders. 9 (xi) Health-supporting infrastructure. 10 (xii) Health insurance that is ade- 11 quate and affordable. 12 (xiii) Race, racism, and bigotry (con- 13 scious and unconscious). 14 (xiv) Sexual orientation. 15 (xv) Health literacy. 16 (xvi) Place of residence (such as 17 urban areas, rural areas, and reservations 18 of Indian tribes). 19 (xvii) Stress. 20 (c) PROCEDURE.— 21 (1) REQUEST.—A request under subsection (a) 22 shall— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 357 •HR 6637 IH (A) describe the bounds of the area to be 1 designated as a health empowerment zone and 2 the process used to select those bounds; 3 (B) demonstrate that the partnership sub- 4 mitting the request is an eligible community 5 partnership described in subsection (b)(1); 6 (C) demonstrate that the area is an eligible 7 area described in subsection (b)(2); 8 (D) include a comprehensive assessment of 9 disparities in health status and health care ex- 10 perience by one or more communities in the 11 area; 12 (E) set forth— 13 (i) a vision and a set of values for the 14 area; and 15 (ii) a comprehensive and holistic set of 16 goals to be achieved in the area through 17 designation as a health empowerment zone; 18 and 19 (F) include a strategic plan and an action 20 plan for achieving the goals described in sub- 21 paragraph (E)(ii). 22 (2) APPROVAL.—Not later than 60 days after 23 the receipt of a request for designation of an area 24 as a health empowerment zone under this section, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 358 •HR 6637 IH the Secretary shall approve or disapprove the re- 1 quest. 2 (d) MINIMUM NUMBER.—The Secretary— 3 (1) shall designate not more than 110 health 4 empowerment zones under this section; and 5 (2) shall designate at least one health empower- 6 ment zone in each of the several States, the District 7 of Columbia, and each territory or possession of the 8 United States. 9 SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 10 At the request of any organization or entity seeking 11 to submit a request under section 453(a), the Secretary 12 shall provide technical assistance, and may award a grant, 13 to assist such organization or entity— 14 (1) to form an eligible community partnership 15 described in section 453(b)(1); 16 (2) to complete a health assessment, including 17 an assessment of health disparities under section 18 453(c)(1)(D); or 19 (3) to prepare and submit a request, including 20 a strategic plan, in accordance with section 453. 21 SEC. 455. BENEFITS OF DESIGNATION. 22 (a) PRIORITY.—In awarding a grant under sub- 23 section (b), a Federal official shall give priority to any ap- 24 plicant that— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 359 •HR 6637 IH (1) meets the eligibility criteria for the grant; 1 (2) proposes to use the grant for activities in a 2 health empowerment zone; and 3 (3) demonstrates that such activities will di- 4 rectly and significantly further the goals of the stra- 5 tegic plan approved for such zone under section 453. 6 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 7 STRATEGIC PLAN.— 8 (1) IN GENERAL.—Upon designating an eligible 9 area as a health empowerment zone at the request 10 of an eligible community partnership, the Secretary 11 shall, subject to the availability of appropriations, 12 make a grant to the community partnership for im- 13 plementation of the strategic plan for such zone. 14 (2) GRANT PERIOD.—A grant under paragraph 15 (1) for a health empowerment zone shall be for a pe- 16 riod of 2 years and may be renewed, except that the 17 total period of grants under paragraph (1) for such 18 zone may not exceed 10 years. 19 (3) LIMITATION.—In awarding grants under 20 this subsection, the Secretary shall not give less pri- 21 ority to an applicant or reduce the amount of a 22 grant because the Secretary rendered technical as- 23 sistance or made a grant to the same applicant 24 under section 454. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 360 •HR 6637 IH (4) REPORTING.—The Secretary shall establish 1 metrics for measuring the progress of grantees 2 under this subsection and, based on such metrics, 3 require each such grantee to report to the Secretary 4 not less than every 6 months on the progress in im- 5 plementing the strategic plan for the health em- 6 powerment zone. 7 SEC. 456. DEFINITION OF SECRETARY. 8 In this subtitle, the term ‘‘Secretary’’ means the Sec- 9 retary of Health and Human Services, acting through the 10 Administrator of the Health Resources and Services Ad- 11 ministration and the Deputy Assistant Secretary for Mi- 12 nority Health, and in cooperation with the Director of the 13 Office of Community Services and the Director of the Na- 14 tional Institute on Minority Health and Health Dispari- 15 ties. 16 SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 17 To carry out this subtitle, there is authorized to be 18 appropriated $100,000,000 for fiscal year 2021. 19 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 361 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 362 •HR 6637 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, including the use of e- 24 cigarettes and vaping; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 363 •HR 6637 IH ‘‘(E) alcohol and substance use; 1 ‘‘(F) injury and violence; 2 ‘‘(G) sexual health; 3 ‘‘(H) mental health; 4 ‘‘(I) musculoskeletal health and arthritis; 5 ‘‘(J) prenatal and postnatal care; 6 ‘‘(K) dental and oral health; 7 ‘‘(L) understanding informed consent; 8 ‘‘(M) stigma; and 9 ‘‘(N) environmental hazards; 10 ‘‘(4) to promote community wellness and aware- 11 ness; and 12 ‘‘(5) to educate and refer target populations to 13 appropriate health care agencies and community- 14 based programs and organizations in order to in- 15 crease access to quality health care services, includ- 16 ing preventive health services. 17 ‘‘(c) APPLICATION.— 18 ‘‘(1) IN GENERAL.—Each eligible entity that 19 desires to receive a grant under subsection (a) shall 20 submit an application to the Secretary, at such time, 21 in such manner, and accompanied by such additional 22 information as the Secretary may require. 23 ‘‘(2) CONTENTS.—Each application submitted 24 pursuant to paragraph (1) shall— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 364 •HR 6637 IH ‘‘(A) describe the activities for which as- 1 sistance under this section is sought; 2 ‘‘(B) contain an assurance that, with re- 3 spect to each community health worker pro- 4 gram receiving funds under the grant awarded, 5 such program provides in-language training and 6 supervision to community health workers to en- 7 able such workers to provide authorized pro- 8 gram activities in (at least) the most commonly 9 used languages within a particular geographic 10 region; 11 ‘‘(C) contain an assurance that the appli- 12 cant will evaluate the effectiveness of commu- 13 nity health worker programs receiving funds 14 under the grant; 15 ‘‘(D) contain an assurance that each com- 16 munity health worker program receiving funds 17 under the grant will provide culturally com- 18 petent services in the linguistic context most 19 appropriate for the individuals served by the 20 program; 21 ‘‘(E) contain a plan to document and dis- 22 seminate project descriptions and results to 23 other States and organizations as identified by 24 the Secretary; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 365 •HR 6637 IH ‘‘(F) describe plans to enhance the capac- 1 ity of individuals to utilize health services and 2 health-related social services under Federal, 3 State, and local programs by— 4 ‘‘(i) assisting individuals in estab- 5 lishing eligibility under the programs and 6 in receiving the services or other benefits 7 of the programs; and 8 ‘‘(ii) providing other services, as the 9 Secretary determines to be appropriate, 10 which may include transportation and 11 translation services. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Secretary shall give priority to those appli- 14 cants— 15 ‘‘(1) who propose to target geographic areas 16 that— 17 ‘‘(A)(i) have a high percentage of residents 18 who are uninsured or underinsured (if the tar- 19 geted geographic area is located in a State that 20 has elected to make medical assistance available 21 under section 1902(a)(10)(A)(i)(VIII) of the 22 Social Security Act to individuals described in 23 such section); 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 366 •HR 6637 IH ‘‘(ii) have a high percentage of under- 1 insured residents in a particular geographic 2 area (if the targeted geographic area is located 3 in a State that has not so elected); or 4 ‘‘(iii) have a high number of households ex- 5 periencing extreme poverty; and 6 ‘‘(B) have a high percentage of families for 7 whom English is not their primary language or 8 including smaller limited English proficient 9 communities within the region that are not oth- 10 erwise reached by linguistically appropriate 11 health services; 12 ‘‘(2) with experience in providing health or 13 health-related social services to individuals who are 14 underserved with respect to such services; and 15 ‘‘(3) with documented community activity and 16 experience with community health workers. 17 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 18 TIONS.—The Secretary shall encourage community health 19 worker programs receiving funds under this section to col- 20 laborate with academic institutions, including minority- 21 serving institutions. Nothing in this section shall be con- 22 strued to require such collaboration. 23 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 24 NESS.—The Secretary shall establish guidelines for ensur- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 367 •HR 6637 IH ing the quality of the training and supervision of commu- 1 nity health workers under the programs funded under this 2 section and for ensuring the cost effectiveness of such pro- 3 grams. 4 ‘‘(g) MONITORING.—The Secretary shall monitor 5 community health worker programs identified in approved 6 applications and shall determine whether such programs 7 are in compliance with the guidelines established under 8 subsection (f). 9 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 10 provide technical assistance to community health worker 11 programs identified in approved applications with respect 12 to planning, developing, and operating programs under the 13 grant. 14 ‘‘(i) REPORT TO CONGRESS.— 15 ‘‘(1) IN GENERAL.—Not later than 4 years 16 after the date on which the Secretary first awards 17 grants under subsection (a), the Secretary shall sub- 18 mit to Congress a report regarding the grant 19 project. 20 ‘‘(2) CONTENTS.—The report required under 21 paragraph (1) shall include the following: 22 ‘‘(A) A description of the programs for 23 which grant funds were used. 24 ‘‘(B) The number of individuals served. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 368 •HR 6637 IH ‘‘(C) An evaluation of— 1 ‘‘(i) the effectiveness of these pro- 2 grams; 3 ‘‘(ii) the cost of these programs; and 4 ‘‘(iii) the impact of these programs on 5 the health outcomes of the community resi- 6 dents. 7 ‘‘(D) Recommendations for sustaining the 8 community health worker programs developed 9 or assisted under this section. 10 ‘‘(E) Recommendations regarding training 11 to enhance career opportunities for community 12 health workers. 13 ‘‘(j) DEFINITIONS.—In this section: 14 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 15 ‘community health worker’ means an individual who 16 promotes health or nutrition within the community 17 in which the individual resides— 18 ‘‘(A) by serving as a liaison between com- 19 munities and health care agencies; 20 ‘‘(B) by providing guidance and social as- 21 sistance to community residents; 22 ‘‘(C) by enhancing community residents’ 23 ability to effectively communicate with health 24 care providers; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 369 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 370 •HR 6637 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 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 $15,000,000 for each of fiscal years 2021 through 2025.’’. 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 371 •HR 6637 IH SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 1 TRITION ASSISTANCE FOR CHILDREN, PREG- 2 NANT PERSONS, AND LAWFULLY PRESENT IN- 3 DIVIDUALS. 4 (a) MEDICAID.—Section 1903(v) of the Social Secu- 5 rity Act (42 U.S.C. 1396b(v)) is amended by striking 6 paragraph (4) and inserting the following new paragraph: 7 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 8 403, and 421 of the Personal Responsibility and Work Op- 9 portunity Reconciliation Act of 1996 and paragraph (1), 10 payment shall be made to a State under this section for 11 medical assistance furnished to an alien under this title 12 (including an alien described in such paragraph) who 13 meets any of the following conditions: 14 ‘‘(i) The alien is otherwise eligible for such as- 15 sistance under the State plan approved under this 16 title (other than the requirement of the receipt of 17 aid or assistance under title IV, supplemental secu- 18 rity income benefits under title XVI, or a State sup- 19 plementary payment) within either or both of the 20 following eligibility categories: 21 ‘‘(I) Children under 21 years of age, in- 22 cluding any optional targeted low-income child 23 (as such term is defined in section 24 1905(u)(2)(B)). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 372 •HR 6637 IH ‘‘(II) Pregnant persons during pregnancy 1 and during the 12-month period beginning on 2 the last day of the pregnancy. 3 ‘‘(ii) The alien is lawfully present in the United 4 States. 5 ‘‘(B) No debt shall accrue under an affidavit of sup- 6 port against any sponsor of an alien who meets the condi- 7 tions specified in subparagraph (A) on the basis of the 8 provision of medical assistance to such alien under this 9 paragraph and the cost of such assistance shall not be con- 10 sidered as an unreimbursed cost.’’. 11 (b) SCHIP.—Subparagraph (N) of section 12 2107(e)(1) of the Social Security Act (42 U.S.C. 13 1397gg(e)(1)) is amended to read as follows: 14 ‘‘(N) Paragraph (4) of section 1903(v) (re- 15 lating to coverage of categories of children, 16 pregnant persons, and other lawfully present in- 17 dividuals).’’. 18 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 19 withstanding sections 401(a), 402(a), and 403(a) of the 20 Personal Responsibility and Work Opportunity Reconcili- 21 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 22 and section 6(f) of the Food and Nutrition Act of 2008 23 (7 U.S.C. 2015(f)), persons who are lawfully present in 24 the United States shall be not be ineligible for benefits 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 373 •HR 6637 IH under the supplemental nutrition assistance program on 1 the basis of their immigration status or date of entry into 2 the United States. 3 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 4 Section 421(d)(3) of the Personal Responsibility and 5 Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 6 1631(d)(3)) is amended by striking ‘‘to the extent that 7 a qualified alien is eligible under section 402(a)(2)(J)’’ 8 and inserting, ‘‘to the extent that a child is a member of 9 a household under the supplemental nutrition assistance 10 program’’. 11 (e) ENSURING PROPER SCREENING.—Section 12 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 13 U.S.C. 2020(e)(2)(B)) is amended— 14 (1) by redesignating clauses (vi) and (vii) as 15 clauses (vii) and (viii); and 16 (2) by inserting after clause (v) the following: 17 ‘‘(vi) shall provide a method for imple- 18 menting section 421 of the Personal Re- 19 sponsibility and Work Opportunity Rec- 20 onciliation Act of 1996 (8 U.S.C. 1631) 21 that does not require any unnecessary in- 22 formation from persons who may be ex- 23 empt from that provision;’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 374 •HR 6637 IH SEC. 503. REPEAL OF DENIAL OF BENEFITS. 1 Section 115 of the Personal Responsibility and Work 2 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 3 is amended— 4 (1) in subsection (a), by striking ‘‘for—’’ and 5 all that follows and inserting ‘‘for assistance under 6 any State program funded under part A of title IV 7 of the Social Security Act (42 U.S.C. 601 et seq.).’’; 8 (2) in subsection (b)— 9 (A) by striking ‘‘(1) PROGRAM OF TEM- 10 PORARY ASSISTANCE FOR NEEDY FAMILIES.—’’; 11 and 12 (B) by striking paragraph (2); and 13 (3) in subsection (e), by striking ‘‘it—’’ and all 14 that follows and inserting ‘‘the term in section 15 419(5) of the Social Security Act (42 U.S.C. 16 619(5)) when referring to assistance provided under 17 a State program funded under paragraph A of title 18 IV of the Social Security Act (42 U.S.C. 601 et 19 seq.).’’. 20 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 21 AND AWARENESS. 22 (a) IN GENERAL.—The Secretary shall establish and 23 implement a birth defects prevention and public awareness 24 program, consisting of the activities described in sub- 25 sections (c) and (d). 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 375 •HR 6637 IH (b) DEFINITIONS.—In this section: 1 (1) MATERNAL.—The term ‘‘maternal’’ refers 2 to persons who are pregnant or breastfeeding of all 3 gender identities. 4 (2) PREGNANCY AND BREASTFEEDING INFOR- 5 MATION SERVICES.—The term ‘‘pregnancy and 6 breastfeeding information services’’ includes only— 7 (A) information services to provide accu- 8 rate, evidence-based, clinical information re- 9 garding maternal exposures during pregnancy 10 that may be associated with birth defects or 11 other health risks, such as exposures to medica- 12 tions, chemicals, infections, foodborne patho- 13 gens, illnesses, nutrition, or lifestyle factors; 14 (B) information services to provide accu- 15 rate, evidence-based, clinical information re- 16 garding maternal exposures during breast- 17 feeding that may be associated with health risks 18 to a breast-fed infant, such as exposures to 19 medications, chemicals, infections, foodborne 20 pathogens, illnesses, nutrition, lifestyle, or cli- 21 mate and weather-related factors; 22 (C) the provision of accurate, evidence- 23 based information weighing risks of exposures 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 376 •HR 6637 IH during breastfeeding against the benefits of 1 breastfeeding; and 2 (D) the provision of information described 3 in subparagraph (A), (B), or (C) through coun- 4 selors, websites, fact sheets, telephonic or elec- 5 tronic communication, community outreach ef- 6 forts, or other appropriate means. 7 (3) SECRETARY.—The term ‘‘Secretary’’ means 8 the Secretary of Health and Human Services, acting 9 through the Director of the Centers for Disease 10 Control and Prevention. 11 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 12 subsection (a), the Secretary shall conduct or support a 13 nationwide media campaign to increase awareness among 14 health care providers and at-risk populations about preg- 15 nancy and breastfeeding information services. 16 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 17 INFORMATION SERVICES.— 18 (1) IN GENERAL.—In carrying out subsection 19 (a), the Secretary shall award grants to State or re- 20 gional agencies or organizations for any of the fol- 21 lowing: 22 (A) INFORMATION SERVICES.—The provi- 23 sion of, or campaigns to increase awareness 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 377 •HR 6637 IH about, pregnancy and breastfeeding information 1 services. 2 (B) SURVEILLANCE AND RESEARCH.—The 3 conduct or support of— 4 (i) surveillance of or research on— 5 (I) maternal exposures and ma- 6 ternal health conditions that may in- 7 fluence the risk of birth defects, pre- 8 maturity, or other adverse pregnancy 9 outcomes; and 10 (II) maternal exposures that may 11 influence health risks to a breastfed 12 infant; or 13 (ii) networking to facilitate surveil- 14 lance or research described in this sub- 15 paragraph. 16 (2) PREFERENCE FOR CERTAIN STATES.—The 17 Secretary, in making any grant under this sub- 18 section, shall give preference to States, otherwise 19 equally qualified, that have a pregnancy and 20 breastfeeding information service in place. 21 (3) MATCHING FUNDS.—The Secretary may 22 only award a grant under this subsection to a State 23 or regional agency or organization that agrees, with 24 respect to the costs to be incurred in carrying out 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 378 •HR 6637 IH the grant activities, to make available (directly or 1 through donations from public or private entities) 2 non-Federal funds toward such costs in an amount 3 equal to not less than 25 percent of the amount of 4 the grant. 5 (4) COORDINATION.—The Secretary shall en- 6 sure that activities funded through a grant under 7 this subsection are coordinated, to the maximum ex- 8 tent practicable, with other birth defects prevention 9 and environmental health activities of the Federal 10 Government, including with respect to pediatric envi- 11 ronmental health specialty units and children’s envi- 12 ronmental health centers. 13 (e) EVALUATION.—In furtherance of the program 14 under subsection (a), the Secretary shall provide for an 15 evaluation of pregnancy and breastfeeding information 16 services to identify efficient and effective models of— 17 (1) providing information; 18 (2) raising awareness and increasing knowledge 19 about birth defects prevention measures and tar- 20 geting education to at-risk groups; 21 (3) modifying risk behaviors; or 22 (4) other outcome measures as determined ap- 23 propriate by the Secretary. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 379 •HR 6637 IH (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 $5,000,000 for fiscal year 2021, $6,000,000 for fiscal year 3 2022, $7,000,000 for fiscal year 2023, $8,000,000 for fis- 4 cal year 2024, and $9,000,000 for fiscal year 2025. 5 SEC. 505. MOMMA’S ACT. 6 (a) SHORT TITLE.—This section may be cited as the 7 ‘‘Mothers and Offspring Mortality and Morbidity Aware- 8 ness Act’’ or the ‘‘MOMMA’s Act’’. 9 (b) FINDINGS.—Congress finds the following: 10 (1) Every year, across the United States, 11 4,000,000 women give birth, about 700 women suf- 12 fer fatal complications during pregnancy, while giv- 13 ing birth or during the postpartum period, and 14 70,000 women suffer near-fatal, partum-related 15 complications. 16 (2) The maternal mortality rate is often used as 17 a proxy to measure the overall health of a popu- 18 lation. While the infant mortality rate in the United 19 States has reached its lowest point, the risk of death 20 for women in the United States during pregnancy, 21 childbirth, or the postpartum period is higher than 22 such risk in many other developed nations. The esti- 23 mated maternal mortality rate (per 100,000 live 24 births) for the 48 contiguous States and Wash- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 380 •HR 6637 IH ington, DC, increased from 18.8 percent in 2000 to 1 23.8 percent in 2014 to 26.6 percent in 2018. This 2 estimated rate is on par with such rate for under- 3 developed nations such as Iraq and Afghanistan. 4 (3) International studies estimate the 2015 ma- 5 ternal mortality rate in the United States as 26.4 6 per 100,000 live births, which is almost twice the 7 2015 World Health Organization estimation of 14 8 per 100,000 live births. 9 (4) It is estimated that more than 60 percent 10 of maternal deaths in the United States are prevent- 11 able. 12 (5) According to the Centers for Disease Con- 13 trol and Prevention, the maternal mortality rate var- 14 ies drastically for women by race and ethnicity. 15 There are 12.7 deaths per 100,000 live births for 16 White women, 43.5 deaths per 100,000 live births 17 for African-American women, and 14.4 deaths per 18 100,000 live births for women of other ethnicities. 19 While maternal mortality disparately impacts Afri- 20 can-American women, this urgent public health crisis 21 traverses race, ethnicity, socioeconomic status, edu- 22 cational background, and geography. 23 (6) African-American women are 3 to 4 times 24 more likely to die from causes related to pregnancy 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 381 •HR 6637 IH and childbirth compared to non-Hispanic White 1 women. 2 (7) The findings described in paragraphs (1) 3 through (6) are of major concern to researchers, 4 academics, members of the business community, and 5 providers across the obstetrical continuum rep- 6 resented by organizations such as March of Dimes; 7 the Preeclampsia Foundation; the American College 8 of Obstetricians and Gynecologists; the Society for 9 Maternal-Fetal Medicine; the Association of Wom- 10 en’s Health, Obstetric, and Neonatal Nurses; the 11 California Maternal Quality Care Collaborative; 12 Black Women’s Health Imperative; the National 13 Birth Equity Collaborative; Black Mamas Matter Al- 14 liance; EverThrive Illinois; the National Association 15 of Certified Professional Midwives; PCOS Challenge: 16 The National Polycystic Ovary Syndrome Associa- 17 tion; and the American College of Nurse Midwives. 18 (8) Hemorrhage, cardiovascular and coronary 19 conditions, cardiomyopathy, infection, embolism, 20 mental health conditions, preeclampsia and eclamp- 21 sia, polycystic ovary syndrome, infection and sepsis, 22 and anesthesia complications are the predominant 23 medical causes of maternal-related deaths and com- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 382 •HR 6637 IH plications. Most of these conditions are largely pre- 1 ventable or manageable. 2 (9) Oral health is an important part of 3 perinatal health. Reducing bacteria in a woman’s 4 mouth during pregnancy can significantly reduce her 5 risk of developing oral diseases and spreading decay- 6 causing bacteria to her baby. Moreover, some evi- 7 dence suggests that women with periodontal disease 8 during pregnancy could be at greater risk for poor 9 birth outcomes, such as preeclampsia, pre-term 10 birth, and low-birth weight. Furthermore, a woman’s 11 oral health during pregnancy is a good predictor of 12 her newborn’s oral health, and since mothers can 13 unintentionally spread oral bacteria to their babies, 14 putting their children at higher risk for tooth decay, 15 prevention efforts should happen even before chil- 16 dren are born, as a matter of pre-pregnancy health 17 and prenatal care during pregnancy. 18 (10) The United States has not been able to 19 submit a formal maternal mortality rate to inter- 20 national data repositories since 2007. Thus, no offi- 21 cial maternal mortality rate exists for the United 22 States. There can be no maternal mortality rate 23 without streamlining maternal mortality-related data 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 383 •HR 6637 IH from the State level and extrapolating such data to 1 the Federal level. 2 (11) In the United States, death reporting and 3 analysis is a State function rather than a Federal 4 process. States report all deaths—including mater- 5 nal deaths—on a semi-voluntary basis, without 6 standardization across States. While the Centers for 7 Disease Control and Prevention has the capacity and 8 system for collecting death-related data based on 9 death certificates, these data are not sufficiently re- 10 ported by States in an organized and standard for- 11 mat across States such that the Centers for Disease 12 Control and Prevention is able to identify causes of 13 maternal death and best practices for the prevention 14 of such death. 15 (12) Vital statistics systems often underesti- 16 mate maternal mortality and are insufficient data 17 sources from which to derive a full scope of medical 18 and social determinant factors contributing to ma- 19 ternal deaths. While the addition of pregnancy 20 checkboxes on death certificates since 2003 have 21 likely improved States’ abilities to identify preg- 22 nancy-related deaths, they are not generally com- 23 pleted by obstetrical providers or persons trained to 24 recognize pregnancy-related mortality. Thus, these 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 384 •HR 6637 IH vital forms may be missing information or may cap- 1 ture inconsistent data. Due to varying maternal 2 mortality-related analyses, lack of reliability, and 3 granularity in data, current maternal mortality 4 informatics do not fully encapsulate the myriad med- 5 ical and socially determinant factors that contribute 6 to such high maternal mortality rates within the 7 United States compared to other developed nations. 8 Lack of standardization of data and data sharing 9 across States and between Federal entities, health 10 networks, and research institutions keep the Nation 11 in the dark about ways to prevent maternal deaths. 12 (13) Having reliable and valid State data ag- 13 gregated at the Federal level is critical to the Na- 14 tion’s ability to quell surges in maternal death and 15 imperative for researchers to identify long-lasting 16 interventions. 17 (14) Leaders in maternal wellness highly rec- 18 ommend that maternal deaths be investigated at the 19 State level first, and that standardized, streamlined, 20 de-identified data regarding maternal deaths be sent 21 annually to the Centers for Disease Control and Pre- 22 vention. Such data standardization and collection 23 would be similar in operation and effect to the Na- 24 tional Program of Cancer Registries of the Centers 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 385 •HR 6637 IH for Disease Control and Prevention and akin to the 1 Confidential Enquiry in Maternal Deaths Pro- 2 gramme in the United Kingdom. Such a maternal 3 mortalities and morbidities registry and surveillance 4 system would help providers, academicians, law- 5 makers, and the public to address questions con- 6 cerning the types of, causes of, and best practices to 7 thwart, pregnancy-related or pregnancy-associated 8 mortality and morbidity. 9 (15) The United Nations Millennium Develop- 10 ment Goal 5a aimed to reduce by 75 percent, be- 11 tween 1990 and 2015, the maternal mortality rate, 12 yet this metric has not been achieved. In fact, the 13 maternal mortality rate in the United States has 14 been estimated to have more than doubled between 15 2000 and 2014. Yet, because national data are not 16 fully available, the United States does not have an 17 official maternal mortality rate. 18 (16) Many States have struggled to establish or 19 maintain Maternal Mortality Review Committees 20 (referred to in this section as ‘‘MMRC’’). On the 21 State level, MMRCs have lagged because States have 22 not had the resources to mount local reviews. State- 23 level reviews are necessary as only the State depart- 24 ments of health have the authority to request med- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 386 •HR 6637 IH ical records, autopsy reports, and police reports crit- 1 ical to the function of the MMRC. 2 (17) The United Kingdom regards maternal 3 deaths as a health systems failure and a national 4 committee of obstetrics experts review each maternal 5 death or near-fatal childbirth complication. Such 6 committee also establishes the predominant course of 7 maternal-related deaths from conditions such as 8 preeclampsia. Consequently, the United Kingdom 9 has been able to reduce its incidence of preeclampsia 10 to less than one in 10,000 women—its lowest rate 11 since 1952. 12 (18) The United States has no comparable, co- 13 ordinated Federal process by which to review cases 14 of maternal mortality, systems failures, or best prac- 15 tices. Many States have active MMRCs and leverage 16 their work to impact maternal wellness. For exam- 17 ple, the State of California has worked extensively 18 with their State health departments, health and hos- 19 pital systems, and research collaborative organiza- 20 tions, including the California Maternal Quality Care 21 Collaborative and the Alliance for Innovation on Ma- 22 ternal Health, to establish MMRCs, wherein such 23 State has determined the most prevalent causes of 24 maternal mortality and recorded and shared data 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 387 •HR 6637 IH with providers and researchers, who have developed 1 and implemented safety bundles and care protocols 2 related to preeclampsia, maternal hemorrhage, and 3 the like. In this way, the State of California has 4 been able to leverage its maternal mortality review 5 board system, generate data, and apply those data 6 to effect changes in maternal care-related protocol. 7 To date, the State of California has reduced its ma- 8 ternal mortality rate, which is now comparable to 9 the low rates of the United Kingdom. 10 (19) Hospitals and health systems across the 11 United States lack standardization of emergency ob- 12 stetrical protocols before, during, and after delivery. 13 Consequently, many providers are delayed in recog- 14 nizing critical signs indicating maternal distress that 15 quickly escalate into fatal or near-fatal incidences. 16 Moreover, any attempt to address an obstetrical 17 emergency that does not consider both clinical and 18 public health approaches falls woefully under the 19 mark of excellent care delivery. State-based maternal 20 quality collaborative organizations, such as the Cali- 21 fornia Maternal Quality Care Collaborative or enti- 22 ties participating in the Alliance for Innovation on 23 Maternal Health (AIM), have formed obstetrical pro- 24 tocols, tool kits, and other resources to improve sys- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 388 •HR 6637 IH tem care and response as they relate to maternal 1 complications and warning signs for such conditions 2 as maternal hemorrhage, hypertension, and 3 preeclampsia. 4 (20) The Centers for Disease Control and Pre- 5 vention reports that nearly half of all maternal 6 deaths occur in the immediate postpartum period— 7 the 42 days following a pregnancy—whereas more 8 than one-third of pregnancy-related or pregnancy-as- 9 sociated deaths occur while a person is still preg- 10 nant. Yet, for women eligible for the Medicaid pro- 11 gram on the basis of pregnancy, such Medicaid cov- 12 erage lapses at the end of the month on which the 13 60th postpartum day lands. 14 (21) The experience of serious traumatic 15 events, such as being exposed to domestic violence, 16 substance use disorder, or pervasive racism, can 17 over-activate the body’s stress-response system. 18 Known as toxic stress, the repetition of high doses 19 of cortisol to the brain can harm healthy neuro- 20 logical development, which can have cascading phys- 21 ical and mental health consequences, as documented 22 in the Adverse Childhood Experiences study of the 23 Centers for Disease Control and Prevention. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 389 •HR 6637 IH (22) A growing body of evidence-based research 1 has shown the correlation between the stress associ- 2 ated with one’s race—the stress of racism—and 3 one’s birthing outcomes. The stress of sex and race 4 discrimination and institutional racism has been 5 demonstrated to contribute to a higher risk of ma- 6 ternal mortality, irrespective of one’s gestational 7 age, maternal age, socioeconomic status, or indi- 8 vidual-level health risk factors, including poverty, 9 limited access to prenatal care, and poor physical 10 and mental health (although these are not nominal 11 factors). African-American women remain the most 12 at risk for pregnancy-associated or pregnancy-re- 13 lated causes of death. When it comes to 14 preeclampsia, for example, which is related to obe- 15 sity, African-American women of normal weight re- 16 main the most at risk of dying during the perinatal 17 period compared to non-African-American obese 18 women. 19 (23) The rising maternal mortality rate in the 20 United States is driven predominantly by the dis- 21 proportionately high rates of African-American ma- 22 ternal mortality. 23 (24) African-American women are 3 to 4 times 24 more likely to die from pregnancy or maternal-re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 390 •HR 6637 IH lated distress than are White women, yielding one of 1 the greatest and most disconcerting racial disparities 2 in public health. 3 (25) Compared to women from other racial and 4 ethnic demographics, African-American women 5 across the socioeconomic spectrum experience pro- 6 longed, unrelenting stress related to racial and gen- 7 der discrimination, contributing to higher rates of 8 maternal mortality, giving birth to low-weight ba- 9 bies, and experiencing pre-term birth. Racism is a 10 risk factor for these aforementioned experiences. 11 This cumulative stress often extends across the life 12 course and is situated in everyday spaces where Afri- 13 can-American women establish livelihood. Structural 14 barriers, lack of access to care, and genetic pre- 15 dispositions to health vulnerabilities exacerbate Afri- 16 can-American women’s likelihood to experience poor 17 or fatal birthing outcomes, but do not fully account 18 for the great disparity. 19 (26) African-American women are twice as like- 20 ly to experience postpartum depression, and dis- 21 proportionately higher rates of preeclampsia com- 22 pared to White women. 23 (27) Racism is deeply ingrained in United 24 States systems, including in health care delivery sys- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 391 •HR 6637 IH tems between patients and providers, often resulting 1 in disparate treatment for pain, irreverence for cul- 2 tural norms with respect to health, and 3 dismissiveness. Research has demonstrated that pa- 4 tients respond more warmly and adhere to medical 5 treatment plans at a higher degree with providers of 6 the same race or ethnicity or with providers with 7 great ability to exercise empathy. However, the pro- 8 vider pool is not primed with many people of color, 9 nor are providers (whether student-doctors in train- 10 ing or licensed practitioners) consistently required to 11 undergo implicit bias, cultural competency, or empa- 12 thy training on a consistent, on-going basis. 13 (c) IMPROVING FEDERAL EFFORTS WITH RESPECT 14 TO PREVENTION OF MATERNAL MORTALITY.— 15 (1) TECHNICAL ASSISTANCE FOR STATES WITH 16 RESPECT TO REPORTING MATERNAL MORTALITY.— 17 Not later than one year after the date of enactment 18 of this Act, the Director of the Centers for Disease 19 Control and Prevention (referred to in this section 20 as the ‘‘Director’’), in consultation with the Admin- 21 istrator of the Health Resources and Services Ad- 22 ministration, shall provide technical assistance to 23 States that elect to report comprehensive data on 24 maternal mortality, including oral, mental, and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 392 •HR 6637 IH breastfeeding health information, for the purpose of 1 encouraging uniformity in the reporting of such data 2 and to encourage the sharing of such data among 3 the respective States. 4 (2) BEST PRACTICES RELATING TO PREVEN- 5 TION OF MATERNAL MORTALITY.— 6 (A) IN GENERAL.—Not later than one year 7 after the date of enactment of this Act— 8 (i) the Director, in consultation with 9 relevant patient and provider groups, shall 10 issue best practices to State maternal mor- 11 tality review committees on how best to 12 identify and review maternal mortality 13 cases, taking into account any data made 14 available by States relating to maternal 15 mortality, including data on oral, mental, 16 and breastfeeding health, and utilization of 17 any emergency services; and 18 (ii) the Director, working in collabora- 19 tion with the Health Resources and Serv- 20 ices Administration, shall issue best prac- 21 tices to hospitals, State professional society 22 groups, and perinatal quality collaboratives 23 on how best to prevent maternal mortality. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 393 •HR 6637 IH (B) AUTHORIZATION OF APPROPRIA- 1 TIONS.—For purposes of carrying out this sub- 2 section, there is authorized to be appropriated 3 $5,000,000 for each of fiscal years 2021 4 through 2025. 5 (3) ALLIANCE FOR INNOVATION ON MATERNAL 6 HEALTH GRANT PROGRAM.— 7 (A) IN GENERAL.—Not later than one year 8 after the date of enactment of this Act, the Sec- 9 retary of Health and Human Services (referred 10 to in this subsection as the ‘‘Secretary’’), acting 11 through the Associate Administrator of the Ma- 12 ternal and Child Health Bureau of the Health 13 Resources and Services Administration, shall 14 establish a grant program to be known as the 15 Alliance for Innovation on Maternal Health 16 Grant Program (referred to in this subsection 17 as ‘‘AIM’’) under which the Secretary shall 18 award grants to eligible entities for the purpose 19 of— 20 (i) directing widespread adoption and 21 implementation of maternal safety bundles 22 through collaborative State-based teams; 23 and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 394 •HR 6637 IH (ii) collecting and analyzing process, 1 structure, and outcome data to drive con- 2 tinuous improvement in the implementa- 3 tion of such safety bundles by such State- 4 based teams with the ultimate goal of 5 eliminating preventable maternal mortality 6 and severe maternal morbidity in the 7 United States. 8 (B) ELIGIBLE ENTITIES.—In order to be 9 eligible for a grant under paragraph (1), an en- 10 tity shall— 11 (i) submit to the Secretary an applica- 12 tion at such time, in such manner, and 13 containing such information as the Sec- 14 retary may require; and 15 (ii) demonstrate in such application 16 that the entity is an interdisciplinary, 17 multi-stakeholder, national organization 18 with a national data-driven maternal safety 19 and quality improvement initiative based 20 on implementation approaches that have 21 been proven to improve maternal safety 22 and outcomes in the United States. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 395 •HR 6637 IH (C) USE OF FUNDS.—An eligible entity 1 that receives a grant under paragraph (1) shall 2 use such grant funds— 3 (i) to develop and implement, through 4 a robust, multi-stakeholder process, mater- 5 nal safety bundles to assist States and 6 health care systems in aligning national, 7 State, and hospital-level quality improve- 8 ment efforts to improve maternal health 9 outcomes, specifically the reduction of ma- 10 ternal mortality and severe maternal mor- 11 bidity; 12 (ii) to ensure, in developing and im- 13 plementing maternal safety bundles under 14 subparagraph (A), that such maternal 15 safety bundles— 16 (I) satisfy the quality improve- 17 ment needs of a State or health care 18 system by factoring in the results and 19 findings of relevant data reviews, such 20 as reviews conducted by a State ma- 21 ternal mortality review committee; 22 and 23 (II) address topics such as— 24 (aa) obstetric hemorrhage; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 396 •HR 6637 IH (bb) maternal mental health; 1 (cc) the maternal venous 2 system; 3 (dd) obstetric care for 4 women with substance use dis- 5 orders, including opioid use dis- 6 order; 7 (ee) postpartum care basics 8 for maternal safety; 9 (ff) reduction of peripartum 10 racial and ethnic disparities; 11 (gg) reduction of primary 12 caesarean birth; 13 (hh) severe hypertension in 14 pregnancy; 15 (ii) severe maternal mor- 16 bidity reviews; 17 (jj) support after a severe 18 maternal morbidity event; 19 (kk) thromboembolism; 20 (ll) optimization of support 21 for breastfeeding; and 22 (mm) maternal oral health; 23 and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 397 •HR 6637 IH (iii) to provide ongoing technical as- 1 sistance at the national and State levels to 2 support implementation of maternal safety 3 bundles under subparagraph (A). 4 (D) MATERNAL SAFETY BUNDLE DE- 5 FINED.—For purposes of this subsection, the 6 term ‘‘maternal safety bundle’’ means standard- 7 ized, evidence-informed processes for maternal 8 health care. 9 (E) AUTHORIZATION OF APPROPRIA- 10 TIONS.—For purposes of carrying out this sub- 11 section, there is authorized to be appropriated 12 $10,000,000 for each of fiscal years 2021 13 through 2025. 14 (4) FUNDING FOR STATE-BASED PERINATAL 15 QUALITY COLLABORATIVES DEVELOPMENT AND SUS- 16 TAINABILITY.— 17 (A) IN GENERAL.—Not later than one year 18 after the date of enactment of this Act, the Sec- 19 retary of Health and Human Services (referred 20 to in this subsection as the ‘‘Secretary’’), acting 21 through the Division of Reproductive Health of 22 the Centers for Disease Control and Prevention, 23 shall establish a grant program to be known as 24 the State-Based Perinatal Quality Collaborative 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 398 •HR 6637 IH grant program under which the Secretary 1 awards grants to eligible entities for the pur- 2 pose of development and sustainability of 3 perinatal quality collaboratives in every State, 4 the District of Columbia, and eligible terri- 5 tories, in order to measurably improve perinatal 6 care and perinatal health outcomes for preg- 7 nant and postpartum women and their infants. 8 (B) GRANT AMOUNTS.—Grants awarded 9 under this subsection shall be in amounts not to 10 exceed $250,000 per year, for the duration of 11 the grant period. 12 (C) STATE-BASED PERINATAL QUALITY 13 COLLABORATIVE DEFINED.—For purposes of 14 this subsection, the term ‘‘State-based perinatal 15 quality collaborative’’ means a network of mul- 16 tidisciplinary teams that— 17 (i) work to improve measurable out- 18 comes for maternal and infant health by 19 advancing evidence-informed clinical prac- 20 tices using quality improvement principles; 21 (ii) work with hospital-based or out- 22 patient facility-based clinical teams, ex- 23 perts, and stakeholders, including patients 24 and families, to spread best practices and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 399 •HR 6637 IH optimize resources to improve perinatal 1 care and outcomes; 2 (iii) employ strategies that include the 3 use of the collaborative learning model to 4 provide opportunities for hospitals and 5 clinical teams to collaborate on improve- 6 ment strategies, rapid-response data to 7 provide timely feedback to hospital and 8 other clinical teams to track progress, and 9 quality improvement science to provide 10 support and coaching to hospital and clin- 11 ical teams; and 12 (iv) have the goal of improving popu- 13 lation-level outcomes in maternal and in- 14 fant health. 15 (D) AUTHORIZATION OF APPROPRIA- 16 TIONS.—For purposes of carrying out this sub- 17 section, there is authorized to be appropriated 18 $14,000,000 per year for each of fiscal years 19 2021 through 2025. 20 (5) EXPANSION OF MEDICAID AND CHIP COV- 21 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 22 (A) REQUIRING COVERAGE OF ORAL 23 HEALTH SERVICES FOR PREGNANT AND 24 POSTPARTUM WOMEN.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 400 •HR 6637 IH (i) MEDICAID.—Section 1905 of the 1 Social Security Act (42 U.S.C. 1396d) is 2 amended— 3 (I) in subsection (a)(4)— 4 (aa) by striking ‘‘; and (D)’’ 5 and inserting ‘‘; (D)’’; and 6 (bb) by inserting ‘‘; and (E) 7 oral health services for pregnant 8 and postpartum women (as de- 9 fined in subsection (ee))’’ after 10 ‘‘subsection (bb))’’; and 11 (II) by adding at the end the fol- 12 lowing new subsection: 13 ‘‘(ee) ORAL HEALTH SERVICES FOR PREGNANT AND 14 POSTPARTUM WOMEN.— 15 ‘‘(1) IN GENERAL.—For purposes of this title, 16 the term ‘oral health services for pregnant and 17 postpartum women’ means dental services necessary 18 to prevent disease and promote oral health, restore 19 oral structures to health and function, and treat 20 emergency conditions that are furnished to a woman 21 during pregnancy (or during the 1-year period be- 22 ginning on the last day of the pregnancy). 23 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 24 the requirement to provide oral health services for 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 401 •HR 6637 IH pregnant and postpartum women, a State shall, at 1 a minimum, provide coverage for preventive, diag- 2 nostic, periodontal, and restorative care consistent 3 with recommendations for perinatal oral health care 4 and dental care during pregnancy from the Amer- 5 ican Academy of Pediatric Dentistry and the Amer- 6 ican College of Obstetricians and Gynecologists.’’. 7 (ii) CHIP.—Section 2103(c)(5)(A) of 8 the Social Security Act (42 U.S.C. 9 1397cc(c)(5)(A)) is amended by inserting 10 ‘‘or a targeted low-income pregnant 11 woman’’ after ‘‘targeted low-income child’’. 12 (B) EXTENDING MEDICAID COVERAGE FOR 13 PREGNANT AND POSTPARTUM WOMEN.—Section 14 1902 of the Social Security Act (42 U.S.C. 15 1396a) is amended— 16 (i) in subsection (e)— 17 (I) in paragraph (5)— 18 (aa) by inserting ‘‘(including 19 oral health services for pregnant 20 and postpartum women (as de- 21 fined in section 1905(ee))’’ after 22 ‘‘postpartum medical assistance 23 under the plan’’; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 402 •HR 6637 IH (bb) by striking ‘‘60-day’’ 1 and inserting ‘‘1-year’’; and 2 (II) in paragraph (6), by striking 3 ‘‘60-day’’ and inserting ‘‘1-year’’; and 4 (ii) in subsection (l)(1)(A), by striking 5 ‘‘60-day’’ and inserting ‘‘1-year’’. 6 (C) EXTENDING MEDICAID COVERAGE FOR 7 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of 8 the Social Security Act (42 U.S.C. 9 1396b(v)(4)(A)) is amended by striking ‘‘60- 10 day’’ and inserting ‘‘1-year’’. 11 (D) EXTENDING CHIP COVERAGE FOR 12 PREGNANT AND POSTPARTUM WOMEN.—Section 13 2112(d)(2)(A) of the Social Security Act (42 14 U.S.C. 1397ll(d)(2)(A)) is amended by striking 15 ‘‘60-day’’ and inserting ‘‘1-year’’. 16 (E) MAINTENANCE OF EFFORT.— 17 (i) MEDICAID.—Section 1902(l) of the 18 Social Security Act (42 U.S.C. 1396a(l)) is 19 amended by adding at the end the fol- 20 lowing new paragraph: 21 ‘‘(5) During the period that begins on the date of 22 enactment of this paragraph and ends on the date that 23 is five years after such date of enactment, as a condition 24 for receiving any Federal payments under section 1903(a) 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 403 •HR 6637 IH for calendar quarters occurring during such period, a 1 State shall not have in effect, with respect to women who 2 are eligible for medical assistance under the State plan 3 or under a waiver of such plan on the basis of being preg- 4 nant or having been pregnant, eligibility standards, meth- 5 odologies, or procedures under the State plan or waiver 6 that are more restrictive than the eligibility standards, 7 methodologies, or procedures, respectively, under such 8 plan or waiver that are in effect on the date of enactment 9 of this paragraph.’’. 10 (ii) CHIP.—Section 2105(d) of the 11 Social Security Act (42 U.S.C. 1397ee(d)) 12 is amended by adding at the end the fol- 13 lowing new paragraph: 14 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR- 15 GETED LOW-INCOME PREGNANT WOMEN.—During 16 the period that begins on the date of enactment of 17 this paragraph and ends on the date that is five 18 years after such date of enactment, as a condition 19 of receiving payments under subsection (a) and sec- 20 tion 1903(a), a State that elects to provide assist- 21 ance to women on the basis of being pregnant (in- 22 cluding pregnancy-related assistance provided to tar- 23 geted low-income pregnant women (as defined in 24 section 2112(d)), pregnancy-related assistance pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 404 •HR 6637 IH vided to women who are eligible for such assistance 1 through application of section 1902(v)(4)(A)(i) 2 under section 2107(e)(1), or any other assistance 3 under the State child health plan (or a waiver of 4 such plan) which is provided to women on the basis 5 of being pregnant) shall not have in effect, with re- 6 spect to such women, eligibility standards, meth- 7 odologies, or procedures under such plan (or waiver) 8 that are more restrictive than the eligibility stand- 9 ards, methodologies, or procedures, respectively, 10 under such plan (or waiver) that are in effect on the 11 date of enactment of this paragraph.’’. 12 (F) INFORMATION ON BENEFITS.—The 13 Secretary of Health and Human Services shall 14 make publicly available on the internet website 15 of the Department of Health and Human Serv- 16 ices, information regarding benefits available to 17 pregnant and postpartum women and under the 18 Medicaid program and the Children’s Health 19 Insurance Program, including information on— 20 (i) benefits that States are required to 21 provide to pregnant and postpartum 22 women under such programs; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 405 •HR 6637 IH (ii) optional benefits that States may 1 provide to pregnant and postpartum 2 women under such programs; and 3 (iii) the availability of different kinds 4 of benefits for pregnant and postpartum 5 women, including oral health and mental 6 health benefits, under such programs. 7 (G) FEDERAL FUNDING FOR COST OF EX- 8 TENDED MEDICAID AND CHIP COVERAGE FOR 9 POSTPARTUM WOMEN.— 10 (i) MEDICAID.—Section 1905 of the 11 Social Security Act (42 U.S.C. 1396d), as 12 amended by paragraph (1), is further 13 amended— 14 (I) in subsection (b), by striking 15 ‘‘and (aa)’’ and inserting ‘‘(aa), and 16 (ff)’’; and 17 (II) by adding at the end the fol- 18 lowing: 19 ‘‘(ff) INCREASED FMAP FOR EXTENDED MEDICAL 20 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith- 21 standing subsection (b), the Federal medical assistance 22 percentage for a State, with respect to amounts expended 23 by such State for medical assistance for a woman who is 24 eligible for such assistance on the basis of being pregnant 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 406 •HR 6637 IH or having been pregnant that is provided during the 305- 1 day period that begins on the 60th day after the last day 2 of her pregnancy (including any such assistance provided 3 during the month in which such period ends), shall be 4 equal to— 5 ‘‘(1) 100 percent for the first 20 calendar quar- 6 ters during which this subsection is in effect; and 7 ‘‘(2) 90 percent for calendar quarters there- 8 after.’’. 9 (ii) CHIP.—Section 2105(c) of the 10 Social Security Act (42 U.S.C. 1397ee(c)) 11 is amended by adding at the end the fol- 12 lowing new paragraph: 13 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED 14 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 15 Notwithstanding subsection (b), the enhanced 16 FMAP, with respect to payments under subsection 17 (a) for expenditures under the State child health 18 plan (or a waiver of such plan) for assistance pro- 19 vided under the plan (or waiver) to a woman who is 20 eligible for such assistance on the basis of being 21 pregnant (including pregnancy-related assistance 22 provided to a targeted low-income pregnant woman 23 (as defined in section 2112(d)), pregnancy-related 24 assistance provided to a woman who is eligible for 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 407 •HR 6637 IH such assistance through application of section 1 1902(v)(4)(A)(i) under section 2107(e)(1), or any 2 other assistance under the plan (or waiver) provided 3 to a woman who is eligible for such assistance on the 4 basis of being pregnant) during the 305-day period 5 that begins on the 60th day after the last day of her 6 pregnancy (including any such assistance provided 7 during the month in which such period ends), shall 8 be equal to— 9 ‘‘(A) 100 percent for the first 20 calendar 10 quarters during which this paragraph is in ef- 11 fect; and 12 ‘‘(B) 90 percent for calendar quarters 13 thereafter.’’. 14 (H) EFFECTIVE DATE.— 15 (i) IN GENERAL.—Subject to subpara- 16 graph (B), the amendments made by this 17 subsection shall take effect on the first day 18 of the first calendar quarter that begins on 19 or after the date that is one year after the 20 date of enactment of this Act. 21 (ii) EXCEPTION FOR STATE LEGISLA- 22 TION.—In the case of a State plan under 23 title XIX of the Social Security Act or a 24 State child health plan under title XXI of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 408 •HR 6637 IH such Act that the Secretary of Health and 1 Human Services determines requires State 2 legislation in order for the respective plan 3 to meet any requirement imposed by 4 amendments made by this subsection, the 5 respective plan shall not be regarded as 6 failing to comply with the requirements of 7 such title solely on the basis of its failure 8 to meet such an additional requirement be- 9 fore the first day of the first calendar 10 quarter beginning after the close of the 11 first regular session of the State legislature 12 that begins after the date of enactment of 13 this Act. For purposes of the previous sen- 14 tence, in the case of a State that has a 2- 15 year legislative session, each year of the 16 session shall be considered to be a separate 17 regular session of the State legislature. 18 (6) REGIONAL CENTERS OF EXCELLENCE.— 19 Part P of title III of the Public Health Service Act 20 is amended by adding at the end the following new 21 section: 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 409 •HR 6637 IH ‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD- 1 DRESSING IMPLICIT BIAS AND CULTURAL 2 COMPETENCY IN PATIENT-PROVIDER INTER- 3 ACTIONS EDUCATION. 4 ‘‘(a) IN GENERAL.—Not later than one year after the 5 date of enactment of this section, the Secretary, in con- 6 sultation with such other agency heads as the Secretary 7 determines appropriate, shall award cooperative agree- 8 ments for the establishment or support of regional centers 9 of excellence addressing implicit bias and cultural com- 10 petency in patient-provider interactions education for the 11 purpose of enhancing and improving how health care pro- 12 fessionals are educated in implicit bias and delivering cul- 13 turally competent health care. 14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper- 15 ative agreement under subsection (a), an entity shall— 16 ‘‘(1) be a public or other nonprofit entity speci- 17 fied by the Secretary that provides educational and 18 training opportunities for students and health care 19 professionals, which may be a health system, teach- 20 ing hospital, community health center, medical 21 school, school of public health, dental school, social 22 work school, school of professional psychology, or 23 any other health professional school or program at 24 an institution of higher education (as defined in sec- 25 tion 101 of the Higher Education Act of 1965) fo- 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 410 •HR 6637 IH cused on the prevention, treatment, or recovery of 1 health conditions that contribute to maternal mor- 2 tality and the prevention of maternal mortality and 3 severe maternal morbidity; 4 ‘‘(2) demonstrate community engagement and 5 participation, such as through partnerships with 6 home visiting and case management programs; and 7 ‘‘(3) provide to the Secretary such information, 8 at such time and in such manner, as the Secretary 9 may require. 10 ‘‘(c) DIVERSITY.—In awarding a cooperative agree- 11 ment under subsection (a), the Secretary shall take into 12 account any regional differences among eligible entities 13 and make an effort to ensure geographic diversity among 14 award recipients. 15 ‘‘(d) DISSEMINATION OF INFORMATION.— 16 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 17 shall make publicly available on the internet website 18 of the Department of Health and Human Services 19 information submitted to the Secretary under sub- 20 section (b)(3). 21 ‘‘(2) EVALUATION.—The Secretary shall evalu- 22 ate each regional center of excellence established or 23 supported pursuant to subsection (a) and dissemi- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 411 •HR 6637 IH nate the findings resulting from each such evalua- 1 tion to the appropriate public and private entities. 2 ‘‘(3) DISTRIBUTION.—The Secretary shall share 3 evaluations and overall findings with State depart- 4 ments of health and other relevant State level offices 5 to inform State and local best practices. 6 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec- 7 tion, the term ‘maternal mortality’ means death of a 8 woman that occurs during pregnancy or within the one- 9 year period following the end of such pregnancy. 10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 11 purposes of carrying out this section, there is authorized 12 to be appropriated $5,000,000 for each of fiscal years 13 2021 through 2025.’’. 14 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO- 15 GRAM FOR WOMEN, INFANTS, AND CHILDREN.—Sec- 16 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 17 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 18 (A) by striking the clause designation and 19 heading and all that follows through ‘‘A State’’ 20 and inserting the following: 21 ‘‘(ii) WOMEN.— 22 ‘‘(I) BREASTFEEDING WOMEN.— 23 A State’’; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 412 •HR 6637 IH (B) in subclause (I) (as so designated), by 1 striking ‘‘1 year’’ and all that follows through 2 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 3 and 4 (C) by adding at the end the following: 5 ‘‘(II) POSTPARTUM WOMEN.—A 6 State may elect to certify a 7 postpartum woman for a period of 2 8 years.’’. 9 (8) DEFINITIONS.—In this section: 10 (A) MATERNAL MORTALITY.—The term 11 ‘‘maternal mortality’’ means death of a woman 12 that occurs during pregnancy or within the one- 13 year period following the end of such preg- 14 nancy. 15 (B) SEVERE MATERNAL MORBIDITY.—The 16 term ‘‘severe maternal morbidity’’ includes un- 17 expected outcomes of labor and delivery that re- 18 sult in significant short-term or long-term con- 19 sequences to a woman’s health. 20 (d) INCREASING EXCISE TAXES ON CIGARETTES AND 21 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO- 22 BACCO PRODUCT TAX RATES.— 23 (1) TAX PARITY FOR ROLL-YOUR-OWN TO- 24 BACCO.—Section 5701(g) of the Internal Revenue 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 413 •HR 6637 IH Code of 1986 is amended by striking ‘‘$24.78’’ and 1 inserting ‘‘$49.56’’. 2 (2) TAX PARITY FOR PIPE TOBACCO.—Section 3 5701(f) of the Internal Revenue Code of 1986 is 4 amended by striking ‘‘$2.8311 cents’’ and inserting 5 ‘‘$49.56’’. 6 (3) TAX PARITY FOR SMOKELESS TOBACCO.— 7 (A) Section 5701(e) of the Internal Rev- 8 enue Code of 1986 is amended— 9 (i) in paragraph (1), by striking 10 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 11 (ii) in paragraph (2), by striking 12 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 13 (iii) by adding at the end the fol- 14 lowing: 15 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 16 SINGLE-USE UNITS.—On discrete single-use units, 17 $100.66 per thousand.’’. 18 (B) Section 5702(m) of such Code is 19 amended— 20 (i) in paragraph (1), by striking ‘‘or 21 chewing tobacco’’ and inserting ‘‘, chewing 22 tobacco, or discrete single-use unit’’; 23 (ii) in paragraphs (2) and (3), by in- 24 serting ‘‘that is not a discrete single-use 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 414 •HR 6637 IH unit’’ before the period in each such para- 1 graph; and 2 (iii) by adding at the end the fol- 3 lowing: 4 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 5 ‘discrete single-use unit’ means any product con- 6 taining tobacco that— 7 ‘‘(A) is not intended to be smoked; and 8 ‘‘(B) is in the form of a lozenge, tablet, 9 pill, pouch, dissolvable strip, or other discrete 10 single-use or single-dose unit.’’. 11 (4) TAX PARITY FOR SMALL CIGARS.—Para- 12 graph (1) of section 5701(a) of the Internal Revenue 13 Code of 1986 is amended by striking ‘‘$50.33’’ and 14 inserting ‘‘$100.66’’. 15 (5) TAX PARITY FOR LARGE CIGARS.— 16 (A) IN GENERAL.—Paragraph (2) of sec- 17 tion 5701(a) of the Internal Revenue Code of 18 1986 is amended by striking ‘‘52.75 percent’’ 19 and all that follows through the period and in- 20 serting the following: ‘‘$49.56 per pound and a 21 proportionate tax at the like rate on all frac- 22 tional parts of a pound but not less than 23 10.066 cents per cigar.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 415 •HR 6637 IH (B) GUIDANCE.—The Secretary of the 1 Treasury, or the Secretary’s delegate, may issue 2 guidance regarding the appropriate method for 3 determining the weight of large cigars for pur- 4 poses of calculating the applicable tax under 5 section 5701(a)(2) of the Internal Revenue 6 Code of 1986. 7 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 8 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 9 of section 5702 of the Internal Revenue Code of 10 1986 is amended by inserting ‘‘, and includes proc- 11 essed tobacco that is removed for delivery or deliv- 12 ered to a person other than a person with a permit 13 provided under section 5713, but does not include 14 removals of processed tobacco for exportation’’ after 15 ‘‘wrappers thereof’’. 16 (7) CLARIFYING TAX RATE FOR OTHER TO- 17 BACCO PRODUCTS.— 18 (A) IN GENERAL.—Section 5701 of the In- 19 ternal Revenue Code of 1986 is amended by 20 adding at the end the following new subsection: 21 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 22 otherwise described under this section that has been deter- 23 mined to be a tobacco product by the Food and Drug Ad- 24 ministration through its authorities under the Family 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 416 •HR 6637 IH Smoking Prevention and Tobacco Control Act shall be 1 taxed at a level of tax equivalent to the tax rate for ciga- 2 rettes on an estimated per use basis as determined by the 3 Secretary.’’. 4 (B) ESTABLISHING PER USE BASIS.—For 5 purposes of section 5701(i) of the Internal Rev- 6 enue Code of 1986, not later than 12 months 7 after the later of the date of the enactment of 8 this Act or the date that a product has been de- 9 termined to be a tobacco product by the Food 10 and Drug Administration, the Secretary of the 11 Treasury (or the Secretary of the Treasury’s 12 delegate) shall issue final regulations estab- 13 lishing the level of tax for such product that is 14 equivalent to the tax rate for cigarettes on an 15 estimated per use basis. 16 (8) CLARIFYING DEFINITION OF TOBACCO 17 PRODUCTS.— 18 (A) IN GENERAL.—Subsection (c) of sec- 19 tion 5702 of the Internal Revenue Code of 1986 20 is amended to read as follows: 21 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod- 22 ucts’ means— 23 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 24 tobacco, and roll-your-own tobacco, and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 417 •HR 6637 IH ‘‘(2) any other product subject to tax pursuant 1 to section 5701(i).’’. 2 (B) CONFORMING AMENDMENTS.—Sub- 3 section (d) of section 5702 of such Code is 4 amended by striking ‘‘cigars, cigarettes, smoke- 5 less tobacco, pipe tobacco, or roll-your-own to- 6 bacco’’ each place it appears and inserting ‘‘to- 7 bacco products’’. 8 (9) INCREASING TAX ON CIGARETTES.— 9 (A) SMALL CIGARETTES.—Section 10 5701(b)(1) of such Code is amended by striking 11 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 12 (B) LARGE CIGARETTES.—Section 13 5701(b)(2) of such Code is amended by striking 14 ‘‘$105.69’’ and inserting ‘‘$211.38’’. 15 (10) TAX RATES ADJUSTED FOR INFLATION.— 16 Section 5701 of such Code, as amended by sub- 17 section (g), is amended by adding at the end the fol- 18 lowing new subsection: 19 ‘‘(j) INFLATION ADJUSTMENT.— 20 ‘‘(1) IN GENERAL.—In the case of any calendar 21 year beginning after 2021, the dollar amounts pro- 22 vided under this chapter shall each be increased by 23 an amount equal to— 24 ‘‘(A) such dollar amount, multiplied by 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 418 •HR 6637 IH ‘‘(B) the cost-of-living adjustment deter- 1 mined under section 1(f)(3) for the calendar 2 year, determined by substituting ‘calendar year 3 2017’ for ‘calendar year 2016’ in subparagraph 4 (A)(ii) thereof. 5 ‘‘(2) ROUNDING.—If any amount as adjusted 6 under paragraph (1) is not a multiple of $0.01, such 7 amount shall be rounded to the next highest multiple 8 of $0.01.’’. 9 (11) FLOOR STOCKS TAXES.— 10 (A) IMPOSITION OF TAX.—On tobacco 11 products manufactured in or imported into the 12 United States which are removed before any tax 13 increase date and held on such date for sale by 14 any person, there is hereby imposed a tax in an 15 amount equal to the excess of— 16 (i) the tax which would be imposed 17 under section 5701 of the Internal Rev- 18 enue Code of 1986 on the article if the ar- 19 ticle had been removed on such date, over 20 (ii) the prior tax (if any) imposed 21 under section 5701 of such Code on such 22 article. 23 (B) CREDIT AGAINST TAX.—Each person 24 shall be allowed as a credit against the taxes 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 419 •HR 6637 IH imposed by paragraph (1) an amount equal to 1 $500. Such credit shall not exceed the amount 2 of taxes imposed by paragraph (1) on such date 3 for which such person is liable. 4 (C) LIABILITY FOR TAX AND METHOD OF 5 PAYMENT.— 6 (i) LIABILITY FOR TAX.—A person 7 holding tobacco products on any tax in- 8 crease date to which any tax imposed by 9 paragraph (1) applies shall be liable for 10 such tax. 11 (ii) METHOD OF PAYMENT.—The tax 12 imposed by paragraph (1) shall be paid in 13 such manner as the Secretary shall pre- 14 scribe by regulations. 15 (iii) TIME FOR PAYMENT.—The tax 16 imposed by paragraph (1) shall be paid on 17 or before the date that is 120 days after 18 the effective date of the tax rate increase. 19 (D) ARTICLES IN FOREIGN TRADE 20 ZONES.—Notwithstanding the Act of June 18, 21 1934 (commonly known as the Foreign Trade 22 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), 23 or any other provision of law, any article which 24 is located in a foreign trade zone on any tax in- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 420 •HR 6637 IH crease date shall be subject to the tax imposed 1 by paragraph (1) if— 2 (i) internal revenue taxes have been 3 determined, or customs duties liquidated, 4 with respect to such article before such 5 date pursuant to a request made under the 6 1st proviso of section 3(a) of such Act; or 7 (ii) such article is held on such date 8 under the supervision of an officer of the 9 United States Customs and Border Protec- 10 tion of the Department of Homeland Secu- 11 rity pursuant to the 2d proviso of such sec- 12 tion 3(a). 13 (E) DEFINITIONS.—For purposes of this 14 subsection— 15 (i) IN GENERAL.—Any term used in 16 this subsection which is also used in sec- 17 tion 5702 of such Code shall have the 18 same meaning as such term has in such 19 section. 20 (ii) TAX INCREASE DATE.—The term 21 ‘‘tax increase date’’ means the effective 22 date of any increase in any tobacco prod- 23 uct excise tax rate pursuant to the amend- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 421 •HR 6637 IH ments made by this section (other than 1 subsection (j) thereof). 2 (iii) SECRETARY.—The term ‘‘Sec- 3 retary’’ means the Secretary of the Treas- 4 ury or the Secretary’s delegate. 5 (F) CONTROLLED GROUPS.—Rules similar 6 to the rules of section 5061(e)(3) of such Code 7 shall apply for purposes of this subsection. 8 (G) OTHER LAWS APPLICABLE.—All provi- 9 sions of law, including penalties, applicable with 10 respect to the taxes imposed by section 5701 of 11 such Code shall, insofar as applicable and not 12 inconsistent with the provisions of this sub- 13 section, apply to the floor stocks taxes imposed 14 by paragraph (1), to the same extent as if such 15 taxes were imposed by such section 5701. The 16 Secretary may treat any person who bore the 17 ultimate burden of the tax imposed by para- 18 graph (1) as the person to whom a credit or re- 19 fund under such provisions may be allowed or 20 made. 21 (12) EFFECTIVE DATES.— 22 (A) IN GENERAL.—Except as provided in 23 paragraphs (2) through (4), the amendments 24 made by this section shall apply to articles re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 422 •HR 6637 IH moved (as defined in section 5702(j) of the In- 1 ternal Revenue Code of 1986) after the last day 2 of the month which includes the date of the en- 3 actment of this Act. 4 (B) DISCRETE SINGLE-USE UNITS AND 5 PROCESSED TOBACCO.—The amendments made 6 by subsections (c)(1)(C), (c)(2), and (f) shall 7 apply to articles removed (as defined in section 8 5702(j) of the Internal Revenue Code of 1986) 9 after the date that is 6 months after the date 10 of the enactment of this Act. 11 (C) LARGE CIGARS.—The amendments 12 made by subsection (e) shall apply to articles 13 removed after December 31, 2021. 14 (D) OTHER TOBACCO PRODUCTS.—The 15 amendments made by subsection (g)(1) shall 16 apply to products removed after the last day of 17 the month which includes the date that the Sec- 18 retary of the Treasury (or the Secretary of the 19 Treasury’s delegate) issues final regulations es- 20 tablishing the level of tax for such product. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 423 •HR 6637 IH SEC. 506. RURAL MATERNAL AND OBSTETRIC MODERNIZA- 1 TION OF SERVICES. 2 (a) SHORT TITLE.—This section may be cited as the 3 ‘‘Rural Maternal and Obstetric Modernization of Services 4 Act’’ or the ‘‘Rural MOMS Act’’. 5 (b) IMPROVING RURAL MATERNAL AND OBSTETRIC 6 CARE DATA.— 7 (1) MATERNAL MORTALITY AND MORBIDITY AC- 8 TIVITIES.—Section 301 of the Public Health Service 9 Act (42 U.S.C. 241) is amended— 10 (A) by redesignating subsections (e) 11 through (h) as subsections (f) through (i), re- 12 spectively; and 13 (B) by inserting after subsection (d), the 14 following: 15 ‘‘(e) The Secretary, acting through the Director of 16 the Centers for Disease Control and Prevention, shall ex- 17 pand, intensify, and coordinate the activities of the Cen- 18 ters for Disease Control and Prevention with respect to 19 maternal mortality and morbidity.’’. 20 (2) OFFICE OF WOMEN’S HEALTH.—Section 21 310A(b)(1) of the Public Health Service Act (42 22 U.S.C. 242s(b)(1)) is amended by inserting 23 ‘‘sociocultural (race, ethnicity, language, class, in- 24 come), including among American Indians and Alas- 25 ka Natives, as such terms are defined in section 4 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 424 •HR 6637 IH of the Indian Health Care Improvement Act, and ge- 1 ographic contexts,’’ after ‘‘biological,’’. 2 (3) SAFE MOTHERHOOD.—Section 317K(b)(2) 3 of the Public Health Service Act (42 U.S.C. 247b– 4 12(b)(2)) is amended— 5 (A) in subparagraph (L), by striking 6 ‘‘and’’ at the end; 7 (B) by redesignating subparagraph (M) as 8 subparagraph (N); and 9 (C) by inserting after subparagraph (L), 10 the following: 11 ‘‘(M) an examination of the relationship 12 between maternal health services in rural areas 13 and outcomes in delivery and postpartum care; 14 and’’. 15 (4) OFFICE OF RESEARCH ON WOMEN’S 16 HEALTH.—Section 486 of the Public Health Service 17 Act (42 U.S.C. 287d) is amended— 18 (A) in subsection (b)— 19 (i) by redesignating paragraphs (4) 20 through (9) as paragraphs (5) through 21 (10), respectively; 22 (ii) by inserting after paragraph (3) 23 the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 425 •HR 6637 IH ‘‘(4) carry out paragraphs (1) and (2) with re- 1 spect to pregnancy, with priority given to deaths re- 2 lated to pregnancy;’’; and 3 (iii) in paragraph (5) (as so redesig- 4 nated), by striking ‘‘through (3)’’ and in- 5 serting ‘‘through (4)’’; and 6 (B) in subsection (d)(4)(A)(iv), by insert- 7 ing ‘‘, including maternal mortality and other 8 maternal morbidity outcomes’’ before the semi- 9 colon. 10 (c) RURAL OBSTETRIC NETWORK GRANTS.—The 11 Public Health Service Act is amended by inserting after 12 section 317L–1 (42 U.S.C. 247b–13a) the following: 13 ‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 14 ‘‘(a) IN GENERAL.—For the purpose of enabling the 15 Secretary (through grants, contracts, or otherwise), acting 16 through the Administrator of the Health Resources and 17 Services Administration, to establish collaborative im- 18 provement and innovation networks (referred to in this 19 section as ‘rural obstetric networks’) to improve outcomes 20 in birth and maternal morbidity and mortality, there is 21 appropriated to the Secretary, out of any money in the 22 Treasury not otherwise appropriated, $3,000,000 for each 23 of fiscal years 2020 through 2024. Such amounts shall 24 remain available until expended. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 426 •HR 6637 IH ‘‘(b) USE OF FUNDS.—Amount appropriated under 1 subsection (a) shall be used for the establishment of col- 2 laborative improvement and innovation networks to im- 3 prove maternal health in rural areas by improving out- 4 comes in birth and maternal morbidity and mortality. 5 Rural obstetric networks established in accordance with 6 this section shall— 7 ‘‘(1) assist pregnant women and individuals in 8 rural areas connect with prenatal, labor and birth, 9 and postpartum care to improve outcomes in birth 10 and maternal mortality and morbidity; 11 ‘‘(2) identify successful prenatal, labor and 12 birth, and postpartum health delivery models for in- 13 dividuals in rural areas, including evidence-based 14 home visiting programs and successful, culturally 15 competent models with positive maternal health out- 16 comes that advance health equity; 17 ‘‘(3) develop a model for collaboration between 18 health facilities that have an obstetric health unit 19 and health facilities that do not have an obstetric 20 health unit; 21 ‘‘(4) provide training and guidance for health 22 facilities that do not have obstetric health units; 23 ‘‘(5) collaborate with academic institutions that 24 can provide regional expertise and research on ac- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 427 •HR 6637 IH cess, outcomes, needs assessments, and other identi- 1 fied data; and 2 ‘‘(6) measure and address inequities in birth 3 outcomes among rural residents, with an emphasis 4 on Black and American Indians and Alaska Native 5 residents, as such terms are defined in section 4 of 6 the Indian Health Care Improvement Act. 7 ‘‘(c) REQUIREMENTS.— 8 ‘‘(1) ESTABLISHMENT.—Not later than October 9 1, 2020, the Secretary shall establish rural obstetric 10 health networks in at least 5 regions. 11 ‘‘(2) DEFINITIONS.—In this section: 12 ‘‘(A) FRONTIER AREA.—The term ‘frontier 13 area’ means a frontier county, as defined in sec- 14 tion 1886(d)(3)(E)(iii)(III) of the Social Secu- 15 rity Act. 16 ‘‘(B) INDIAN TRIBE.—The term ‘Indian 17 tribe’ has the meaning given such term in sec- 18 tion 4 of the Indian Health Care Improvement 19 Act. 20 ‘‘(C) NATIVE HAWAIIAN HEALTH CARE 21 SYSTEM.—The term ‘Native Hawaiian Health 22 Care System’ has the meaning given such term 23 in section 12 of the Native Hawaiian Health 24 Care Improvement Act. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 428 •HR 6637 IH ‘‘(D) REGION.—The term ‘region’ means a 1 State, Indian tribe, rural area, or frontier area. 2 ‘‘(E) RURAL AREA.—The term ‘rural area’ 3 has the meaning given that term in section 4 1886(d)(2)(D) of the Social Security Act. 5 ‘‘(F) TRIBAL ORGANIZATION.—The term 6 ‘tribal organization’ has the meaning given such 7 term in the Indian Self-Determination Act. 8 ‘‘(G) STATE.—The term ‘State’ has the 9 meaning given that term for purposes of title V 10 of the Social Security Act.’’. 11 (d) TELEHEALTH NETWORK AND TELEHEALTH RE- 12 SOURCE CENTERS GRANT PROGRAMS.—Section 330I of 13 the Public Health Service Act (42 U.S.C. 254c–14) is 14 amended— 15 (1) in subsection (f)(1)(B)(iii), by adding at the 16 end the following: 17 ‘‘(XIII) Providers of maternal, 18 including prenatal, labor and birth, 19 and postpartum care services and en- 20 tities operation obstetric care units.’’; 21 (2) in subsection (i)(1)(B), by inserting ‘‘labor 22 and birth, postpartum,’’ before ‘‘or prenatal’’; and 23 (3) in subsection (k)(1)(B), by inserting ‘‘equip- 24 ment useful for caring for pregnant women and indi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 429 •HR 6637 IH viduals, including ultrasound machines and fetal 1 monitoring equipment,’’ before ‘‘and other equip- 2 ment’’. 3 (e) RURAL MATERNAL AND OBSTETRIC CARE TRAIN- 4 ING DEMONSTRATION.—Part D of title VII of the Public 5 Health Service Act is amended by inserting after section 6 760 (42 U.S.C. 294k) the following: 7 ‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 8 TRAINING DEMONSTRATION. 9 ‘‘(a) IN GENERAL.—The Secretary shall establish a 10 training demonstration program to award grants to eligi- 11 ble entities to support— 12 ‘‘(1) training for physicians, medical residents, 13 including family medicine and obstetrics and gyne- 14 cology residents, and fellows to practice maternal 15 and obstetric medicine in rural community-based 16 settings; 17 ‘‘(2) training for licensed and accredited nurse 18 practitioners, physician assistants, certified nurse 19 midwives, certified midwives, certified professional 20 midwives, home visiting nurses, or non-clinical pro- 21 fessionals such as doulas and community health 22 workers, to provide maternal care services in rural 23 community-based settings; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 430 •HR 6637 IH ‘‘(3) establishing, maintaining, or improving 1 academic units or programs that— 2 ‘‘(A) provide training for students or fac- 3 ulty, including through clinical experiences and 4 research, to improve maternal care in rural 5 areas; or 6 ‘‘(B) develop evidence-based practices or 7 recommendations for the design of the units or 8 programs described in subparagraph (A), in- 9 cluding curriculum content standards. 10 ‘‘(b) ACTIVITIES.— 11 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 12 FELLOWS.—A recipient of a grant under subsection 13 (a)(1)— 14 ‘‘(A) shall use the grant funds— 15 ‘‘(i) to plan, develop, and operate a 16 training program to provide obstetric care 17 in rural areas for family practice or obstet- 18 rics and gynecology residents and fellows; 19 or 20 ‘‘(ii) to train new family practice or 21 obstetrics and gynecology residents and fel- 22 lows in maternal and obstetric health care 23 to provide and expand access to maternal 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 431 •HR 6637 IH and obstetric health care in rural areas; 1 and 2 ‘‘(B) may use the grant funds to provide 3 additional support for the administration of the 4 program or to meet the costs of projects to es- 5 tablish, maintain, or improve faculty develop- 6 ment, or departments, divisions, or other units 7 necessary to implement such training. 8 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re- 9 cipient of a grant under subsection (a)(2)— 10 ‘‘(A) shall use the grant funds to plan, de- 11 velop, or operate a training program to provide 12 maternal health care services in rural, commu- 13 nity-based settings; and 14 ‘‘(B) may use the grant funds to provide 15 additional support for the administration of the 16 program or to meet the costs of projects to es- 17 tablish, maintain, or improve faculty develop- 18 ment, or departments, divisions, or other units 19 necessary to implement such program. 20 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re- 21 cipient of a grant under subsection (a)(3) shall enter 22 into a partnership with organizations such as an 23 education accrediting organization (such as the Liai- 24 son Committee on Medical Education, the Accredita- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 432 •HR 6637 IH tion Council for Graduate Medical Education, the 1 Commission on Osteopathic College Accreditation, 2 the Accreditation Commission for Education in 3 Nursing, the Commission on Collegiate Nursing 4 Education, the Accreditation Commission for Mid- 5 wifery Education, or the Accreditation Review Com- 6 mission on Education for the Physician Assistant) to 7 carry out activities under subsection (a)(3). 8 ‘‘(4) TRAINING PROGRAM REQUIREMENTS.— 9 The recipient of a grant under subsection (a)(1) or 10 (a)(2) shall ensure that training programs carried 11 out under the grant include instruction on— 12 ‘‘(A) maternal mental health, including 13 perinatal depression and anxiety and 14 postpartum depression; 15 ‘‘(B) maternal substance use disorder; 16 ‘‘(C) social determinants of health that im- 17 pact individuals living in rural communities, in- 18 cluding poverty, social isolation, access to nutri- 19 tion, education, transportation, and housing; 20 and 21 ‘‘(D) implicit bias. 22 ‘‘(c) ELIGIBLE ENTITIES.— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 433 •HR 6637 IH ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 1 FELLOWS.—To be eligible to receive a grant under 2 subsection (a)(1), an entity shall— 3 ‘‘(A) be a consortium consisting of— 4 ‘‘(i) at least one teaching health cen- 5 ter; or 6 ‘‘(ii) the sponsoring institution (or 7 parent institution of the sponsoring insti- 8 tution) of— 9 ‘‘(I) an obstetrics and gynecology 10 or family medicine residency program 11 that is accredited by the Accreditation 12 Council of Graduate Medical Edu- 13 cation (or the parent institution of 14 such a program); or 15 ‘‘(II) a fellowship in maternal or 16 obstetric medicine, as determined ap- 17 propriate by the Secretary; or 18 ‘‘(B) be an entity described in subpara- 19 graph (A)(ii) that provides opportunities for 20 medical residents or fellows to train in rural 21 community-based settings. 22 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 23 eligible to receive a grant under subsection (a)(2), 24 an entity shall be— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 434 •HR 6637 IH ‘‘(A) a teaching health center (as defined 1 in section 749A(f)); 2 ‘‘(B) a federally qualified health center (as 3 defined in section 1905(l)(2)(B) of the Social 4 Security Act); 5 ‘‘(C) a community mental health center (as 6 defined in section 1861(ff)(3)(B) of the Social 7 Security Act); 8 ‘‘(D) a rural health clinic (as defined in 9 section 1861(aa) of the Social Security Act); 10 ‘‘(E) a freestanding birth center (as de- 11 fined in section 1905(l)(3) of the Social Secu- 12 rity Act); 13 ‘‘(F) a health center operated by the In- 14 dian Health Service, an Indian tribe, a tribal 15 organization, or a Native Hawaiian Health Care 16 System (as such terms are defined in section 4 17 of the Indian Health Care Improvement Act 18 and section 12 of the Native Hawaiian Health 19 Care Improvement Act); or 20 ‘‘(G) an entity with a demonstrated record 21 of success in providing academic training for 22 nurse practitioners, physician assistants, cer- 23 tified nurse-midwives, certified midwives, cer- 24 tified professional midwives, home visiting 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 435 •HR 6637 IH nurses, or non-clinical professionals, such as 1 doulas and community health workers. 2 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 3 eligible to receive a grant under subsection (a)(3), 4 an entity shall be a school of medicine or osteopathic 5 medicine, a nursing school, a physician assistant 6 training program, an accredited public or nonprofit 7 private hospital, an accredited medical residency pro- 8 gram, a school accredited by the Midwifery Edu- 9 cation and Accreditation Council, or a public or pri- 10 vate nonprofit entity which the Secretary has deter- 11 mined is capable of carrying out such grant. 12 ‘‘(4) APPLICATION.—To be eligible to receive a 13 grant under subsection (a), an entity shall submit to 14 the Secretary an application at such time, in such 15 manner, and containing such information as the Sec- 16 retary may require, including an estimate of the 17 amount to be expended to conduct training activities 18 under the grant (including ancillary and administra- 19 tive costs). 20 ‘‘(d) DURATION.—Grants awarded under this section 21 shall be for a minimum of 5 years. 22 ‘‘(e) STUDY AND REPORT.— 23 ‘‘(1) STUDY.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 436 •HR 6637 IH ‘‘(A) IN GENERAL.—The Secretary, acting 1 through the Administrator of the Health Re- 2 sources and Services Administration, shall con- 3 duct a study on the results of the demonstra- 4 tion program under this section. 5 ‘‘(B) DATA SUBMISSION.—Not later than 6 90 days after the completion of the first year 7 of the training program, and each subsequent 8 year for the duration of the grant, that the pro- 9 gram is in effect, each recipient of a grant 10 under subsection (a) shall submit to the Sec- 11 retary such data as the Secretary may require 12 for analysis for the report described in para- 13 graph (2). 14 ‘‘(2) REPORT TO CONGRESS.—Not later than 1 15 year after receipt of the data described in paragraph 16 (1)(B), the Secretary shall submit to Congress a re- 17 port that includes— 18 ‘‘(A) an analysis of the effect of the dem- 19 onstration program under this section on the 20 quality, quantity, and distribution of maternal, 21 including prenatal, labor and birth, and 22 postpartum care services and the demographics 23 of the recipients of those services; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 437 •HR 6637 IH ‘‘(B) an analysis of maternal and infant 1 health outcomes (including quality of care, mor- 2 bidity, and mortality) before and after imple- 3 mentation of the program in the communities 4 served by entities participating in the dem- 5 onstration; and 6 ‘‘(C) recommendations on whether the 7 demonstration program should be expanded. 8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 $5,000,000 for each of fiscal years 2020 through 2024.’’. 11 (f) GAO REPORT.—Not later than 1 year after the 12 date of enactment of this Act, the Comptroller General 13 of the United States shall submit to the appropriate com- 14 mittees of Congress a report on the maternal, including 15 prenatal, labor and birth, and postpartum care in rural 16 areas. Such report shall include the following: 17 (1) The location of gaps in maternal and ob- 18 stetric clinicians and health professionals, including 19 non-clinical professionals such as doulas and com- 20 munity health workers. 21 (2) The location of gaps in facilities able to pro- 22 vide maternal, including prenatal, labor and birth, 23 and postpartum care in rural areas, including care 24 for high-risk pregnancies. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 438 •HR 6637 IH (3) The gaps in data on maternal mortality and 1 recommendations to standardize the format on col- 2 lecting data related to maternal mortality and mor- 3 bidity. 4 (4) The gaps in maternal health by race and 5 ethnicity in rural communities, with a focus on ra- 6 cial inequities for Black residents and among Indian 7 Tribes and American Indian/Alaska Native rural 8 residents (as such terms are defined in section 4 of 9 the Indian Health Care Improvement Act). 10 (5) A list of specific activities that the Sec- 11 retary of Health and Human Services plans to con- 12 duct on maternal, including prenatal, labor and 13 birth, and postpartum care. 14 (6) A plan for completing such activities. 15 (7) An explanation of Federal agency involve- 16 ment and coordination needed to conduct such ac- 17 tivities. 18 (8) A budget for conducting such activities. 19 (9) Other information that the Comptroller 20 General determines appropriate. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 439 •HR 6637 IH SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 1 UNEXPECTED INFANT DEATH AND SUDDEN 2 UNEXPLAINED DEATH IN CHILDHOOD. 3 (a) ESTABLISHMENT.—The Secretary of Health and 4 Human Services, acting through the Administrator of the 5 Health Resources and Services Administration and in con- 6 sultation with the Director of the Centers for Disease Con- 7 trol and Prevention and the Director of the National Insti- 8 tutes of Health (in this section referred to as the ‘‘Sec- 9 retary’’), shall establish and implement a culturally and 10 linguistically competent public health awareness and edu- 11 cation campaign to provide information that is focused on 12 decreasing the risk factors for sudden unexpected infant 13 death and sudden unexplained death in childhood, includ- 14 ing educating individuals about safe sleep environments, 15 sleep positions, and reducing exposure to smoking during 16 pregnancy and after birth. 17 (b) TARGETED POPULATIONS.—The campaign under 18 subsection (a) shall be designed to reduce health dispari- 19 ties through the targeting of populations with high rates 20 of sudden unexpected infant death and sudden unex- 21 plained death in childhood. 22 (c) CONSULTATION.—In establishing and imple- 23 menting the campaign under subsection (a), the Secretary 24 shall consult with national organizations representing 25 health care providers, including nurses and physicians, 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 440 •HR 6637 IH parents, child care providers, children’s advocacy and safe- 1 ty organizations, maternal and child health programs, nu- 2 trition professionals focusing on women, infants, and chil- 3 dren, and other individuals and groups determined nec- 4 essary by the Secretary for such establishment and imple- 5 mentation. 6 (d) GRANTS.— 7 (1) IN GENERAL.—In carrying out the cam- 8 paign under subsection (a), the Secretary shall 9 award grants to national organizations, State and 10 local health departments, and community-based or- 11 ganizations for the conduct of education and out- 12 reach programs for nurses, parents, child care pro- 13 viders, public health agencies, and community orga- 14 nizations. 15 (2) APPLICATION.—To be eligible to receive a 16 grant under paragraph (1), an entity shall submit to 17 the Secretary an application at such time, in such 18 manner, and containing such information as the Sec- 19 retary may require. 20 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2021 through 2025. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 441 •HR 6637 IH SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 1 NANCIES. 2 Title III of the Public Health Service Act (42 U.S.C. 3 241 et seq.) is amended by adding at the end the fol- 4 lowing: 5 ‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 6 SERVICES 7 ‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 8 THE ACCESS OF MARGINALIZED YOUTH TO 9 SEXUAL HEALTH SERVICES. 10 ‘‘(a) GRANTS.—The Secretary may award grants on 11 a competitive basis to eligible entities to support the access 12 of marginalized youth to sexual health services. 13 ‘‘(b) USE OF FUNDS.—An eligible entity that is 14 awarded a grant under subsection (a) may use the funds 15 to— 16 ‘‘(1) provide medically accurate and complete 17 and age-, developmentally, and culturally appro- 18 priate sexual health information to marginalized 19 youth, including information on how to access sexual 20 health services; 21 ‘‘(2) promote effective communication regarding 22 sexual health among marginalized youth; 23 ‘‘(3) promote and support better health, edu- 24 cation, and economic opportunities for school-age 25 parents; and 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 442 •HR 6637 IH ‘‘(4) train individuals who work with 1 marginalized youth to promote— 2 ‘‘(A) the prevention of unintended preg- 3 nancy; 4 ‘‘(B) the prevention of sexually transmitted 5 infections, including the human immuno- 6 deficiency virus (HIV); 7 ‘‘(C) healthy relationships; and 8 ‘‘(D) the development of safe and sup- 9 portive environments. 10 ‘‘(c) APPLICATION.—To be awarded a grant under 11 subsection (a), an eligible entity shall submit an applica- 12 tion to the Secretary at such time, in such manner, and 13 containing such information as the Secretary may require. 14 ‘‘(d) PRIORITY.—In awarding grants under sub- 15 section (a), the Secretary shall give priority to eligible enti- 16 ties— 17 ‘‘(1) with a history of supporting the access of 18 marginalized youth to sexuality education or sexual 19 health services; and 20 ‘‘(2) that plan to serve marginalized youth that 21 are not served by Federal adolescent programs for 22 the prevention of pregnancy, HIV, and other sexu- 23 ally transmitted infections. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 443 •HR 6637 IH ‘‘(e) REQUIREMENTS.—The Secretary may not award 1 a grant under subsection (a) to an eligible entity unless— 2 ‘‘(1) such eligible entity has formed a partner- 3 ship with a community organization; and 4 ‘‘(2) such eligible entity agrees— 5 ‘‘(A) to employ a scientifically effective 6 strategy; 7 ‘‘(B) that all information provided to 8 marginalized youth will be— 9 ‘‘(i) age- and developmentally appro- 10 priate; 11 ‘‘(ii) medically accurate and complete; 12 ‘‘(iii) scientifically based; and 13 ‘‘(iv) provided in the language and 14 cultural context that is most appropriate 15 for the individuals served by the eligible 16 entity; and 17 ‘‘(C) that for each year the eligible entity 18 receives grant funds under subsection (a), the 19 eligible entity will submit to the Secretary an 20 annual report that includes— 21 ‘‘(i) the use of grant funds by the eli- 22 gible entity; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 444 •HR 6637 IH ‘‘(ii) how the use of grant funds has 1 increased the access of marginalized youth 2 to sexual health services; and 3 ‘‘(iii) such other information as the 4 Secretary may require. 5 ‘‘(f) PUBLICATION AND EVALUATIONS.— 6 ‘‘(1) EVALUATIONS.—Not less than once every 7 two years after the date of the enactment of this 8 part, the Secretary shall evaluate the effectiveness of 9 whichever of the following is greater: 10 ‘‘(A) Eight grants awarded under sub- 11 section (a). 12 ‘‘(B) Ten percent of the grants awarded 13 under subsection (a). 14 ‘‘(2) PUBLICATION.—The Secretary shall make 15 available to the public— 16 ‘‘(A) the evaluations required under para- 17 graph (1); and 18 ‘‘(B) the reports required under subsection 19 (e)(2)(C). 20 ‘‘(g) LIMITATIONS.—No funds made available to an 21 eligible entity under this section may be used by such enti- 22 ty to provide access to sexual health services that— 23 ‘‘(1) withhold sexual health-promoting or life- 24 saving information; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 445 •HR 6637 IH ‘‘(2) are medically inaccurate or have been sci- 1 entifically shown to be ineffective; 2 ‘‘(3) promote gender stereotypes; 3 ‘‘(4) are insensitive or unresponsive to the 4 needs of young people, including— 5 ‘‘(A) youth with varying gender identities, 6 gender expressions, and sexual orientations; 7 ‘‘(B) sexually active youth; 8 ‘‘(C) pregnant or parenting youth; 9 ‘‘(D) survivors of sexual abuse or assault; 10 and 11 ‘‘(E) youth of all physical, developmental, 12 and mental abilities; or 13 ‘‘(5) are inconsistent with the ethical impera- 14 tives of medicine and public health. 15 ‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal- 16 ance of funds made available under section 510(d) of the 17 Social Security Act (42 U.S.C. 710(d)) (as in effect on 18 the day before the date of the enactment of this part) are 19 hereby transferred and made available to the Secretary to 20 carry out this section. The amounts transferred and made 21 available to carry out this section shall remain available 22 until expended. 23 ‘‘(i) DEFINITIONS.—In this section: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 446 •HR 6637 IH ‘‘(1) COMMUNITY ORGANIZATION.—The term 1 ‘community organization’ includes a State or local 2 health or education agency, public school, youth-fo- 3 cused organization that is faith-based and commu- 4 nity-based, juvenile justice entity, or other organiza- 5 tion that provides confidential and appropriate sexu- 6 ality education or sexual health services to 7 marginalized youth. 8 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en- 9 tity’ includes a State or local health or education 10 agency, public school, nonprofit organization, hos- 11 pital, or an Indian Tribe or Tribal organization (as 12 such terms are defined in section 4 of the Indian 13 Self-Determination and Education Assistance Act 14 (25 U.S.C. 5304)). 15 ‘‘(3) MARGINALIZED YOUTH.—The term 16 ‘marginalized youth’ means a person under the age 17 of 26 that is disadvantaged by underlying structural 18 barriers and social inequity. 19 ‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 20 The term ‘medically accurate and complete’, when 21 used with respect to information, means information 22 that— 23 ‘‘(A) is supported by research and recog- 24 nized as accurate, objective, and complete by 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 447 •HR 6637 IH leading medical, psychological, psychiatric, or 1 public health organizations and agencies; and 2 ‘‘(B) does not withhold any information re- 3 lating to the effectiveness and benefits of cor- 4 rect and consistent use of condoms or other 5 contraceptives and pregnancy prevention meth- 6 ods. 7 ‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 8 The term ‘scientifically effective strategy’ means a 9 strategy that— 10 ‘‘(A) is widely recognized by leading med- 11 ical and public health agencies as effective in 12 promoting sexual health awareness and healthy 13 behavior; and 14 ‘‘(B) either— 15 ‘‘(i) has been demonstrated to be ef- 16 fective on the basis of rigorous scientific 17 research; or 18 ‘‘(ii) incorporates characteristics of ef- 19 fective programs. 20 ‘‘(6) SEXUAL HEALTH SERVICES.—The term 21 ‘sexual health services’ includes— 22 ‘‘(A) sexual health information, education, 23 and counseling; 24 ‘‘(B) contraception; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 448 •HR 6637 IH ‘‘(C) emergency contraception; 1 ‘‘(D) condoms and other barrier methods 2 to prevent pregnancy or sexually transmitted in- 3 fections; 4 ‘‘(E) routine gynecological care, including 5 human papillomavirus (HPV) vaccines and can- 6 cer screenings; 7 ‘‘(F) pre-exposure prophylaxis or post-ex- 8 posure prophylaxis; 9 ‘‘(G) mental health services; 10 ‘‘(H) sexual assault survivor services; and 11 ‘‘(I) other prevention, care, or treatment.’’. 12 SEC. 509. GESTATIONAL DIABETES. 13 Part B of title III of the Public Health Service Act 14 (42 U.S.C. 243 et seq.) is amended by adding after section 15 317H the following: 16 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 17 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 18 TIONAL DIABETES.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Director of the Centers for Disease 21 Control and Prevention, in consultation with the Di- 22 abetes Mellitus Interagency Coordinating Committee 23 established under section 429 and representatives of 24 appropriate national health organizations, shall de- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 449 •HR 6637 IH velop a multisite gestational diabetes research 1 project within the diabetes program of the Centers 2 for Disease Control and Prevention to expand and 3 enhance surveillance data and public health research 4 on gestational diabetes. 5 ‘‘(2) AREAS TO BE ADDRESSED.—The research 6 project developed under paragraph (1) shall ad- 7 dress— 8 ‘‘(A) procedures to establish accurate and 9 efficient systems for the collection of gestational 10 diabetes data within each State and common- 11 wealth, territory, or possession of the United 12 States; 13 ‘‘(B) the progress of collaborative activities 14 with the National Vital Statistics System, the 15 National Center for Health Statistics, and 16 State health departments with respect to the 17 standard birth certificate, in order to improve 18 surveillance of gestational diabetes; 19 ‘‘(C) postpartum methods of tracking indi- 20 viduals with gestational diabetes after delivery 21 as well as targeted interventions proven to 22 lower the incidence of type 2 diabetes in that 23 population; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 450 •HR 6637 IH ‘‘(D) variations in the distribution of diag- 1 nosed and undiagnosed gestational diabetes, 2 and of impaired fasting glucose tolerance and 3 impaired fasting glucose, within and among 4 groups of pregnant individuals; and 5 ‘‘(E) factors and culturally sensitive inter- 6 ventions that influence risks and reduce the in- 7 cidence of gestational diabetes and related com- 8 plications during childbirth, including cultural, 9 behavioral, racial, ethnic, geographic, demo- 10 graphic, socioeconomic, and genetic factors. 11 ‘‘(3) REPORT.—Not later than 2 years after the 12 date of the enactment of this section, and annually 13 thereafter, the Secretary shall generate a report on 14 the findings and recommendations of the research 15 project including prevalence of gestational diabetes 16 in the multisite area and disseminate the report to 17 the appropriate Federal and non-Federal agencies. 18 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 19 SEARCH.— 20 ‘‘(1) IN GENERAL.—The Secretary shall expand 21 and intensify public health research regarding gesta- 22 tional diabetes. Such research may include— 23 ‘‘(A) developing and testing novel ap- 24 proaches for improving postpartum diabetes 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 451 •HR 6637 IH testing or screening and for preventing type 2 1 diabetes in individuals who can become preg- 2 nant with a history of gestational diabetes; and 3 ‘‘(B) conducting public health research to 4 further understanding of the epidemiologic, 5 socioenvironmental, behavioral, translation, and 6 biomedical factors and health systems that in- 7 fluence the risk of gestational diabetes and the 8 development of type 2 diabetes in individuals 9 who can become pregnant with a history of ges- 10 tational diabetes. 11 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 12 There is authorized to be appropriated to carry out 13 this subsection $5,000,000 for each of fiscal years 14 2021 through 2025. 15 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 16 RATE OF GESTATIONAL DIABETES.— 17 ‘‘(1) IN GENERAL.—The Secretary, acting 18 through the Director of the Centers for Disease 19 Control and Prevention, shall award grants, on a 20 competitive basis, to eligible entities for demonstra- 21 tion projects that implement evidence-based inter- 22 ventions to reduce the incidence of gestational diabe- 23 tes, the recurrence of gestational diabetes in subse- 24 quent pregnancies, and the development of type 2 di- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 452 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 453 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 454 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 455 •HR 6637 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 2021 through 2025. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 456 •HR 6637 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 contraceptives. 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 promotores, 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 contraceptives and an explanation 24 of the use, safety, efficacy, affordability, and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 457 •HR 6637 IH availability, including over-the-counter access, 1 of such contraceptives and options for access 2 without cost-sharing through insurance and 3 other programs; 4 (B) include emergency contraception to 5 health care providers, including pharmacists; 6 and 7 (C) be pilot tested for consumer com- 8 prehension, cultural and linguistic appropriate- 9 ness, and acceptance of the messages across 10 geographically, racially, ethnically, and linguis- 11 tically diverse populations. 12 (b) EMERGENCY CONTRACEPTION INFORMATION 13 PROGRAM FOR HEALTH CARE PROVIDERS.— 14 (1) IN GENERAL.—The Secretary, acting 15 through the Administrator of the Health Resources 16 and Services Administration and in consultation 17 with major medical and public health organizations, 18 shall develop and disseminate to health care pro- 19 viders, including pharmacists, information on emer- 20 gency contraceptives. 21 (2) INFORMATION.—The information dissemi- 22 nated under paragraph (1) shall include, at a min- 23 imum— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 458 •HR 6637 IH (A) information describing the use, safety, 1 efficacy, and availability of emergency contra- 2 ceptives, and options for access without cost- 3 sharing through insurance and other programs; 4 (B) a recommendation regarding the use of 5 such contraceptives; and 6 (C) information explaining how to obtain 7 copies of the information developed under sub- 8 section (a) for distribution to the patients of 9 the providers. 10 (c) DEFINITIONS.—In this section: 11 (1) HEALTH CARE PROVIDER.—The term 12 ‘‘health care provider’’ means an individual who is li- 13 censed or certified under State law to provide health 14 care services and who is operating within the scope 15 of such license. Such term shall include a phar- 16 macist. 17 (2) INSTITUTION OF HIGHER EDUCATION.—The 18 term ‘‘institution of higher education’’ has the same 19 meaning given such term in section 101(a) of the 20 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 21 (3) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services. 23 (d) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 459 •HR 6637 IH such sums as may be necessary for each of the fiscal years 1 2021 through 2025. 2 SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 3 (a) PURPOSES; FINDING; SENSE OF CONGRESS.— 4 (1) PURPOSES.—The purposes of this section 5 are to provide young people with comprehensive sex 6 education programs that— 7 (A) promote and uphold the rights of 8 young people to information in order to make 9 healthy decisions about their sexual health; 10 (B) provide the information and skills all 11 young people need to make informed, respon- 12 sible, and healthy decisions in order to become 13 sexually healthy adults and have healthy rela- 14 tionships; 15 (C) provide information about the preven- 16 tion of unintended pregnancy, sexually trans- 17 mitted infections, including HIV, dating vio- 18 lence, sexual assault, bullying, and harassment; 19 and 20 (D) provide resources and information on 21 topics ranging from gender stereotyping and 22 gender roles and stigma and socio-cultural in- 23 fluences surrounding sex and sexuality. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 460 •HR 6637 IH (2) FINDING ON REQUIRED RESOURCES.—In 1 order to provide the comprehensive sex education de- 2 scribed in paragraph (1), Congress finds that in- 3 creased resources are required for sex education pro- 4 grams that— 5 (A) substantially incorporate elements of 6 evidence-based programs or characteristics of 7 effective programs; 8 (B) cover a broad range of topics, includ- 9 ing medically accurate and complete informa- 10 tion that is age and developmentally appro- 11 priate about all the aspects of sex, sexual 12 health, and sexuality; 13 (C) are gender and gender identity-sen- 14 sitive, emphasizing the importance of equality 15 and the social environment for achieving sexual 16 and reproductive health and overall well-being; 17 (D) promote educational achievement, crit- 18 ical thinking, decisionmaking, self-esteem, and 19 self-efficacy; 20 (E) help develop healthy attitudes and in- 21 sights necessary for understanding relationships 22 between oneself and others and society; 23 (F) foster leadership skills and community 24 engagement by— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 461 •HR 6637 IH (i) promoting principles of fairness, 1 human dignity, and respect; and 2 (ii) engaging young people as partners 3 in their communities; and 4 (G) are culturally and linguistically appro- 5 priate, reflecting the diverse circumstances and 6 realities of young people. 7 (3) SENSE OF CONGRESS.—It is the sense of 8 Congress that— 9 (A) federally funded sex education pro- 10 grams should aim to— 11 (i) provide information about a range 12 of human sexuality topics, including— 13 (I) human development, healthy 14 relationships, personal skills; 15 (II) sexual behavior including ab- 16 stinence; 17 (III) sexual health including pre- 18 venting unintended pregnancy; 19 (IV) sexually transmitted infec- 20 tions including HIV; and 21 (V) society and culture; 22 (ii) promote safe and healthy relation- 23 ships; 24 (iii) promote gender equity; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 462 •HR 6637 IH (iv) use, and be informed by, the best 1 scientific information available; 2 (v) be culturally appropriate and in- 3 clusive of youth with varying gender identi- 4 ties, gender expressions, and sexual ori- 5 entations; 6 (vi) be built on characteristics of ef- 7 fective programs; 8 (vii) expand the existing body of re- 9 search on comprehensive sex education 10 programs through program evaluation; 11 (viii) expand training programs for 12 teachers of comprehensive sex education; 13 (ix) build on programs funded under 14 section 513 of the Social Security Act (42 15 U.S.C. 713) and the Office of Adolescent 16 Health’s Teen Pregnancy Prevention Pro- 17 gram, funded under title II of the Consoli- 18 dated Appropriations Act, 2010 (Public 19 Law 111–117; 123 Stat. 3253), and on 20 programs supported through the Centers 21 for Disease Control and Prevention (CDC); 22 and 23 (x) promote and uphold the rights of 24 young people to information in order to 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 463 •HR 6637 IH make healthy and autonomous decisions 1 about their sexual health; and 2 (B) no Federal funds should be used for 3 health education programs that— 4 (i) withhold health-promoting or life- 5 saving information about sexuality-related 6 topics, including HIV; 7 (ii) are medically inaccurate or have 8 been scientifically shown to be ineffective; 9 (iii) promote gender or racial stereo- 10 types; 11 (iv) are insensitive and unresponsive 12 to the needs of sexually active young peo- 13 ple; 14 (v) are insensitive and unresponsive to 15 the needs of survivors of sexual violence; 16 (vi) are insensitive and unresponsive 17 to the needs of youth of all physical, devel- 18 opmental, and mental abilities; 19 (vii) are insensitive and unresponsive 20 to the needs of youth with varying gender 21 identities, gender expressions, and sexual 22 orientations; or 23 (viii) are inconsistent with the ethical 24 imperatives of medicine and public health. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 464 •HR 6637 IH (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 1 FOR ADOLESCENTS.— 2 (1) PROGRAM AUTHORIZED.—The Secretary of 3 Health and Human Services, in coordination with 4 the Associate Commissioner of the Family and 5 Youth Services Bureau of the Administration on 6 Children, Youth, and Families of the Department of 7 Health and Human Services, the Director of the Of- 8 fice of Adolescent Health, the Director of the Divi- 9 sion of Adolescent and School Health within the 10 Centers for Disease Control and Prevention and the 11 Secretary of Education, shall award grants, on a 12 competitive basis, to eligible entities to enable such 13 eligible entities to carry out programs that provide 14 adolescents with comprehensive sex education, as de- 15 scribed in paragraph (6). 16 (2) DURATION.—Grants awarded under this 17 section shall be for a period of 5 years. 18 (3) ELIGIBLE ENTITY.—In this section, the 19 term ‘‘eligible entity’’ means a public or private enti- 20 ty that focuses on adolescent health and education 21 or has experience working with adolescents. 22 (4) APPLICATIONS.—An eligible entity desiring 23 a grant under this subsection shall submit an appli- 24 cation to the Secretary at such time, in such man- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 465 •HR 6637 IH ner, and containing such information as the Sec- 1 retary may require, including an assurance to par- 2 ticipate in the evaluation described in subsection (e). 3 (5) PRIORITY.—In awarding grants under this 4 section, the Secretary shall give priority to eligible 5 entities that— 6 (A) are State or local public entities; 7 (B) are entities not currently receiving 8 funds under— 9 (i) section 513 of the Social Security 10 Act (42 U.S.C. 713); 11 (ii) the Office of Adolescent Health’s 12 Teen Pregnancy Prevention Program, 13 funded under title II of the Consolidated 14 Appropriations Act, 2010 (Public Law 15 111–117; 123 Stat. 3253), or any substan- 16 tially similar successive program; or 17 (iii) the Centers for Disease Control 18 and Prevention’s Division of Adolescent 19 and School Health; and 20 (C) address health inequities among young 21 people that face systemic barriers resulting in 22 disproportionate rates of not less than one of 23 the following: 24 (i) Unintended pregnancies. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 466 •HR 6637 IH (ii) Sexually transmitted infections, 1 including HIV. 2 (iii) Dating violence and sexual vio- 3 lence. 4 (6) USE OF FUNDS.— 5 (A) IN GENERAL.—Each eligible entity 6 that receives a grant under this section shall 7 use the grant funds to carry out an education 8 program that provides adolescents with com- 9 prehensive sex education that— 10 (i) is age and developmentally appro- 11 priate; 12 (ii) is medically accurate and com- 13 plete; 14 (iii) substantially incorporates ele- 15 ments of evidence-based sex education in- 16 struction; or 17 (iv) creates a demonstration project 18 based on characteristics of effective pro- 19 grams. 20 (B) CONTENTS OF COMPREHENSIVE SEX 21 EDUCATION PROGRAMS.—The comprehensive 22 sex education programs funded under this sec- 23 tion shall include instruction and materials that 24 address— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 467 •HR 6637 IH (i) the physical, social, and emotional 1 changes of human development including, 2 human anatomy, reproduction, and sexual 3 development; 4 (ii) healthy relationships, including 5 friendships, within families, and society, 6 that are based on mutual respect, and the 7 ability to distinguish between healthy and 8 unhealthy relationships, including— 9 (I) effective communication, ne- 10 gotiation and refusal skills, including 11 the skills to recognize and report in- 12 appropriate or abusive sexual ad- 13 vances; 14 (II) bodily autonomy, setting and 15 respecting personal boundaries, prac- 16 ticing personal safety, and consent; 17 and 18 (III) the limitations and harm of 19 gender-role stereotypes, violence, coer- 20 cion, bullying, harassment, and intimi- 21 dation in relationships; 22 (iii) healthy decision-making skills 23 about sexuality and relationships that in- 24 clude— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 468 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 469 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 470 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 471 •HR 6637 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, as described in 24 paragraph (5)(B). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 472 •HR 6637 IH (2) DURATION.—Grants awarded under this 1 subsection shall be for a period of 5 years. 2 (3) APPLICATIONS.—An institution of higher 3 education or consortium of such institutions desiring 4 a grant under this subsection shall submit an appli- 5 cation to the Secretary at such time, in such man- 6 ner, and containing such information as the Sec- 7 retary may require, including an assurance to par- 8 ticipate in the evaluation described in subsection (e). 9 (4) PRIORITY.—In awarding grants under this 10 subsection, the Secretary shall give priority to an in- 11 stitution of higher education that— 12 (A) has an enrollment of needy students, 13 as 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 473 •HR 6637 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, or a consortium, receiving a grant 21 under this subsection shall use grant funds to 22 integrate issues relating to comprehensive sex 23 education into the institution of higher edu- 24 cation, or consortium, in order to reach a large 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 474 •HR 6637 IH number of students, by carrying out 1 or more 1 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 475 •HR 6637 IH materials that address the contents required 1 under subsection (b)(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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 476 •HR 6637 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 subsection shall submit an applica- 22 tion to the Secretary at such time, in such manner, 23 and containing such information as the Secretary 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 477 •HR 6637 IH may require, including an assurance to participate in 1 the 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 478 •HR 6637 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 subsection may 20 award subgrants to nonprofit organizations that 21 possess a demonstrated record of providing 22 training to faculty, school administrators, 23 teachers, and staff on comprehensive sex edu- 24 cation to— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 479 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 480 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 481 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 482 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 483 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 484 •HR 6637 IH section. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 485 •HR 6637 IH (f) NONDISCRIMINATION.—Programs funded under 1 this section shall not discriminate on the basis of actual 2 or perceived sex, race, color, ethnicity, national origin, dis- 3 ability, sexual orientation, gender identity, or religion. 4 Nothing in this section 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 section 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 486 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 487 •HR 6637 IH of the Elementary and Secondary Education Act of 1 1965 (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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 488 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 489 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 490 •HR 6637 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 subsection (f), the term ‘‘gender identity’’, when 11 used with respect to a sex education program, means 12 the gender-related identity, appearance, mannerisms, 13 or other gender-related characteristics of an indi- 14 vidual, regardless of the individual’s designated sex 15 at birth including a person’s deeply held sense or 16 knowledge of their own gender; such as male, fe- 17 male, both or 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 491 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 492 •HR 6637 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 (f), 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 section. 13 (j) FUNDING.— 14 (1) APPROPRIATION.—For the purpose of car- 15 rying out this section, there is appropriated 16 $75,000,000 for each of fiscal years 2021 through 17 2026. 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 493 •HR 6637 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 paragraph (1) 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 494 •HR 6637 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 section. 11 The amounts transferred and made available to 12 carry out this section shall remain available until ex- 13 pended. 14 (5) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 15 RIAGE PROGRAM.—Section 510 of the Social Secu- 16 rity Act (42 U.S.C. 710) is repealed. 17 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 18 GENCIES. 19 (a) MEDICARE.— 20 (1) LIMITATION ON PAYMENT.—Section 21 1866(a)(1) of the Social Security Act (42 U.S.C. 22 1395cc(a)(1)) is amended— 23 (A) by moving the indentation of subpara- 24 graph (W) 2 ems to the left; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 495 •HR 6637 IH (B) in subparagraph (X)— 1 (i) by moving the indentation 2 ems 2 to the left; and 3 (ii) by striking ‘‘and’’ at the end; 4 (C) in subparagraph (Y), by striking the 5 period at the end and inserting ‘‘; and’’; and 6 (D) by inserting after subparagraph (Y) 7 the following new subparagraph: 8 ‘‘(Z) in the case of a hospital or critical access 9 hospital, to adopt and enforce a policy to ensure 10 compliance with the requirements of subsection (l) 11 and to meet the requirements of such subsection.’’. 12 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 13 the Social Security Act (42 U.S.C. 1395cc) is 14 amended by adding at the end the following new 15 subsection: 16 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 17 GENCIES.— 18 ‘‘(1) IN GENERAL.—For purposes of section 19 1866(a)(1)(Z), a hospital meets the requirements of 20 this subsection if the hospital provides each of the 21 services described in paragraph (2) to each indi- 22 vidual, whether or not eligible for benefits under this 23 title or under any other form of health insurance, 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 496 •HR 6637 IH who comes to the hospital on or after January 1, 1 2021, and— 2 ‘‘(A) who states to hospital personnel that 3 they are victims of sexual assault; 4 ‘‘(B) who is accompanied by an individual 5 who states to hospital personnel that the indi- 6 vidual is a victim of sexual assault; or 7 ‘‘(C) whom hospital personnel, during the 8 course of treatment and care for the individual, 9 have reason to believe is a victim of sexual as- 10 sault. 11 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 12 purposes of paragraph (1), the services described in 13 this subparagraph are the following: 14 ‘‘(A) Provision of medically and factually 15 accurate and unbiased written and oral infor- 16 mation about emergency contraception that— 17 ‘‘(i) is written in clear and concise 18 language; 19 ‘‘(ii) is readily comprehensible; 20 ‘‘(iii) includes an explanation that 21 emergency contraceptives— 22 ‘‘(I) has been approved by the 23 Food and Drug Administration for in- 24 dividuals and is a safe and effective 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 497 •HR 6637 IH way to prevent pregnancy after unpro- 1 tected intercourse or contraceptive 2 failure if taken in a timely manner; 3 ‘‘(II) is more effective the sooner 4 it is taken; and 5 ‘‘(III) does not cause an abortion 6 and cannot interrupt an established 7 pregnancy; 8 ‘‘(iv) meets such conditions regarding 9 the provision of such information in lan- 10 guages other than English as the Secretary 11 may establish; and 12 ‘‘(v) is provided without regard to the 13 ability of the individual or their family to 14 pay costs associated with the provision of 15 such information to the individual. 16 ‘‘(B) Immediate offer to provide emergency 17 contraception to the individual at the hospital 18 and, in the case that the individual accepts such 19 offer, immediate provision to the individual of 20 such contraception on the same day it is re- 21 quested without regard to the inability of the 22 individual or their family to pay costs associ- 23 ated with the offer and provision of such con- 24 traception. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 498 •HR 6637 IH ‘‘(C) Development and implementation of a 1 written policy to ensure that an individual is 2 present at the hospital, or on-call, who— 3 ‘‘(i) has authority to dispense or pre- 4 scribe emergency contraception, independ- 5 ently, or under a protocol prepared by a 6 physician for the administration of emer- 7 gency contraception at the hospital to a 8 victim of sexual assault; and 9 ‘‘(ii) is trained to comply with the re- 10 quirements of this section. 11 ‘‘(D) Provision of medically and factually 12 accurate and unbiased written and oral infor- 13 mation and counseling about post-exposure pro- 14 phylaxis (PEP) protocol for the prevention of 15 HIV. 16 ‘‘(E) Immediately offer to begin PEP to 17 the individual at the hospital except in cases 18 where the medical professional’s best judgement 19 is that further evaluation is required or that 20 such a regimen will be substantially detrimental 21 to the individual’s health. Such provision shall 22 be offered regardless of the individual’s ability 23 to pay. Hospitals shall be responsible for ensur- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 499 •HR 6637 IH ing adequate supply of PEP medications to pro- 1 vide to patients. 2 ‘‘(3) HOSPITAL DEFINED.—For purposes of 3 this paragraph, the term ‘hospital’ includes a critical 4 access hospital, as defined in section 5 1861(mm)(1).’’. 6 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 7 Section 1903(i) of the Social Security Act (42 U.S.C. 8 1396b(i)) is amended by inserting after paragraph (8) the 9 following new paragraph: 10 ‘‘(9) with respect to any amount expended for 11 care or services furnished under the plan by a hos- 12 pital on or after January 1, 2021, unless such hos- 13 pital meets the requirements specified in section 14 1866(l) for purposes of title XVIII.’’. 15 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 16 MACIES TO ENSURE PROVISION OF FDA-AP- 17 PROVED CONTRACEPTION. 18 Part B of title II of the Public Health Service Act 19 (42 U.S.C. 238 et seq.) is amended by adding at the end 20 the following: 21 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 22 OF FDA-APPROVED CONTRACEPTION. 23 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 24 pharmacy that receives Food and Drug Administration- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 500 •HR 6637 IH approved drugs or devices in interstate commerce shall 1 maintain compliance with the following: 2 ‘‘(1) If a customer requests a contraceptive or 3 a medication related to a contraceptive, including 4 emergency contraception, that is in stock, the phar- 5 macy shall ensure that the contraceptive is provided 6 to the customer without delay. 7 ‘‘(2) If a customer requests a contraceptive or 8 a medication related to a contraceptive that is not 9 in stock and the pharmacy in the normal course of 10 business stocks contraception, the pharmacy shall 11 immediately inform the customer that the contracep- 12 tive is not in stock and without delay offer the cus- 13 tomer the following options: 14 ‘‘(A) If the customer prefers to obtain the 15 contraceptive or a medication related to a con- 16 traceptive through a referral or transfer, the 17 pharmacy shall— 18 ‘‘(i) locate a pharmacy of the cus- 19 tomer’s choice or the closest pharmacy 20 confirmed to have the contraceptive or a 21 medication related to a contraceptive in 22 stock; and 23 ‘‘(ii) refer the customer or transfer 24 the prescription to that pharmacy. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 501 •HR 6637 IH ‘‘(B) If the customer prefers for the phar- 1 macy to order the contraceptive or a medication 2 related to a contraceptive, the pharmacy shall 3 obtain the contraceptive or medication under 4 the pharmacy’s standard procedure for expe- 5 dited ordering of medication and notify the cus- 6 tomer when the contraceptive or medication ar- 7 rives. 8 ‘‘(3) The pharmacy shall ensure that— 9 ‘‘(A) the pharmacy does not operate an en- 10 vironment in which customers are intimidated, 11 threatened, or harassed in the delivery of serv- 12 ices relating to a request for contraception or a 13 medication related to a contraceptive; 14 ‘‘(B) the pharmacy’s employees do not 15 interfere with or obstruct the delivery of serv- 16 ices relating to a request for contraception or a 17 medication related to a contraceptive; 18 ‘‘(C) the pharmacy’s employees do not in- 19 tentionally misrepresent or deceive customers 20 about the availability of a contraceptive or a 21 medication related to a contraceptive, or the 22 mechanism of action of such contraceptive or 23 medication; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 502 •HR 6637 IH ‘‘(D) the pharmacy’s employees do not 1 breach medical confidentiality with respect to a 2 request for a contraceptive or a medication re- 3 lated to a contraceptive or threaten to breach 4 such confidentiality; or 5 ‘‘(E) the pharmacy’s employees do not 6 refuse to return a valid, lawful prescription for 7 a contraceptive or a medication related to a 8 contraceptive upon customer request. 9 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 10 STOCKED.—Nothing in subsection (a)(2) shall be con- 11 strued to require any pharmacy to comply with such sub- 12 section if the pharmacy does not ordinarily stock contra- 13 ceptives or a medication related to a contraceptive in the 14 normal course of business. 15 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 16 MACY PRACTICE.—This section does not prohibit a phar- 17 macy from refusing to provide a contraceptive or a medi- 18 cation related to a contraceptive to a customer in accord- 19 ance with any of the following: 20 ‘‘(1) If it is unlawful to dispense the contracep- 21 tive or a medication related to a contraceptive to the 22 customer without a valid, lawful prescription and no 23 such prescription is presented. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 503 •HR 6637 IH ‘‘(2) If the customer is unable to pay for the 1 contraceptive or the medication related to a contra- 2 ceptive. 3 ‘‘(3) If the employee of the pharmacy refuses to 4 provide the contraceptive or a medication related to 5 a contraceptive on the basis of a professional clinical 6 judgment. 7 ‘‘(d) RELATION TO OTHER LAW.— 8 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 9 this section shall be construed to invalidate or limit 10 rights, remedies, procedures, or legal standards 11 under title VII of the Civil Rights Act of 1964. 12 ‘‘(2) CERTAIN CLAIMS.—The Religious Free- 13 dom Restoration Act of 1993 shall not provide a 14 claim concerning, or a defense to a claim under this 15 section, or provide a basis for challenging the appli- 16 cation or enforcement of this section. 17 ‘‘(e) PREEMPTION.—This section does not preempt 18 any provision of State law or any professional obligation 19 made applicable by a State board or other entity respon- 20 sible for licensing or discipline of pharmacies or phar- 21 macists, to the extent that such State law or professional 22 obligation provides protections for customers that are 23 greater than the protections provided by this section. 24 ‘‘(f) ENFORCEMENT.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 504 •HR 6637 IH ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 1 lates a requirement of subsection (a) is liable to the 2 United States for a civil penalty in an amount not 3 exceeding $1,000 per day of violation, not to exceed 4 $100,000 for all violations adjudicated in a single 5 proceeding. 6 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 7 aggrieved as a result of a violation of a requirement 8 of subsection (a) may, in any court of competent ju- 9 risdiction, commence a civil action against the phar- 10 macy involved to obtain appropriate relief, including 11 actual and punitive damages, injunctive relief, and a 12 reasonable attorney’s fee and cost. 13 ‘‘(3) LIMITATIONS.—A civil action under para- 14 graph (1) or (2) may not be commenced against a 15 pharmacy after the expiration of the 5-year period 16 beginning on the date on which the pharmacy alleg- 17 edly engaged in the violation involved. 18 ‘‘(g) DEFINITIONS.—In this section: 19 ‘‘(1) CONTRACEPTION.—The term ‘contracep- 20 tion’ or ‘contraceptive’ means any drug or device ap- 21 proved by the Food and Drug Administration to pre- 22 vent pregnancy. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 505 •HR 6637 IH ‘‘(2) EMPLOYEE.—The term ‘employee’ means 1 a person hired, by contract or any other form of an 2 agreement, by a pharmacy. 3 ‘‘(3) MEDICATION RELATED TO A CONTRACEP- 4 TIVE.—The term ‘medication related to a contracep- 5 tive’ means any drug or device approved by the Food 6 and Drug Administration that a medical professional 7 determines necessary to use before or in conjunction 8 with a contraceptive. 9 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 10 an entity that— 11 ‘‘(A) is authorized by a State to engage in 12 the business of selling prescription drugs at re- 13 tail; and 14 ‘‘(B) employs one or more employees. 15 ‘‘(5) PRODUCT.—The term ‘product’ means a 16 Food and Drug Administration-approved drug or de- 17 vice. 18 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 19 The term ‘professional clinical judgment’ means the 20 use of professional knowledge and skills to form a 21 clinical judgment, in accordance with prevailing 22 medical standards. 23 ‘‘(7) WITHOUT DELAY.—The term ‘without 24 delay’, with respect to a pharmacy providing, pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 506 •HR 6637 IH viding a referral for, or ordering contraception, or 1 transferring the prescription for contraception, 2 means within the usual and customary timeframe at 3 the pharmacy for providing, providing a referral for, 4 or ordering other products, or transferring the pre- 5 scription for other products, respectively. 6 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 7 fect on the 31st day after the date of the enactment of 8 this section, without regard to whether the Secretary has 9 issued any guidance or final rule regarding this section.’’. 10 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 11 WOMEN’S HEALTH. 12 Section 229(b) of the Public Health Service Act (42 13 U.S.C. 237a(b)) is amended— 14 (1) in paragraph (6), at the end, by striking 15 ‘‘and’’; 16 (2) in paragraph (7), at the end, by striking the 17 period and inserting a semicolon; and 18 (3) by adding at the end the following new 19 paragraph: 20 ‘‘(8) facilitate policymakers, health system lead- 21 ers and providers, consumers, and other stake- 22 holders in understanding optimal maternity care and 23 support for the provision of such care, including the 24 priorities of— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 507 •HR 6637 IH ‘‘(A) protecting, promoting, and supporting 1 the innate capacities of childbearing individuals 2 and their newborns for childbirth, breastfeed- 3 ing, and attachment; 4 ‘‘(B) using obstetric interventions only 5 when such interventions are supported by 6 strong, high-quality evidence, and minimizing 7 overuse of maternity practices that have been 8 shown to have benefit in limited situations and 9 that can expose women, infants, or both to risk 10 of harm if used routinely and indiscriminately, 11 including continuous electronic fetal monitoring, 12 labor induction, epidural analgesia, primary ce- 13 sarean section, and routine repeat cesarean 14 birth; 15 ‘‘(C) reliably incorporating noninvasive, 16 evidence-based practices that have documented 17 correlation with considerable improvement in 18 outcomes with no detrimental side effects, such 19 as smoking cessation programs in pregnancy 20 and proven models of group prenatal care that 21 integrate health assessment, education, and 22 support into a unified program and supporting 23 evidence-based breastfeeding promotion efforts 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 508 •HR 6637 IH with respect for a breastfeeding individual’s 1 personal decisionmaking; 2 ‘‘(D) a shared understanding of the quali- 3 fications of licensed providers of maternity care 4 and the best evidence about the safety, satisfac- 5 tion, outcomes, and costs of their care, and ap- 6 propriate deployment of such caregivers within 7 the maternity care workforce to address the 8 needs of childbearing individuals and newborns 9 and the growing shortage of maternity care- 10 givers; 11 ‘‘(E) a shared understanding of the results 12 of the best available research comparing hos- 13 pital, birth center, and planned home births, in- 14 cluding information about each setting’s safety, 15 satisfaction, outcomes, and costs; 16 ‘‘(F) high-quality, evidence-based child- 17 birth education that promotes a natural, 18 healthy, and safe approach to pregnancy, child- 19 birth, and early parenting; is taught by certified 20 educators, peer counselors, and health profes- 21 sionals; and promotes informed decisionmaking 22 by childbearing individuals; and 23 ‘‘(G) developing measures that enable a 24 more robust, balanced set of standardized ma- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 509 •HR 6637 IH ternity care measures, including performance 1 and quality measures;’’. 2 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 3 THE PROMOTION OF OPTIMAL MATERNITY 4 OUTCOMES. 5 (a) IN GENERAL.—Part A of title II of the Public 6 Health Service Act (42 U.S.C. 202 et seq.) is amended 7 by adding at the end the following: 8 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 9 THE PROMOTION OF OPTIMAL MATERNITY 10 OUTCOMES. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Deputy Assistant Secretary for Women’s Health under 13 section 229 and in collaboration with the Federal officials 14 specified in subsection (b), shall establish the Interagency 15 Coordinating Committee on the Promotion of Optimal Ma- 16 ternity Outcomes (referred to in this section as the 17 ‘ICCPOM’). 18 ‘‘(b) OTHER AGENCIES.—The officials specified in 19 this subsection are the Secretary of Labor, the Secretary 20 of Defense, the Secretary of Veterans Affairs, the Surgeon 21 General, the Director of the Centers for Disease Control 22 and Prevention, the Administrator of the Health Re- 23 sources and Services Administration, the Administrator of 24 the Centers for Medicare & Medicaid Services, the Direc- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 510 •HR 6637 IH tor of the Indian Health Service, the Administrator of the 1 Substance Abuse and Mental Health Services Administra- 2 tion, the Director of the National Institute on Child 3 Health and Development, the Director of the Agency for 4 Healthcare Research and Quality, the Assistant Secretary 5 for Children and Families, the Deputy Assistant Secretary 6 for Minority Health, the Director of the Office of Per- 7 sonnel Management, and such other Federal officials as 8 the Secretary of Health and Human Services determines 9 to be appropriate. 10 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 11 Women’s Health shall serve as the chair of the ICCPOM. 12 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 13 program development across the Federal Government with 14 respect to promotion of optimal maternity care, provided, 15 however, that nothing in this section shall be construed 16 as transferring regulatory or program authority from an 17 agency to the ICCPOM. 18 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 19 seek the input of, and shall consult with, all appropriate 20 and interested stakeholders, including State health depart- 21 ments, public health research and interest groups, founda- 22 tions, childbearing individuals and their advocates, and 23 maternity care professional associations and organiza- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 511 •HR 6637 IH tions, reflecting racially, ethnically, demographically, and 1 geographically diverse communities. 2 ‘‘(f) ANNUAL REPORT.— 3 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 4 the ICCPOM, shall annually submit to Congress a 5 report that summarizes— 6 ‘‘(A) all programs and policies of Federal 7 agencies (including the Medicare Program 8 under title XVIII of the Social Security Act and 9 the Medicaid program under title XIX of such 10 Act) designed to promote optimal maternity 11 care, focusing particularly on programs and 12 policies that support the adoption of evidence 13 based maternity care, as defined by timely, sci- 14 entifically sound systematic reviews; 15 ‘‘(B) 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 address the problems of mater- 20 nal mortality and morbidity, infant mortality, 21 prematurity, and low birth weight, including 22 such programs and policies designed to address 23 racial and ethnic disparities with respect to 24 each of such problems; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 512 •HR 6637 IH ‘‘(C) the extent of progress in reducing 1 maternal mortality and infant mortality, low 2 birth weight, and prematurity at State and na- 3 tional levels; and 4 ‘‘(D) such other information regarding op- 5 timal maternity care (such as quality and per- 6 formance measures) as the Secretary deter- 7 mines to be appropriate. 8 The information specified in subparagraph (C) shall 9 be included in each such report in a manner that 10 disaggregates such information by race, ethnicity, 11 and indigenous status in order to determine the ex- 12 tent of progress in reducing racial and ethnic dis- 13 parities and disparities related to indigenous status. 14 ‘‘(2) CERTAIN INFORMATION.—Each report 15 under paragraph (1) shall include information 16 (disaggregated by race, ethnicity, and indigenous 17 status, as applicable) on the following rates and 18 costs by State: 19 ‘‘(A) The rate of primary cesarean deliv- 20 eries and repeat cesarean deliveries. 21 ‘‘(B) The rate of vaginal births after cesar- 22 ean. 23 ‘‘(C) The rate of vaginal breech births. 24 ‘‘(D) The rate of induction of labor. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 513 •HR 6637 IH ‘‘(E) The rate of freestanding birth center 1 births. 2 ‘‘(F) The rate of planned and unplanned 3 home birth. 4 ‘‘(G) The rate of attended births by pro- 5 vider, including by an obstetrician-gynecologist, 6 family practice physician, obstetrician-gyne- 7 cologist physician assistant, certified nurse-mid- 8 wife, certified midwife, and certified profes- 9 sional midwife. 10 ‘‘(H) The cost of maternity care 11 disaggregated by place of birth and provider of 12 care, including— 13 ‘‘(i) uncomplicated vaginal birth; 14 ‘‘(ii) complicated vaginal birth; 15 ‘‘(iii) uncomplicated cesarean birth; 16 and 17 ‘‘(iv) complicated cesarean birth. 18 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated, in addition to amounts 20 authorized to be appropriated under section 229(e), to 21 carry out this section $1,000,000 for each of the fiscal 22 years 2021 through 2025.’’. 23 (b) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 514 •HR 6637 IH (1) INCLUSION AS DUTY OF HHS OFFICE ON 1 WOMEN’S HEALTH.—Section 229(b) of such Act (42 2 U.S.C. 237a(b)), as amended by section 514, is fur- 3 ther amended by adding at the end the following 4 new paragraph: 5 ‘‘(9) establish the Interagency Coordinating 6 Committee on the Promotion of Optimal Maternity 7 Outcomes in accordance with section 229A; and’’. 8 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 9 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 10 amended by inserting ‘‘(other than under subsection 11 (b)(9))’’ after ‘‘under this section’’. 12 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 13 Section 229(b) of the Public Health Service Act (42 14 U.S.C. 237a(b)), as amended by sections 514 and 515, 15 is further amended by adding at the end the following: 16 ‘‘(10) not later than one year after the date of 17 the enactment of the Health Equity and Account- 18 ability Act of 2020, develop and implement a 4-year 19 culturally and linguistically appropriate multimedia 20 consumer education campaign that is designed to 21 promote understanding and acceptance of evidence- 22 based maternity practices and models of care for op- 23 timal maternity outcomes among individuals of 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 515 •HR 6637 IH childbearing ages and families of such individuals 1 and that— 2 ‘‘(A) highlights the importance of pro- 3 tecting, promoting, and supporting the innate 4 capacities of childbearing individuals and their 5 newborns for childbirth, breastfeeding, and at- 6 tachment; 7 ‘‘(B) promotes understanding of the impor- 8 tance of using obstetric interventions when 9 medically necessary and when supported by 10 strong, high-quality evidence; 11 ‘‘(C) highlights the widespread overuse of 12 maternity practices that have been shown to 13 have benefit when used appropriately in situa- 14 tions of medical necessity, but which can expose 15 pregnant individuals, infants, or both to risk of 16 harm if used routinely and indiscriminately, in- 17 cluding continuous fetal monitoring, labor in- 18 duction, epidural anesthesia, elective primary 19 cesarean section, and repeat cesarean delivery; 20 ‘‘(D) emphasizes the noninvasive maternity 21 practices that have strong proven correlation or 22 may be associated with considerable improve- 23 ment in outcomes with no detrimental side ef- 24 fects, and are significantly underused in the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 516 •HR 6637 IH United States, including smoking cessation pro- 1 grams in pregnancy, group model prenatal care, 2 continuous labor support, nonsupine positions 3 for birth, and external version to turn breech 4 babies at term; 5 ‘‘(E) educates consumers about the quali- 6 fications of licensed providers of maternity care 7 and the best evidence about their safety, satis- 8 faction, outcomes, and costs; 9 ‘‘(F) informs consumers about the best 10 available research comparing birth center 11 births, planned home births, and hospital 12 births, including information about each set- 13 ting’s safety, satisfaction, outcomes, and costs; 14 ‘‘(G) fosters participation in high-quality, 15 evidence-based childbirth education that pro- 16 motes a natural, healthy, and safe approach to 17 pregnancy, childbirth, and early parenting; is 18 taught by certified educators, peer counselors, 19 and health professionals; and promotes in- 20 formed decisionmaking by childbearing individ- 21 uals; and 22 ‘‘(H) is pilot tested for consumer com- 23 prehension, cultural sensitivity, and acceptance 24 of the messages across geographically, racially, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 517 •HR 6637 IH ethnically, and linguistically diverse popu- 1 lations.’’. 2 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 3 VIEWS FOR CARE OF CHILDBEARING INDI- 4 VIDUALS AND NEWBORNS. 5 (a) IN GENERAL.—Not later than one year after the 6 date of the enactment of this Act, the Secretary of Health 7 and Human Services, through the Agency for Healthcare 8 Research and Quality, shall— 9 (1) make publicly available an online biblio- 10 graphic database identifying systematic reviews, in- 11 cluding an explanation of the level and quality of 12 evidence, for care of childbearing individuals and 13 newborns; and 14 (2) initiate regular updates that incorporate 15 newly issued and updated systematic reviews. 16 (b) SOURCES.—To aim for a comprehensive inventory 17 of systematic reviews relevant to maternal and newborn 18 care, the database shall identify reviews from diverse 19 sources, including— 20 (1) scientific peer-reviewed journals; 21 (2) databases, including Cochrane Database of 22 Systematic Reviews, Clinical Evidence, and Data- 23 base of Abstracts of Reviews of Effects; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 518 •HR 6637 IH (3) Internet websites of agencies and organiza- 1 tions throughout the world that produce such sys- 2 tematic reviews. 3 (c) FEATURES.—The database shall— 4 (1) provide bibliographic citations for each 5 record within the database, and for each such cita- 6 tion include an explanation of the level and quality 7 of evidence; 8 (2) include abstracts, as available; 9 (3) provide reference to companion documents 10 as may exist for each review, such as evidence tables 11 and guidelines or consumer educational materials de- 12 veloped from the review; 13 (4) provide links to the source of the full review 14 and to any companion documents; 15 (5) provide links to the source of a previous 16 version or update of the review; 17 (6) be searchable by intervention or other topic 18 of the review, reported outcomes, author, title, and 19 source; and 20 (7) offer to users periodic electronic notification 21 of database updates relating to users’ topics of inter- 22 est. 23 (d) OUTREACH.—Not later than the first date the 24 database is made publicly available and periodically there- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 519 •HR 6637 IH after, the Secretary of Health and Human Services shall 1 publicize the availability, features, and uses of the data- 2 base under this section to the stakeholders described in 3 subsection (e). 4 (e) CONSULTATION.—For purposes of developing the 5 database under this section and maintaining and updating 6 such database, the Secretary of Health and Human Serv- 7 ices shall convene and consult with an advisory committee 8 composed of relevant stakeholders, including— 9 (1) Federal Medicaid administrators and State 10 agencies administrating State plans under title XIX 11 of the Social Security Act pursuant to section 12 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 13 (2) providers of maternity and newborn care 14 from both academic and community-based settings, 15 including obstetrician-gynecologists, family physi- 16 cians, certified nurse midwives, certified midwives, 17 certified professional midwives, physician assistants, 18 perinatal nurses, pediatricians, and nurse practi- 19 tioners; 20 (3) maternal-fetal medicine specialists; 21 (4) neonatologists; 22 (5) childbearing individuals and advocates for 23 such individuals, including childbirth educators cer- 24 tified by a nationally accredited program, rep- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 520 •HR 6637 IH resenting communities that are diverse in terms of 1 race, ethnicity, indigenous status, and geographic 2 area; 3 (6) employers and purchasers; 4 (7) health facility and system leaders, including 5 both hospital and birth center facilities; 6 (8) journalists; and 7 (9) bibliographic informatics specialists. 8 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 9 authorized to be appropriated $2,500,000 for each of the 10 fiscal years 2021 through 2023 for the purpose of devel- 11 oping the database and such sums as may be necessary 12 for each subsequent fiscal year for updating the database 13 and providing outreach and notification to users, as de- 14 scribed in this section. 15 SEC. 518. EXPANSION OF CDC PREVENTION RESEARCH 16 CENTERS PROGRAM TO INCLUDE CENTERS 17 ON OPTIMAL MATERNITY OUTCOMES. 18 (a) IN GENERAL.—Not later than one year after the 19 date of the enactment of this Act, the Secretary of Health 20 and Human Services shall support the establishment of 21 additional Prevention Research Centers under the Preven- 22 tion Research Center Program administered by the Cen- 23 ters for Disease Control and Prevention. Such additional 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 521 •HR 6637 IH centers shall each be known as a Center for Excellence 1 on Optimal Maternity Outcomes. 2 (b) RESEARCH.—Each Center for Excellence on Opti- 3 mal Maternity Outcomes shall— 4 (1) conduct at least one focused program of re- 5 search to improve maternity outcomes, including the 6 reduction of cesarean birth rates, elective inductions, 7 prematurity rates, and low birth weight rates within 8 an underserved population that has a disproportion- 9 ately large burden of suboptimal maternity out- 10 comes, including maternal mortality and morbidity, 11 infant mortality, prematurity, or low birth weight, 12 and developing performance and quality measures 13 for accountability; 14 (2) work with partners on special interest 15 projects, as specified by the Centers for Disease 16 Control and Prevention and other relevant agencies 17 within the Department of Health and Human Serv- 18 ices, and on projects funded by other sources; and 19 (3) involve a minimum of two distinct birth set- 20 ting models, such as a hospital labor and delivery 21 model and freestanding birth center model; or a hos- 22 pital labor and delivery model and planned home 23 birth model. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 522 •HR 6637 IH (c) INTERDISCIPLINARY PROVIDERS.—Each Center 1 for Excellence on Optimal Maternity Outcomes shall in- 2 clude the following interdisciplinary providers of maternity 3 care: 4 (1) Obstetrician-gynecologists. 5 (2) At least two of the following providers: 6 (A) Family practice physicians. 7 (B) Nurse practitioners. 8 (C) Physician assistants. 9 (D) Certified professional midwives. 10 (d) SERVICES.—Research conducted by each Center 11 for Excellence on Optimal Maternity Outcomes shall in- 12 clude at least 2 (and preferably more) of the following sup- 13 portive provider services: 14 (1) Mental health. 15 (2) Doula labor support. 16 (3) Nutrition education. 17 (4) Childbirth education. 18 (5) Social work. 19 (6) Physical therapy or occupation therapy. 20 (7) Substance abuse services. 21 (8) Home visiting. 22 (e) COORDINATION.—The programs of research at 23 each of the two Centers of Excellence on Optimal Mater- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 523 •HR 6637 IH nity Outcomes shall complement and not replicate the 1 work of the other. 2 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 3 authorized to be appropriated to carry out this section 4 $2,000,000 for each of the fiscal years 2021 through 5 2025. 6 SEC. 519. EXPANDING MODELS ALLOWED TO BE TESTED BY 7 CENTER FOR MEDICARE & MEDICAID INNO- 8 VATION TO INCLUDE MATERNITY CARE MOD- 9 ELS. 10 Section 1115A(b)(2)(B) of the Social Security Act 11 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 12 end the following new clause: 13 ‘‘(xxviii) Promoting evidence-based 14 models of care that have been associated 15 with reductions in maternal and infant 16 health disparities, including incorporating 17 the use of doula and promotoras support 18 for pregnant and childbearing individuals 19 into evidence-based models of prenatal 20 care, labor and delivery, and postpartum 21 care, and supporting the appropriate use of 22 out-of-hospital birth models, including 23 births at home and in freestanding birth 24 centers.’’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 524 •HR 6637 IH SEC. 520. DEVELOPMENT OF INTERPROFESSIONAL MATER- 1 NITY CARE EDUCATIONAL MODELS AND 2 TOOLS. 3 (a) IN GENERAL.—Not later than 6 months after the 4 date of the enactment of this Act, the Secretary of Health 5 and Human Services, acting in conjunction with the Ad- 6 ministrator of Health Resources and Services Administra- 7 tion, shall convene, for a 1-year period, an Interprofes- 8 sional Maternity Provider Education Commission to dis- 9 cuss and make recommendations for— 10 (1) a consensus standard physiologic maternity 11 care curriculum that takes into account the core 12 competencies for basic midwifery practice such as 13 those developed by the American College of Nurse 14 Midwives and the North American Registry of Mid- 15 wives, and the educational objectives for physicians 16 practicing in obstetrics and gynecology as deter- 17 mined by the Council on Resident Education in Ob- 18 stetrics and Gynecology; 19 (2) suggestions for multidisciplinary use of the 20 consensus physiologic curriculum; 21 (3) strategies to integrate and coordinate edu- 22 cation across maternity care disciplines, including 23 recommendations to increase medical and midwifery 24 student exposure to out-of-hospital birth; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 525 •HR 6637 IH (4) pilot demonstrations of interprofessional 1 educational models. 2 (b) PARTICIPANTS.—The Commission shall include 3 maternity care educators, curriculum developers, service 4 leaders, certification leaders, and accreditation leaders 5 from the various professions that provide maternity care 6 in the United States. Such professions shall include obste- 7 trician gynecologists, certified nurse midwives or certified 8 midwives, family practice physicians, nurse practitioners, 9 physician assistants, certified professional midwives, and 10 perinatal nurses. Additionally, the Commission shall in- 11 clude representation from maternity care consumer advo- 12 cates. 13 (c) CURRICULUM.—The consensus standard physio- 14 logic maternity care curriculum described in subsection 15 (a)(1) shall— 16 (1) have a public health focus with a foundation 17 in health promotion and disease prevention; 18 (2) foster physiologic childbearing and woman 19 and family centered care; 20 (3) integrate strategies to reduce maternal and 21 infant morbidity and mortality; 22 (4) incorporate recommendations to ensure re- 23 spectful, safe, and seamless consultation, referral, 24 transport, and transfer of care when necessary; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 526 •HR 6637 IH (5) include cultural sensitivity and strategies to 1 decrease disparities in maternity outcomes; and 2 (6) include implicit bias training. 3 (d) REPORT.—Not later than 6 months after the final 4 meeting of the Commission, the Secretary of Health and 5 Human Services shall— 6 (1) submit to Congress a report containing the 7 recommendations made by the Commission under 8 this section; and 9 (2) make such report publicly available. 10 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 11 authorized to be appropriated to carry out this section 12 $1,000,000 for each of the fiscal years 2021 and 2022, 13 and such sums as are necessary for each of the fiscal years 14 2023 through 2025. 15 SEC. 521. INCLUDING SERVICES FURNISHED BY CERTAIN 16 STUDENTS, INTERNS, AND RESIDENTS SU- 17 PERVISED BY CERTIFIED NURSE MIDWIVES 18 WITHIN INPATIENT HOSPITAL SERVICES 19 UNDER MEDICARE. 20 (a) IN GENERAL.—Section 1861(b) of the Social Se- 21 curity Act (42 U.S.C. 1395x(b)) is amended— 22 (1) in paragraph (6), by striking ‘‘; or’’ at the 23 end and inserting ‘‘, or in the case of services in a 24 hospital or osteopathic hospital by a student midwife 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 527 •HR 6637 IH or an intern or resident-in-training under a teaching 1 program previously described in this paragraph who 2 is in the field of obstetrics and gynecology, if such 3 student midwife, intern, or resident-in-training is su- 4 pervised by a certified nurse-midwife to the extent 5 permitted under applicable State law and as may be 6 authorized by the hospital;’’; 7 (2) in paragraph (7), by striking the period at 8 the end and inserting ‘‘; or’’; and 9 (3) by adding at the end the following new 10 paragraph: 11 ‘‘(8) a certified nurse-midwife where the hos- 12 pital has a teaching program approved as specified 13 in paragraph (6), if— 14 ‘‘(A) the hospital elects to receive any pay- 15 ment due under this title for reasonable costs of 16 such services; and 17 ‘‘(B) all certified nurse-midwives in such 18 hospital agree not to bill charges for profes- 19 sional services rendered in such hospital to indi- 20 viduals covered under the insurance program 21 established by this title.’’. 22 (b) EFFECTIVE DATE.—The amendments made by 23 subsection (a) shall apply to services furnished on or after 24 the date of the enactment of this Act. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 528 •HR 6637 IH SEC. 522. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 1 INCREASE DIVERSITY IN MATERNAL, REPRO- 2 DUCTIVE, AND SEXUAL HEALTH PROFES- 3 SIONALS. 4 (a) IN GENERAL.—The Secretary of Health and 5 Human Services, through the Administrator of the Health 6 Resources and Services Administration, shall carry out a 7 grant program under which the Secretary may make to 8 eligible organizations— 9 (1) for fiscal year 2021, planning grants de- 10 scribed in subsection (b); and 11 (2) for the subsequent 4-year period, implemen- 12 tation grants described in subsection (c). 13 (b) PLANNING GRANTS.— 14 (1) IN GENERAL.—Planning grants described in 15 this subsection are grants for the following purposes: 16 (A) To collect data and identify any work- 17 force disparities, with respect to a health pro- 18 fession, at each of the following areas along the 19 health professional continuum: 20 (i) Pipeline availability with respect to 21 students at the high school and college or 22 university levels considering and working 23 toward entrance in the profession, includ- 24 ing barriers triggered by criminal records. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 529 •HR 6637 IH (ii) Entrance into the training pro- 1 gram for the profession. 2 (iii) Graduation from such training 3 program. 4 (iv) Entrance into practice, including 5 barriers triggered by criminal records. 6 (v) Retention in practice for more 7 than a 5-year period. 8 (B) To develop one or more strategies to 9 address the workforce disparities within the 10 health profession, as identified under (and in 11 response to the findings pursuant to) subpara- 12 graph (A). 13 (2) APPLICATION.—To be eligible to receive a 14 grant under this subsection, an eligible health pro- 15 fessional organization shall submit to the Secretary 16 of Health and Human Services an application in 17 such form and manner and containing such informa- 18 tion as specified by the Secretary. 19 (3) AMOUNT.—Each grant awarded under this 20 subsection shall be for an amount not to exceed 21 $300,000. 22 (4) REPORT.—Each recipient of a grant under 23 this subsection shall submit to the Secretary of 24 Health and Human Services a report containing— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 530 •HR 6637 IH (A) information on the extent and distribu- 1 tion of workforce disparities identified through 2 the grant; and 3 (B) reasonable objectives and strategies 4 developed to address such disparities within a 5 5-, 10-, and 25-year period. 6 (c) IMPLEMENTATION GRANTS.— 7 (1) IN GENERAL.—Implementation grants de- 8 scribed in this subsection are grants to implement 9 one or more of the strategies developed pursuant to 10 a planning grant awarded under subsection (b). 11 (2) APPLICATION.—To be eligible to receive a 12 grant under this subsection, an eligible health pro- 13 fessional organization shall submit to the Secretary 14 of Health and Human Services an application in 15 such form and manner as specified by the Secretary. 16 Each such application shall contain information on 17 the capability of the organization to carry out a 18 strategy described in paragraph (1), involvement of 19 partners or coalitions, plans for developing sustain- 20 ability of the efforts after the culmination of the 21 grant cycle, and any other information specified by 22 the Secretary. 23 (3) AMOUNT.—Each grant awarded under this 24 subsection shall be for an amount not to exceed 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 531 •HR 6637 IH $500,000 each year during the 4-year period of the 1 grant. 2 (4) REPORTS.—For each of the first 3 years for 3 which an eligible health professional organization is 4 awarded a grant under this subsection, the organiza- 5 tion shall submit to the Secretary of Health and 6 Human Services a report on the activities carried 7 out by such organization through the grant during 8 such year and objectives for the subsequent year. 9 For the fourth year for which an eligible health pro- 10 fessional organization is awarded a grant under this 11 subsection, the organization shall submit to the Sec- 12 retary a report that includes an analysis of all the 13 activities carried out by the organization through the 14 grant and a detailed plan for continuation of out- 15 reach efforts. 16 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 17 TION DEFINED.—For purposes of this section, the term 18 ‘‘eligible health professional organization’’ means a profes- 19 sional organization representing obstetrician-gynecolo- 20 gists, certified nurse midwives, certified midwives, family 21 practice physicians, nurse practitioners whose scope of 22 practice includes maternity or sexual and reproductive 23 health care, physician assistants whose scope of practice 24 includes obstetrical or sexual and reproductive health care, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 532 •HR 6637 IH or certified professional midwives adolescent medicine spe- 1 cialists, and pediatricians who provide sexual and repro- 2 ductive health care. 3 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 4 authorized to be appropriated to carry out this section 5 $2,000,000 for fiscal year 2021 and $3,000,000 for each 6 of the fiscal years 2022 through 2025. 7 SEC. 523. INTERAGENCY UPDATE TO THE QUALITY FAMILY 8 PLANNING GUIDELINES. 9 (a) IN GENERAL.—Not later than six months after 10 the date of enactment of this Act, the Director of the Cen- 11 ters for Disease Control and Prevention and the Office 12 of Population Affairs shall review and expand the 2014 13 Quality Family Planning Guidelines to address— 14 (1) health disparities; and 15 (2) the importance of patient-directed contra- 16 ceptive decisionmaking. 17 (b) CONSULTATION.—In carrying out subsection (a), 18 the Director of the Centers for Disease Control and Pre- 19 vention and the Office of Population Affairs shall convene 20 a meeting, and solicit the views of, stakeholders including 21 experts on health disparities, experts on reproductive coer- 22 cion, representatives of provider organizations, patient ad- 23 vocates, reproductive justice organizations, organizations 24 that represent racial and ethnic minority communities, or- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 533 •HR 6637 IH ganizations that represent people with disabilities, organi- 1 zations that represent LGBTQ persons, and organizations 2 that represent people with limited English proficiency. 3 SEC. 524. DISSEMINATION OF THE QUALITY FAMILY PLAN- 4 NING GUIDELINES. 5 (a) IN GENERAL.—Not later than six months after 6 the date of enactment of this Act, the Secretary of Health 7 and Human Services and the Director of the Centers for 8 Disease Control and Prevention shall— 9 (1) develop a plan for outreach to publicly fund- 10 ed health care providers, including federally qualified 11 health centers and branches of the Indian Health 12 Service, about the quality family planning guidelines 13 referred to in section 524; and 14 (2) award grants to eligible entities to imple- 15 ment these guidelines for all patients seeking family 16 planning services. 17 (b) DEFINITION.—In this section, the term ‘‘eligible 18 entity’’ means a publicly funded health care provider that 19 serves persons of reproductive age. 20 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 534 •HR 6637 IH Subtitle B—Pregnancy Screening 1 SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE 2 DEMONSTRATION PROGRAM. 3 Part P of title III of the Public Health Service Act 4 (42 U.S.C. 280g et seq.) is amended by adding at the end 5 the following: 6 ‘‘SEC. 399V–7. PREGNANCY INTENTION SCREENING INITIA- 7 TIVE DEMONSTRATION PROGRAM. 8 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 9 acting through the Director of the Centers for Disease 10 Control and Prevention, shall establish a demonstration 11 program to facilitate the clinical adoption of pregnancy in- 12 tention screening initiatives by health care and social serv- 13 ices providers. 14 ‘‘(b) GRANTS.—The Secretary may carry out the 15 demonstration program through awarding grants to eligi- 16 ble entities to implement pregnancy intention screening 17 initiatives, collect data, and evaluate such initiatives. 18 ‘‘(c) ELIGIBLE ENTITIES.— 19 ‘‘(1) IN GENERAL.—An eligible entity under 20 this section is an entity described in paragraph (2) 21 that provides non-directive, comprehensive, medically 22 accurate information. 23 ‘‘(2) ENTITIES DESCRIBED.—For purposes of 24 paragraph (1), an entity described in this paragraph 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 535 •HR 6637 IH is a community-based organization, voluntary health 1 organization, public health department, community 2 health center, or other interested public or private 3 primary, behavioral, or other health care or social 4 service provider or organization. 5 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 6 TIVE.—For purposes of this section, the term ‘pregnancy 7 intention screening initiative’ means any initiative by an 8 eligible entity to routinely screen women with respect to 9 their pregnancy intentions and goals to either prevent un- 10 intended pregnancies or improve the likelihood of healthy 11 pregnancies, in order to better provide health care that 12 meets the contraceptive or pre-pregnancy needs and goals 13 of such women. 14 ‘‘(e) EVALUATION.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, shall, by grant or contract, 18 and after consultation as described in paragraph (2), 19 conduct an evaluation of the demonstration pro- 20 gram, with respect to pregnancy intention screening 21 initiatives, conducted under this section. Such eval- 22 uation shall include: 23 ‘‘(A) Assessment of the implementation of 24 pregnancy intention screening protocols among 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 536 •HR 6637 IH a diverse group of patients and providers, in- 1 cluding collecting data on the experiences and 2 outcomes for diverse patient populations in a 3 variety of clinical settings. 4 ‘‘(B) Analysis of outcome measures that 5 will facilitate effective and widespread adoption 6 of such protocols by health care providers for 7 inquiring about and responding to pregnancy 8 goals of women with both contraceptive and 9 pre-pregnancy care. 10 ‘‘(C) Consideration of health disparities 11 among the population served. 12 ‘‘(D) Assessment of the equitable and vol- 13 untary application of such initiatives to minor- 14 ity and medically underserved communities. 15 ‘‘(E) Assessment of the training, capacity, 16 and ongoing technical assistance needed for 17 providers to effectively implement such preg- 18 nancy intention screening protocols. 19 ‘‘(F) Assessment of whether referral sys- 20 tems for selected protocols follow evidence-based 21 standards that ensure access to comprehensive 22 health services and appropriate follow-up care. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 537 •HR 6637 IH ‘‘(G) Measuring through rigorous methods 1 the effect of such initiatives on key health out- 2 comes. 3 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX- 4 PERT ADVISORY PANEL.—In conducting evaluation 5 under paragraph (1), the Director of the Centers for 6 Disease Control and Prevention shall consult with 7 physicians, physician assistants, advanced practice 8 registered nurses, nurse midwives, and other health 9 care providers who specialize in women’s health, and 10 other experts in public health, clinical practice, pro- 11 gram evaluation, and research. 12 ‘‘(3) REPORT.—Not later than one year after 13 the last day of the demonstration program under 14 this section, the Director of the Centers for Disease 15 Control and Prevention shall submit to Congress a 16 report on the results of the evaluation conducted 17 under paragraph (1) and shall make the report pub- 18 licly available. 19 ‘‘(f) FUNDING.— 20 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 21 To carry out this section, there is authorized to be 22 appropriated $10,000,000 for each of fiscal years 23 2021 through 2025. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 538 •HR 6637 IH ‘‘(2) LIMITATION.—Not more than 20 percent 1 of funds appropriated to carry out this section pur- 2 suant to paragraph (1) for a fiscal year may be used 3 for purposes of the evaluation under subsection 4 (e).’’. 5 TITLE VI—MENTAL HEALTH 6 SEC. 601. MENTAL HEALTH FINDINGS. 7 Congress finds the following: 8 (1) Despite the existence of effective treat- 9 ments, inequities lie in the availability, accessibility, 10 and quality of mental health services for racial and 11 ethnic minorities and people with disabilities. 12 (2) These inequities have powerful significance 13 for minority groups and for society as a whole. 14 (3) Racial and ethnic minorities and people 15 with disabilities bear a greater burden from unmet 16 mental health needs and thus suffer a greater loss 17 to their overall health and productivity. 18 (4) Improving community conditions and one’s 19 home environment, paired with high-quality, acces- 20 sible, and culturally tailored mental health services, 21 can reduce the likelihood, frequency, and intensity of 22 challenges to one’s mental health. 23 (5) The presence of strong social connections 24 and trust, opportunities to experience and share cul- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 539 •HR 6637 IH tural identity, safe gathering places, and economic 1 opportunity are community factors that benefit men- 2 tal health. 3 (6) The social, physical, and economic condi- 4 tions in communities can have tremendous influence 5 on daily stressors that shape mental health out- 6 comes. 7 (7) The foremost barriers include the cost of 8 care, societal stigma, and the fragmented organiza- 9 tion of services. 10 (8) People with disabilities who are racial or 11 ethnic minorities may have co-occurring mental 12 health conditions which, without proper accommoda- 13 tions and support, further stigmatize them and limit 14 their participation in society. 15 (9) African-American, Latinx, Asian-American, 16 Pacific Islander, Native, and other people of color 17 have attitudes toward mental health challenges that 18 are another barrier to seeking mental health care. 19 (10) Mental illness retains considerable stigma 20 in many communities of color, including those of 21 Asian Americans and Pacific Islanders, and seeking 22 treatment is not always encouraged. 23 (11) Addressing mental health stigma and in- 24 creasing culturally appropriate treatment modalities 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 540 •HR 6637 IH in communities will help to increase utilization of 1 mental health services for people who have trouble 2 functioning because of mental health challenges. 3 (12) There is a link between mental health di- 4 agnosis and the likelihood of an individual commit- 5 ting suicide. 6 (13) A comprehensive public health approach to 7 behavioral health fosters protective factors in racial 8 and ethnic communities that support mental health. 9 (14) Approaches to mental health and address- 10 ing trauma must keep in mind the historical and 11 cultural trauma that has impacted many commu- 12 nities of color. 13 (15) Treatment modalities must keep individual 14 communities’ approaches to mental health in mind, 15 for example— 16 (A) cultural healing practices; and 17 (B) the mental health professionals needed 18 to provide those services such as peer support 19 specialists. 20 (16) Approaches to mental health and address- 21 ing trauma must keep in mind the concept of 22 intersectionality of individuals; that individuals may 23 have many inequities that shape the way they proc- 24 ess and experience everyday life. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 541 •HR 6637 IH SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERA- 1 PIST SERVICES, MENTAL HEALTH COUN- 2 SELOR SERVICES, AND SUBSTANCE ABUSE 3 COUNSELOR SERVICES UNDER PART B OF 4 THE MEDICARE PROGRAM. 5 (a) COVERAGE OF SERVICES.— 6 (1) IN GENERAL.—Section 1861(s)(2) of the 7 Social Security Act (42 U.S.C. 1395x(s)(2)), as 8 amended by section 431(c), is amended— 9 (A) in subparagraph (GG), by striking 10 ‘‘and’’ at the end; 11 (B) in subparagraph (HH), by inserting 12 ‘‘and’’ at the end; and 13 (C) by adding at the end the following new 14 subparagraph: 15 ‘‘(II) marriage and family therapist services (as 16 defined in subsection (lll)(1)) and mental health 17 counselor services (as defined in subsection (lll)(3)) 18 and substance abuse counselor services (as defined 19 in subsection (lll)(5));’’. 20 (2) DEFINITIONS.—Section 1861 of the Social 21 Security Act (42 U.S.C. 1395x), as amended by sec- 22 tions 205(b)(a), 413(a), and 431(c), is amended by 23 adding at the end the following new subsection: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 542 •HR 6637 IH ‘‘Marriage and Family Therapist Services; Marriage and 1 Family Therapist; Mental Health Counselor Serv- 2 ices; Mental Health Counselor; Substance Abuse 3 Counselor Services; Substance Abuse Counselor; 4 Peer Support Specialist 5 ‘‘(lll)(1) The term ‘marriage and family therapist 6 services’ means services performed by a marriage and 7 family therapist (as defined in paragraph (2)) for the diag- 8 nosis and treatment of mental illnesses, which the mar- 9 riage and family therapist is legally authorized to perform 10 under State law (or the State regulatory mechanism pro- 11 vided by State law) of the State in which such services 12 are performed, as would otherwise be covered if furnished 13 by a physician or as an incident to a physician’s profes- 14 sional service, but only if no facility or other provider 15 charges or is paid any amounts with respect to the fur- 16 nishing of such services. 17 ‘‘(2) The term ‘marriage and family therapist’ means 18 an individual who— 19 ‘‘(A) possesses a master’s or doctoral degree 20 that qualifies for licensure or certification as a mar- 21 riage and family therapist pursuant to State law, in- 22 cluding but not limited to, clinical social workers and 23 occupational therapists; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 543 •HR 6637 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 that the mental health counselor is le- 12 gally authorized to perform under State law (or the State 13 regulatory mechanism provided by the State law) of the 14 State in which such services are performed, as would oth- 15 erwise be covered if furnished by a physician or as incident 16 to a physician’s professional service, but only if no facility 17 or other provider charges or is paid any amounts with re- 18 spect 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, including 23 clinical social workers and occupational therapists; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 544 •HR 6637 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 that the substance 12 abuse counselor is legally authorized to perform under 13 State law (or the State regulatory mechanism provided by 14 the State law) of the State in which such services are per- 15 formed, as would otherwise be covered if furnished by a 16 physician or as incident to a physician’s professional serv- 17 ice, but only if no facility or other provider charges or is 18 paid any amounts with respect to the furnishing of such 19 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 545 •HR 6637 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 ‘‘(7) The term ‘peer support specialist’ means an in- 10 dividual who— 11 ‘‘(A) is an individual living in recovery with 12 mental illness, addiction, or systems involvement; 13 ‘‘(B) has skills learned in formal training; and 14 ‘‘(C) delivers services in behavioral health set- 15 tings to promote mind-body recovery and resil- 16 iency.’’. 17 (3) PROVISION FOR PAYMENT UNDER PART 18 B.—Section 1832(a)(2)(B) of the Social Security 19 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 20 (A) by striking ‘‘and’’ at the end of clause 21 (iv); and 22 (B) by adding at the end the following new 23 clause: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 546 •HR 6637 IH ‘‘(v) marriage and family therapist 1 services, mental health counselor services, 2 and substance abuse counselor services; 3 and’’. 4 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 5 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 6 as amended by section 431(c)(3), is amended— 7 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 8 (B) by inserting before the semicolon at 9 the end the following: ‘‘, and (EE) with respect 10 to marriage and family therapist services, men- 11 tal health counselor services, and substance 12 abuse counselor services under section 13 1861(s)(2)(II), the amounts paid shall be 80 14 percent of the lesser of the actual charge for 15 the services or 75 percent of the amount deter- 16 mined for payment of a psychologist under sub- 17 paragraph (L)’’. 18 (5) EXCLUSION OF MARRIAGE AND FAMILY 19 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR 20 SERVICES, AND PEER SUPPORT SPECIALIST SERV- 21 ICES FROM SKILLED NURSING FACILITY PROSPEC- 22 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 23 of the Social Security Act (42 U.S.C. 24 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 547 •HR 6637 IH riage and family therapist services (as defined in 1 section 1861(lll)(1)), mental health counselor serv- 2 ices (as defined in section 1861(lll)(3)),’’ after 3 ‘‘qualified psychologist services,’’. 4 (6) INCLUSION OF MARRIAGE AND FAMILY 5 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 6 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 7 FOR ASSIGNMENT OF CLAIMS.—Section 8 1842(b)(18)(C) of the Social Security Act (42 9 U.S.C. 1395u(b)(18)(C)) is amended by adding at 10 the end the following new clauses: 11 ‘‘(vii) A marriage and family therapist (as de- 12 fined in section 1861(lll)(2)). 13 ‘‘(viii) A mental health counselor (as defined in 14 section 1861(lll)(4)). 15 ‘‘(ix) A substance abuse counselor (as defined 16 in section 1861(lll)(6)). 17 ‘‘(x) A peer support specialist (as defined in 18 section 1861(III)(7)).’’. 19 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 20 ICES PROVIDED IN CERTAIN SETTINGS.— 21 (1) RURAL HEALTH CLINICS AND FEDERALLY 22 QUALIFIED HEALTH CENTERS.—Section 23 1861(aa)(1)(B) of the Social Security Act (42 24 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 548 •HR 6637 IH by a clinical social worker (as defined in subsection 1 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 2 (as defined in subsection (hh)(1)), by a marriage 3 and family therapist (as defined in subsection 4 (lll)(2)), or by a mental health counselor (as defined 5 in subsection (lll)(4)), or by a substance abuse coun- 6 selor (as defined in section 1861 (lll)(6)).’’. 7 (2) HOSPICE PROGRAMS.—Section 8 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 9 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in- 10 serting ‘‘or one marriage and family therapist (as 11 defined in subsection (lll)(2))’’ after ‘‘social worker’’. 12 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 13 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 14 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 15 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 16 amended by inserting ‘‘marriage and family therapist (as 17 defined in subsection (lll)(2)),’’ after ‘‘social worker,’’. 18 (d) EFFECTIVE DATE.—The amendments made by 19 this section shall apply with respect to services furnished 20 on or after January 1, 2021. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 549 •HR 6637 IH SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 1 PROGRAM. 2 Part D of title V of the Public Health Service Act 3 (42 U.S.C. 290dd et seq.) is amended by adding at the 4 end the following: 5 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 6 PROVISION OF BEHAVIORAL HEALTH CARE 7 IN PRIMARY CARE SETTINGS. 8 ‘‘(a) GRANTS.—The Secretary, acting through the 9 Assistant Secretary for Mental Health and Substance 10 Abuse, shall award grants to eligible entities for the pur- 11 pose of establishing interprofessional health care teams 12 that provide behavioral health care. 13 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 14 a grant under this section, an entity shall be a Federally 15 qualified health center (as defined in section 1861(aa) of 16 the Social Security Act), rural health clinic, or women’s 17 health clinics behavioral health program (including any 18 such program operated by a community-based organiza- 19 tion) serving a high proportion of individuals from racial 20 and ethnic minority groups (as defined in section 21 1707(g)). 22 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 23 allied health professionals to enter the mental health field, 24 an eligible entity receiving a grant under this section shall 25 agree to use at least $10,000 of the grant on a loan for- 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 550 •HR 6637 IH giveness program for practitioners who commit to working 1 in the mental health field for a period of two years. 2 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 3 Integrated health care funded through this section shall 4 be scientifically and culturally based, taking into consider- 5 ation the results of the most recent peer-reviewed research 6 available. 7 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there is authorized to be appro- 9 priated $20,000,000 for each of fiscal years 2021 through 10 2025.’’. 11 SEC. 604. ADDRESSING RACIAL AND ETHNIC MENTAL 12 HEALTH DISPARITIES RESEARCH GAPS. 13 (a) IN GENERAL.—Not later than 6 months after the 14 date of the enactment of this Act, the Director of the Na- 15 tional Institute on Minority Health and Health Disparities 16 shall enter into an arrangement with the National Acad- 17 emy of Sciences to carry out the activities under sub- 18 section (b), or, if the National Academy of Sciences de- 19 clines to enter into such an arrangement, the Director of 20 the National Institute on Minority Health and Health Dis- 21 parities, in cooperation with the Agency for Healthcare 22 Research and Quality, shall carry out the activities under 23 subsection (b). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 551 •HR 6637 IH (b) ACTIVITIES.—The applicable entity under sub- 1 section (a) shall— 2 (1) 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) submit to Congress a report on the results 7 of such study, including— 8 (A) a compilation of information on the dy- 9 namics of mental health outcomes in such racial 10 and ethnic minority groups; and 11 (B) the degree of the co-occurrence of 12 mental conditions with other disabilities in such 13 racial and ethnic groups, including physical dis- 14 abilities, mental disabilities, and mental dis- 15 orders or mental health conditions which co- 16 occur with one another; 17 (C) a compilation of information on the 18 impact of exposure to community violence, com- 19 munity trauma, adverse childhood experiences, 20 weather extremes worsened by climate change 21 (such as heat waves, hurricanes, and wildfires), 22 substance use, and other psychological traumas, 23 on mental disorders in such racial and minority 24 groups, stratified by household income level; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 552 •HR 6637 IH (D) a compilation of information on the 1 impact of the intersectionality of transgender 2 men in racial and ethnic minority groups; and 3 (E) a description of how protective factors 4 contrast and compare among different commu- 5 nities of color, identifying cultural strengths. 6 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 7 DRESS RACIAL AND ETHNIC MENTAL HEALTH 8 DISPARITIES. 9 (a) IN GENERAL.—The Secretary of Health and 10 Human Services, acting through the Assistant Secretary 11 for Mental Health and Substance Use, shall award grants 12 to qualified national organizations for the purposes of— 13 (1) developing, and disseminating to health pro- 14 fessional educational programs curricula or core 15 competencies addressing mental health inequities 16 among racial and ethnic minority groups for use in 17 the training of students in the professions of social 18 work, psychology, psychiatry, marriage and family 19 therapy, mental health counseling, peer support, and 20 substance abuse counseling; and 21 (2) certifying community health workers and 22 peer wellness specialists with respect to such cur- 23 ricula and core competencies and integrating and ex- 24 panding the use of such workers and specialists into 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 553 •HR 6637 IH health care and community-based settings to address 1 mental health disparities among racial and ethnic 2 minority groups. 3 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 4 tions receiving funds under subsection (a) may use the 5 funds to engage in the following activities related to the 6 development and dissemination of curricula or core com- 7 petencies described in subsection (a)(1): 8 (1) Formation of committees or working groups 9 comprised of experts from accredited health profes- 10 sions schools to identify core competencies relating 11 to mental health disparities among racial and ethnic 12 minority groups. 13 (2) Planning of workshops in national fora to 14 allow for public input, including input from commu- 15 nities of color with lived experience, into the edu- 16 cational needs associated with mental health dispari- 17 ties among racial and ethnic minority groups. 18 (3) Dissemination and promotion of the use of 19 curricula or core competencies in undergraduate and 20 graduate health professions training programs na- 21 tionwide. 22 (4) Establishing external stakeholder advisory 23 boards to provide meaningful input into policy and 24 program development and best practices to reduce 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 554 •HR 6637 IH mental health inequities among racial and ethnic 1 groups, including participation from communities of 2 color with lived experience of the impacts of mental 3 health disparities. 4 (c) DEFINITIONS.—In this section: 5 (1) QUALIFIED NATIONAL ORGANIZATION.—The 6 term ‘‘qualified national organization’’ means a na- 7 tional organization that focuses on the education of 8 students in programs of social work, occupational 9 therapy, psychology, psychiatry, and marriage and 10 family therapy. 11 (2) RACIAL AND ETHNIC MINORITY GROUP.— 12 The term ‘‘racial and ethnic minority group’’ has the 13 meaning given to such term in section 1707(g) of 14 the Public Health Service Act (42 U.S.C. 300u– 15 6(g)). 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 2021 through 2025. 20 SEC. 606. GEOACCESS STUDY. 21 The Assistant Secretary for Mental Health and Sub- 22 stance Use shall— 23 (1) conduct a study to— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 555 •HR 6637 IH (A) determine which geographic areas of 1 the United States have shortages of specialty 2 mental health providers; and 3 (B) assess the preparedness of speciality 4 mental health providers to deliver culturally and 5 linguistically appropriate, affordable, and acces- 6 sible services; and 7 (2) submit a report to Congress on the results 8 of such study. 9 SEC. 607. ASIAN AMERICAN, NATIVE HAWAIIAN, PACIFIC IS- 10 LANDER, AND HISPANIC AND LATINO BEHAV- 11 IORAL AND MENTAL HEALTH OUTREACH AND 12 EDUCATION STRATEGIES. 13 Part D of title V of the Public Health Service Act 14 (42 U.S.C. 290dd et seq.), as amended by section 603, 15 is further amended by adding at the end the following new 16 section: 17 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 18 AND EDUCATION STRATEGIES. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Assistant Secretary for Mental Health and Substance 21 Use, shall, in coordination with advocacy and behavioral 22 and mental health organizations serving populations of 23 Asian American, Native Hawaiian, Pacific Islander, and 24 Hispanic and Latino individuals or communities, develop 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 556 •HR 6637 IH and implement an outreach and education strategy to pro- 1 mote behavioral and mental health, clarify that behavioral 2 and mental health conditions are treatable and that rea- 3 sonable accommodations are required under section 504 4 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and 5 titles II and III of the Americans with Disabilities Act 6 of 1990 (42 U.S.C. 12131 et seq.), and reduce stigma as- 7 sociated with mental health conditions and substance 8 abuse among the Asian American, Native Hawaiian, and 9 Pacific Islander and Hispanic and Latino populations. 10 Such strategy shall— 11 ‘‘(1) be designed to— 12 ‘‘(A) meet the diverse cultural and lan- 13 guage needs of the various Asian American, 14 Native Hawaiian, Pacific Islander, and His- 15 panic and Latino populations; and 16 ‘‘(B) ensure such strategies are develop- 17 mentally (with respect to the beneficiary’s rel- 18 ative age and experience) and age appropriate, 19 as well as cognitively accessible to persons with 20 cognitive disabilities; 21 ‘‘(2) increase awareness of symptoms of mental 22 illnesses common among such populations, taking 23 into account differences within subgroups (such as 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 557 •HR 6637 IH gender, gender identity, age, sexual orientation, dis- 1 ability, and ethnicity) of such populations; 2 ‘‘(3) provide information on evidence-based, cul- 3 turally and linguistically appropriate and adapted 4 interventions and treatments; 5 ‘‘(4) ensure full participation of, and engage, 6 both consumers and community members in the de- 7 velopment and implementation of materials; and 8 ‘‘(5) seek to broaden the perspective among 9 both individuals in such communities and stake- 10 holders serving such communities to use a com- 11 prehensive public health approach to promoting be- 12 havioral health that addresses a holistic view of 13 health by focusing on the intersection between be- 14 havioral and physical health. 15 ‘‘(b) REPORTS.—Beginning not later than 1 year 16 after the date of the enactment of this section and annu- 17 ally thereafter, the Secretary, acting through the Assistant 18 Secretary, shall submit to Congress, and make publicly 19 available, a report on the extent to which the strategy de- 20 veloped and implemented under subsection (a) increased 21 behavioral and mental health outcomes associated with 22 mental health conditions and substance abuse among 23 Asian American, Native Hawaiian, Pacific Islander, and 24 Hispanic and Latino populations. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 558 •HR 6637 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 $300,000 for fiscal year 2021.’’. 3 SEC. 608. MENTAL HEALTH IN SCHOOLS. 4 (a) PURPOSE.—It is the purpose of this section to— 5 (1) revise, increase funding for, and expand the 6 scope of the Project AWARE State Educational 7 Agency Grant Program carried out by the Secretary 8 of Health and Human Services, in order to provide 9 access to more comprehensive school-based mental 10 health services and supports; 11 (2) provide for comprehensive staff development 12 for school and community service personnel working 13 in the school; 14 (3) provide for comprehensive training to im- 15 prove health and academic outcomes for children 16 with, or at risk for, mental health conditions, for 17 parents or guardians, siblings, and other family 18 members of such children, and for concerned mem- 19 bers of the community; 20 (4) provide for comprehensive, universal, evi- 21 dence-based screening to identify children and ado- 22 lescents with potential mental health conditions or 23 unmet emotional health needs; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 559 •HR 6637 IH (5) recognize best practices for the delivery of 1 mental health care in school-based settings, includ- 2 ing school-based health centers; 3 (6) provide for comprehensive training for par- 4 ents or guardians, siblings, other family members, 5 and concerned members of the community on behalf 6 of children and adolescents experiencing mental 7 health trauma, disorder, or disability; and 8 (7) establish formal working relationships be- 9 tween health, human service, and educational enti- 10 ties that support the mental and emotional health of 11 children and adolescents in the school setting. 12 (b) TECHNICAL AMENDMENTS.—The second part G 13 (relating to services provided through religious organiza- 14 tions) of title V of the Public Health Service Act (42 15 U.S.C. 290kk et seq.) is amended— 16 (1) by redesignating such part as part J; and 17 (2) by redesignating sections 581 through 584 18 as sections 596 through 596C, respectively. 19 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 20 DREN AND VIOLENCE.—Section 581 of the Public Health 21 Service Act (42 U.S.C. 290hh) is amended to read as fol- 22 lows: 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 560 •HR 6637 IH ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 1 AND ADOLESCENTS AND TRAUMA. 2 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 3 with the Secretary of Education, shall, directly or through 4 grants, contracts, or cooperative agreements awarded to 5 eligible entities described in subsection (c), assist local 6 communities and schools (including schools funded by the 7 Bureau of Indian Education) in applying a public health 8 approach to mental health services both in schools and in 9 the community. Such approach should provide comprehen- 10 sive developmentally appropriate services and supports, 11 that are linguistically and culturally appropriate and trau- 12 ma-informed, and incorporate developmentally appropriate 13 strategies of positive behavioral interventions and sup- 14 ports. A comprehensive school mental health program 15 funded under this section shall assist children in dealing 16 with traumatic experiences, grief, bereavement, risk of sui- 17 cide, violence, and individual and community trauma that 18 children may experience, and shall be implemented with 19 a focus on positive youth development. Causes of trauma 20 for children may include but are not limited to exposure 21 to multiple forms of violence and abuse, structural racism 22 and discrimination, family housing instability, family job 23 loss, and climate-related disasters. 24 ‘‘(b) ACTIVITIES.—Under the program under sub- 25 section (a), the Secretary may— 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 561 •HR 6637 IH ‘‘(1) provide financial support to enable local 1 communities to implement a comprehensive cul- 2 turally and linguistically appropriate, trauma-in- 3 formed, and developmentally appropriate, school- 4 based mental health program that— 5 ‘‘(A) builds awareness of multiple forms of 6 trauma, individual trauma, and intergenera- 7 tional, continuum of impacts of trauma, on pop- 8 ulations; 9 ‘‘(B) trains appropriate staff and edu- 10 cators to identify, and screen for, signs of trau- 11 ma exposure, mental health conditions, or risk 12 of suicide; and 13 ‘‘(C) incorporates positive behavioral inter- 14 ventions, family engagement, student treatment, 15 and multi-generational supports to foster the 16 health and development of children, prevent 17 mental health conditions, and ameliorate the 18 impacts of trauma; 19 ‘‘(2) provide technical assistance to local com- 20 munities with respect to the development of pro- 21 grams described in paragraph (1); 22 ‘‘(3) provide assistance to local communities in 23 the development of policies to address child and ado- 24 lescent trauma and mental health conditions; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 562 •HR 6637 IH ‘‘(4) facilitate community partnerships among 1 families, students, law enforcement agencies, edu- 2 cation agencies, mental health and substance use 3 disorder systems, family-based mental health service 4 systems, child welfare agencies, health care providers 5 (including primary care physicians, mental health 6 professionals, and other professionals who specialize 7 in children’s mental health such as child and adoles- 8 cent psychiatrists), institutions of higher education, 9 faith-based programs, trauma networks, public 10 health, youth development and recreation, youth em- 11 ployment organizations, and other community-based 12 systems; and 13 ‘‘(5) establish and promote trauma-informed, 14 culturally based, and supportive mechanisms for 15 children and adolescents to share their experiences 16 of individual and community trauma, including their 17 exposure to violence, with trusted adults. 18 ‘‘(c) REQUIREMENTS.— 19 ‘‘(1) IN GENERAL.—To be eligible for a grant, 20 contract, or cooperative agreement under subsection 21 (a), an entity shall— 22 ‘‘(A) be a partnership that includes— 23 ‘‘(i) a State educational agency (as 24 defined in section 8101 of the Elementary 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 563 •HR 6637 IH and Secondary Education Act of 1965) in 1 coordination with one or more local edu- 2 cational agencies (as defined in section 3 8101 of such Act) or a consortium of enti- 4 ties described in subparagraph (B), (C), 5 (D), or (E) of the definition of a local edu- 6 cational agency in section 8101 of such 7 Act; and 8 ‘‘(ii) in accordance with paragraph 9 (2)(A)(i), appropriate public or private en- 10 tities that employ interventions that are 11 evidence-based (as defined in section 8101 12 of the Elementary and Secondary Edu- 13 cation Act of 1965); and 14 ‘‘(B) submit an application, endorsed by 15 all members of the partnership, that— 16 ‘‘(i) specifies which members will 17 serve as the lead partners; and 18 ‘‘(ii) contains the assurances described 19 in paragraph (2). 20 ‘‘(2) REQUIRED ASSURANCES.—An application 21 under paragraph (1) shall contain assurances as fol- 22 lows: 23 ‘‘(A) The eligible entity will ensure that, in 24 carrying out activities under this section, the el- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 564 •HR 6637 IH igible entity will enter into a memorandum of 1 understanding— 2 ‘‘(i) with at least 2 entities from the 3 following categories: community-based, 4 public or private mental-health providers, 5 health care entities, public health entities, 6 law enforcement or juvenile justice entities, 7 child welfare agencies, family-based mental 8 health entities, trauma networks, commu- 9 nity-based entities, or other entities as de- 10 termined by the Secretary (which may in- 11 clude a human services agency or institu- 12 tion of higher education); and 13 ‘‘(ii) that clearly states— 14 ‘‘(I) the responsibilities of each 15 partner with respect to the activities 16 to be carried out, including how fam- 17 ily and community engagement will be 18 incorporated in the activities; 19 ‘‘(II) how school-employed and 20 school-based mental health profes- 21 sionals will be utilized for carrying out 22 such responsibilities; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 565 •HR 6637 IH ‘‘(III) how each such partner will 1 be accountable for carrying out such 2 responsibilities; and 3 ‘‘(IV) the amount of non-Federal 4 funding or in-kind contributions that 5 each such partner will contribute in 6 order to sustain the program. 7 ‘‘(B) The comprehensive school-based men- 8 tal health program carried out under this sec- 9 tion supports the flexible use of funds to ad- 10 dress— 11 ‘‘(i) universal prevention, through the 12 promotion of the social, emotional, mental, 13 and behavioral health of all students in an 14 environment that is conducive to learning; 15 ‘‘(ii) the reduction in the likelihood of 16 at-risk students developing social, emo- 17 tional, or behavioral health problems, or 18 substance use disorders; 19 ‘‘(iii) the screening for, and early 20 identification of, social, emotional, mental, 21 and behavioral problems, or substance use 22 disorders and the provision of early inter- 23 vention services; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 566 •HR 6637 IH ‘‘(iv) the treatment or referral for 1 treatment of students with existing social, 2 emotional, and mental behavioral health 3 problems, or substance use disorders; 4 ‘‘(v) the development and implementa- 5 tion of evidence-based programs (including 6 program curricula, school supports, and 7 after-school programs) to assist children 8 who are experiencing or have been exposed 9 to individual and community trauma or ex- 10 posed to multiple forms of violence; and 11 ‘‘(vi) the development and implemen- 12 tation of evidence-based programs to assist 13 children who are grieving, which may in- 14 clude training for school personnel on the 15 impact of trauma and bereavement on chil- 16 dren, and services to provide support to 17 grieving children. 18 ‘‘(C) The comprehensive school-based men- 19 tal health program carried out under this sec- 20 tion will provide for in-service training of all 21 school personnel, including ancillary staff and 22 volunteers, in— 23 ‘‘(i) the techniques and supports need- 24 ed to promote early identification of chil- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 567 •HR 6637 IH dren with trauma histories, children who 1 are grieving, and children with a mental 2 health condition or at risk of developing a 3 mental health condition, or who are at risk 4 of suicide; 5 ‘‘(ii) the use of referral mechanisms 6 that effectively link such children to appro- 7 priate prevention, treatment, and interven- 8 tion services in the school and in the com- 9 munity and to follow up when services are 10 not available; 11 ‘‘(iii) strategies that promote a school- 12 wide positive environment, including strat- 13 egies to prevent bullying, which includes 14 cyber-bullying; 15 ‘‘(iv) strategies for promoting the so- 16 cial, emotional, mental, and behavioral 17 health of all students; 18 ‘‘(v) strategies for promoting the so- 19 cial, emotional, mental, and behavioral 20 health of all students; and 21 ‘‘(vi) strategies to increase the knowl- 22 edge and skills of school and community 23 leaders about the impact of individual and 24 community trauma and exposure to mul- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 568 •HR 6637 IH tiple forms of violence on the application of 1 a public health approach to comprehensive 2 school-based mental health programs. 3 ‘‘(D) The comprehensive school-based men- 4 tal health program carried out under this sec- 5 tion will include comprehensive training for par- 6 ents or guardians, siblings, and other family 7 members of children with mental health condi- 8 tions, and for concerned members of the com- 9 munity, in— 10 ‘‘(i) the techniques and supports need- 11 ed to promote early identification of chil- 12 dren with trauma histories, children who 13 are grieving, children with a mental health 14 condition or at risk of developing a mental 15 health condition, and children who are at 16 risk of suicide; 17 ‘‘(ii) the use of referral mechanisms 18 that effectively link such children to appro- 19 priate prevention, treatment, and interven- 20 tion services in the school and in the com- 21 munity and followup when such services 22 are not available; and 23 ‘‘(iii) strategies that promote a school- 24 and community-wide positive environment, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 569 •HR 6637 IH including strategies to prevent bullying, in- 1 cluding cyber-bullying. 2 ‘‘(E) The comprehensive school-based men- 3 tal health program carried out under this sec- 4 tion will demonstrate the measures to be taken 5 to sustain the program (which may include 6 seeking funding for the program under a State 7 Medicaid plan under title XIX of the Social Se- 8 curity Act or a waiver of such a plan, or under 9 a State plan under subpart 1 of part B or part 10 E of title IV of the Social Security Act). 11 ‘‘(F) The eligible entity is supported by the 12 State agency with primary responsibility for be- 13 havioral health to ensure that comprehensive 14 school-based mental health program carried out 15 under this section will be sustainable after 16 funding under this section terminates. 17 ‘‘(G) The comprehensive school-based men- 18 tal health program carried out under this sec- 19 tion will be coordinated with early intervening 20 activities carried out under the Individuals with 21 Disabilities Education Act or activities funded 22 under part A of title IV of the Elementary and 23 Secondary Education Act of 1965. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 570 •HR 6637 IH ‘‘(H) The comprehensive school-based 1 mental health program carried out under this 2 section will be coordinated with early inter- 3 vening activities carried out under the Individ- 4 uals with Disabilities Education Act. 5 ‘‘(I) The comprehensive school-based men- 6 tal health program carried out under this sec- 7 tion will be trauma informed, evidence based, 8 and developmentally, culturally, and linguis- 9 tically appropriate. 10 ‘‘(J) The comprehensive school-based men- 11 tal health program carried out under this sec- 12 tion will include a broad needs assessment of 13 youth who drop out or are expelled from school 14 due to policies of ‘zero tolerance’ with respect 15 to drugs, alcohol, or weapons and an inability 16 to obtain appropriate services. 17 ‘‘(K) The mental health services provided 18 through the comprehensive school-based mental 19 health program carried out under this section 20 will be provided by qualified mental and behav- 21 ioral health professionals who are— 22 ‘‘(i) certified, credentialed, or licensed 23 by the State involved in compliance with 24 applicable Federal and State law; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 571 •HR 6637 IH ‘‘(ii) practicing within their area of 1 expertise. 2 ‘‘(L) The comprehensive school-based men- 3 tal health program carried out under this sec- 4 tion will permit students to self-refer to the pro- 5 gram for mental health care and self-consent 6 for mental health crisis care to the extent per- 7 mitted by State or other applicable law. 8 ‘‘(3) COORDINATOR.—Any entity that is a 9 member of a partnership described in paragraph 10 (1)(A) may serve as the coordinator of funding and 11 activities under the grant if all members of the part- 12 nership agree. 13 ‘‘(4) COMPLIANCE WITH HIPAA.—A grantee 14 under this section shall be deemed to be a covered 15 entity for purposes of compliance with the regula- 16 tions promulgated under section 264(c) of the 17 Health Insurance Portability and Accountability Act 18 of 1996 with respect to any patient records devel- 19 oped through activities under the grant. 20 ‘‘(5) COMPLIANCE WITH FERPA.—Section 444 21 of the General Education Provisions Act (commonly 22 known as the ‘Family Educational Rights and Pri- 23 vacy Act of 1974’) shall apply to any entity that is 24 a member of the partnership in the same manner 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 572 •HR 6637 IH that such section applies to an educational agency or 1 institution (as that term is defined in such section). 2 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 3 shall ensure that grants, contracts, or cooperative agree- 4 ments under subsection (a) will be distributed equitably 5 among the regions of the country and among urban and 6 rural areas. 7 ‘‘(e) DURATION OF AWARDS.—With respect to the 8 award of a grant, contract, or cooperative agreement 9 under subsection (a), the award shall be for a period of 10 5 years and may be renewed for subsequent 5-year peri- 11 ods. 12 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 13 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist- 14 ant Secretary shall develop a fiscally appropriate 15 process for evaluating activities carried out under 16 this section. Such process shall include— 17 ‘‘(A) the development of guidelines for the 18 submission of program data by grant, contract, 19 or cooperative agreement recipients; 20 ‘‘(B) the development of measures of out- 21 comes (in accordance with paragraph (2)) to be 22 applied by such recipients in evaluating pro- 23 grams carried out under this section; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 573 •HR 6637 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 Assistant Sec- 5 retary shall develop measures of outcomes to be 6 applied by recipients of assistance under this 7 section, and the Assistant Secretary, in evalu- 8 ating the effectiveness of programs carried out 9 under this section. Such measures shall include 10 student and family measures as provided for in 11 subparagraph (B) and local educational meas- 12 ures 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 and interventions carried out under a pro- 18 gram under this section, at a minimum include 19 provisions to evaluate whether the program is 20 effective in— 21 ‘‘(i) enhancing the social skills and 22 emotional resilience of all students, as well 23 as providing support to students who expe- 24 rience peer-inflicted bullying and isolation; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 574 •HR 6637 IH ‘‘(ii) improving academic outcomes, 1 including as measured by proficiency on 2 the annual assessments under section 3 1111(b)(2) of the Elementary and Sec- 4 ondary Education Act of 1965; 5 ‘‘(iii) reducing the incidence of behav- 6 iors that harm the self or others, or other- 7 wise disrupt the learning environment of 8 other students, when such behavior cannot 9 be reduced by the presence of reasonable 10 accommodations; 11 ‘‘(iv) improving participation and en- 12 gagement in classroom activities in chil- 13 dren with mental health conditions; 14 ‘‘(v) reducing substance use disorders; 15 ‘‘(vi) reducing rates of suicide; 16 ‘‘(vii) reducing suspensions, truancy, 17 expulsions, and violence; 18 ‘‘(viii) increasing high school gradua- 19 tion rates, calculated using the four-year 20 adjusted cohort graduation rate or the ex- 21 tended-year adjusted cohort graduation 22 rate (as such terms are defined in section 23 8101 of the Elementary and Secondary 24 Education Act of 1965); and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 575 •HR 6637 IH ‘‘(ix) improving attendance rates and 1 rates of chronic absenteeism; 2 ‘‘(x) improving access to care for men- 3 tal health conditions, including access to 4 mental health services that are trauma-in- 5 formed, and developmentally, linguistically, 6 and culturally appropriate; 7 ‘‘(xi) improving health outcomes; and 8 ‘‘(xii) decreasing disparities among 9 vulnerable and protected populations in 10 outcomes described in clauses (i) through 11 (xi). 12 ‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 13 The outcome measures developed under para- 14 graph (1)(B) relating to local educational sys- 15 tems shall, with respect to activities carried out 16 under a program under this section, at a min- 17 imum include provisions to evaluate— 18 ‘‘(i) the effectiveness of comprehensive 19 school mental health programs established 20 under this section; 21 ‘‘(ii) the effectiveness of formal part- 22 nership linkages among child and family 23 serving institutions, community support 24 systems, and the educational system; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 576 •HR 6637 IH ‘‘(iii) the progress made in sustaining 1 the program once funding under the grant 2 has expired; 3 ‘‘(iv) the effectiveness of training and 4 professional development programs for all 5 school personnel that incorporate indica- 6 tors that measure cultural and linguistic 7 competencies under the program in a man- 8 ner that incorporates appropriate cultural 9 and linguistic training; 10 ‘‘(v) the improvement in perception of 11 a safe and supportive learning environment 12 among school staff, students, and parents; 13 ‘‘(vi) the improvement in case-finding 14 of students in need of more intensive serv- 15 ices and referral of identified students to 16 early intervention and clinical services; 17 ‘‘(vii) the improvement in the imme- 18 diate availability of clinical assessment and 19 treatment services within the context of 20 the local community to students posing a 21 danger to themselves or others; 22 ‘‘(viii) the increased successful matric- 23 ulation to postsecondary school; 24 ‘‘(ix) reduced suicide rates; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 577 •HR 6637 IH ‘‘(x) referrals to juvenile justice; and 1 ‘‘(xi) increased educational equity. 2 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 3 ble entity described in subsection (c) that receives a 4 grant, contract, or cooperative agreement under this 5 section shall annually submit to the Assistant Sec- 6 retary a report that includes data to evaluate the 7 success of the program carried out by the entity 8 based on whether such program is achieving the pur- 9 poses of the program. Such reports shall utilize the 10 measures of outcomes under paragraph (2) in a rea- 11 sonable manner to demonstrate the progress of the 12 program in achieving such purposes. 13 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 14 Based on the data submitted under paragraph (3), 15 the Assistant Secretary shall annually submit to 16 Congress a report concerning the results and effec- 17 tiveness of the programs carried out with assistance 18 received under this section. 19 ‘‘(5) LIMITATION.—An eligible entity shall use 20 not more than 20 percent of amounts received under 21 a grant under this section to carry out evaluation 22 activities under this subsection. 23 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 24 retary shall establish comprehensive information and edu- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 578 •HR 6637 IH cation programs to disseminate the findings of the knowl- 1 edge development and application under this section to the 2 general public and to health care professionals. 3 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 4 APPROPRIATIONS.— 5 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 6 section shall be in an amount that is not more than 7 $2,000,000 for each of the first 5 fiscal years fol- 8 lowing the date of enactment of the Mental Health 9 Services for Students Act of 2019. The Secretary 10 shall determine the amount of each such grant based 11 on the population of children up to age 21 of the 12 area to be served under the grant. 13 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 14 There is authorized to be appropriated to carry out 15 this section $200,000,000 for each of the first 5 fis- 16 cal years following the date of enactment of the Im- 17 migrants’ Mental Health Act of 2020.’’. 18 (d) CONFORMING AMENDMENT.—Part G of title V 19 of the Public Health Service Act (42 U.S.C. 290hh et 20 seq.), as amended by this section, is further amended by 21 striking the part heading and inserting the following: 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 579 •HR 6637 IH ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 1 SEC. 609. BUILDING AN EFFECTIVE WORKFORCE IN MEN- 2 TAL HEALTH. 3 (a) IN GENERAL.—The Secretary of Health and 4 Human Services, in coordination with the Assistant Sec- 5 retary for Mental Health and Substance Use, the Adminis- 6 trator of the Health Resources and Services Administra- 7 tion, and the Secretary of Labor, shall, in coordination 8 with advocacy and behavioral and mental health organiza- 9 tions serving people of color— 10 (1) develop, strengthen, and implement strate- 11 gies to bolster career pathways for mental health 12 professionals; and 13 (2) identify the breadth of settings where men- 14 tal and behavioral health care can take place. 15 (b) CONTENTS.—Strategies under subsection (a) 16 shall include— 17 (1) the variety of settings where mental health 18 professionals are needed, including community-based 19 organizations, women’s centers, shelters, organiza- 20 tions focused on youth development, workforce agen- 21 cies, job placement and development centers, emer- 22 gency rooms, the special supplemental nutrition pro- 23 gram for women, infants, and children under section 24 17 of the Child Nutrition Act of 1966 (42 U.S.C. 25 1786), food banks, legal aid, and benefit issuers as 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 580 •HR 6637 IH defined in section 3 of the Food and Nutrition Act 1 of 2008 (7 U.S.C. 2012); 2 (2) defining career pathways in mental and be- 3 havioral health, to help communities understand the 4 variety of careers in mental health that are avail- 5 able; 6 (3) building career pathways in mental and be- 7 havioral health as part of the curriculum at the 8 postsecondary education level; 9 (4) providing accessible training and certifi- 10 cation pathways for lay health workers such as com- 11 munity health workers and other peer support indi- 12 viduals to ensure that careers pay a living wage; 13 (5) creating incentives for students in the fields 14 of occupational therapy, social work, medicine, and 15 nursing to learn more about mental health, and to 16 include a mental health rotation as a part of the 17 health professional curricula; 18 (6) including training and education for teach- 19 ers about the basics of section 504 of the Rehabilita- 20 tion Act of 1973 (29 U.S.C. 794) and individualized 21 education programs (as defined in section 614(d) of 22 the Individuals with Disabilities in Education Act 23 (20 U.S.C. 1414(d)); 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 581 •HR 6637 IH (7) researching, developing, and implementing 1 programs for mental and behavioral health profes- 2 sionals to prevent burnout; 3 (8) finding better and increased avenues to en- 4 sure equity by providing better loan forgiveness pro- 5 grams, including a focus area within the National 6 Health Service Corps focused on community trauma. 7 SEC. 610. MENTAL HEALTH AT THE BORDER. 8 (a) SHORT TITLE.—This section may be cited as the 9 ‘‘Immigrants’ Mental Health Act of 2020’’. 10 (b) TRAINING FOR CERTAIN CBP PERSONNEL IN 11 MENTAL HEALTH ISSUES.— 12 (1) TRAINING TO IDENTIFY RISK FACTORS AND 13 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 14 (A) IN GENERAL.—The Commissioner of 15 U.S. Customs and Border Protection, in con- 16 sultation with the Assistant Secretary for Men- 17 tal Health and Substance Use, the Adminis- 18 trator of the Health Resources and Services Ad- 19 ministration, and nongovernmental experts in 20 the delivery of health care in humanitarian cri- 21 ses and in the delivery of health care to chil- 22 dren, shall develop and implement a training 23 curriculum for U.S. Customs and Border Pro- 24 tection agents and officers assigned to U.S. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 582 •HR 6637 IH Customs and Border Protection facilities to en- 1 able such agents and officers to identify the 2 risk factors and warning signs in immigrants 3 and refugees of mental health issues relating to 4 trauma. 5 (B) REQUIREMENTS.—The training cur- 6 riculum described in subparagraph (A) shall— 7 (i) apply to all U.S. Customs and 8 Border Protection agents and officers 9 working at U.S. Customs and Border Pro- 10 tection facilities; 11 (ii) provide for crisis intervention 12 using a trauma-informed approach; and 13 (iii) provide for mental health 14 screenings for immigrants and refugees ar- 15 riving at the border in their preferred lan- 16 guage or with appropriate language assist- 17 ance. 18 (2) TRAINING TO ADDRESS MENTAL HEALTH 19 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 20 (A) IN GENERAL.—The Commissioner of 21 U.S. Customs and Border Protection, in con- 22 sultation with the Assistant Secretary for Men- 23 tal Health and Substance Use, the Adminis- 24 trator of the Health Resources and Services Ad- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 583 •HR 6637 IH ministration, and nongovernmental experts in 1 the delivery of mental health care, shall develop 2 and implement a training curriculum for U.S. 3 Customs and Border Protection agents and offi- 4 cers assigned to U.S. Customs and Border Pro- 5 tection facilities to address the mental health 6 and wellness of individuals working at such fa- 7 cilities. 8 (B) REQUIREMENT.—The training cur- 9 riculum described in subparagraph (A) shall be 10 designed to help U.S. Customs and Border Pro- 11 tection agents and officers working at U.S. 12 Customs and Border Protection facilities to— 13 (i) better manage their own stress and 14 the stress of their coworkers; and 15 (ii) be more aware of the psychological 16 pressures experienced during their jobs. 17 (3) ANNUAL REVIEW OF TRAINING.—Beginning 18 with respect to fiscal year 2022, the Assistant Sec- 19 retary for Mental Health and Substance Use shall— 20 (A) conduct an annual review of the train- 21 ing implemented pursuant to paragraphs (1) 22 and (2); and 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 584 •HR 6637 IH (B) submit the results of each such review, 1 including any recommendations for improve- 2 ment of such training, to— 3 (i) the Commissioner of U.S. Customs 4 and Border Protection; and 5 (ii) the Committees on Appropria- 6 tions, Energy and Commerce, Homeland 7 Security, and the Judiciary of the House 8 of Representatives and the Committees on 9 Appropriations, Health, Education, Labor, 10 and Pensions, and Homeland Security and 11 Governmental Affairs of the Senate. 12 (4) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this subsection, there is authorized to be 14 appropriated— 15 (A) for fiscal year 2021, $50,000 to de- 16 velop the training under paragraphs (1) and 17 (2); and 18 (B) for each of fiscal years 2022 through 19 2026— 20 (i) $20,000 to implement such train- 21 ing pursuant to paragraphs (1) and (2); 22 and 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 585 •HR 6637 IH (ii) such sums as may be necessary to 1 review and make recommendations for 2 such training pursuant to paragraph (3). 3 (c) STAFFING BORDER FACILITIES AND DETENTION 4 CENTERS.— 5 (1) IN GENERAL.—To adequately evaluate the 6 mental health needs of immigrants, refugees, border 7 patrol agents, and staff, the Commissioner of U.S. 8 Customs and Border Protection shall assign at least 9 one qualified mental or behavioral health expert to 10 each U.S. Customs and Border Protection facility. 11 (2) QUALIFICATIONS.—To be qualified for pur- 12 poses of paragraph (1), a mental or behavioral 13 health expert shall be— 14 (A) bilingual; 15 (B) well-versed in culturally appropriate 16 and trauma-informed interventions; and 17 (C) have particular expertise in child or 18 adolescent mental health or family mental 19 health. 20 (3) AUTHORIZATION OF APPROPRIATIONS.—To 21 carry out this subsection, there is authorized to be 22 appropriated $3,000,000 for each of fiscal years 23 2021 through 2025. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 586 •HR 6637 IH (d) NO SHARING OF DEPARTMENT OF HEALTH AND 1 HUMAN SERVICES MENTAL HEALTH INFORMATION FOR 2 ASYLUM DETERMINATIONS, IMMIGRATION HEARINGS, OR 3 DEPORTATION PROCEEDINGS.—The officers, employees, 4 and agents of the Department of Health and Human Serv- 5 ices, including the Office of Refugee Resettlement, may 6 not share with the Department of Homeland Security, and 7 the officers, employees, and agents of the Department of 8 Homeland Security may not request or receive from the 9 Department of Health and Human Services, for the pur- 10 poses of an asylum determination, immigration hearing, 11 or deportation proceeding, any information or record 12 that— 13 (1) concerns the mental health of an alien; and 14 (2) was obtained or produced by a mental or 15 behavioral health professional while the alien was in 16 a shelter or otherwise in the custody of the Federal 17 Government. 18 (e) DEFINITIONS.—In this section: 19 (1) The term ‘‘U.S. Customs and Border Pro- 20 tection facility’’ means any of the following facilities 21 that typically detain migrants on behalf of U.S. Cus- 22 toms and Border Protection: 23 (A) U.S. Border Patrol stations. 24 (B) Ports of entry. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 587 •HR 6637 IH (C) Checkpoints. 1 (D) Forward operating bases. 2 (E) Secondary inspection areas. 3 (F) Short-term custody facilities. 4 (2) The term ‘‘forward operating base’’ means 5 a permanent facility established by U.S. Customs 6 and Border Protection in forward or remote loca- 7 tions, and designated as such by U.S. Customs and 8 Border Protection. 9 TITLE VII—ADDRESSING HIGH- 10 IMPACT MINORITY DISEASES 11 Subtitle A—Cancer 12 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 13 (a) SHORT TITLE.—This section may be cited as the 14 ‘‘Lung Cancer Mortality Reduction Act of 2020’’. 15 (b) FINDINGS.—Congress makes the following find- 16 ings: 17 (1) Lung cancer is the leading cause of cancer 18 death for both men and women, accounting for 25 19 percent of all cancer deaths. 20 (2) Lung cancer kills more people annually 21 than breast cancer, prostate cancer, colon cancer, 22 liver cancer, melanoma, and kidney cancer combined. 23 (3) Since the National Cancer Act of 1971 24 (Public Law 92–218; 85 Stat. 778), coordinated and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 588 •HR 6637 IH comprehensive research has raised the 5-year sur- 1 vival rates for breast cancer to 90 percent, for pros- 2 tate cancer to 99 percent, and for colon cancer to 3 64 percent. 4 (4) The 5-year survival rate for lung cancer is 5 still only 18 percent, and a similar coordinated and 6 comprehensive research effort is required to achieve 7 increases in lung cancer survivability rates. 8 (5) Sixty percent of lung cancer cases are now 9 diagnosed in nonsmokers or former smokers. 10 (6) Two-thirds of nonsmokers diagnosed with 11 lung cancer are women. 12 (7) Certain minority populations, such as Afri- 13 can-American males, have disproportionately high 14 rates of lung cancer incidence and mortality, despite 15 their smoking rate being similar to other racial 16 groups. 17 (8) Members of the Baby Boomer Generation 18 are entering their 60s, the most common age at 19 which people develop lung cancer. 20 (9) Tobacco addiction and exposure to other 21 lung cancer carcinogens such as Agent Orange and 22 other herbicides and battlefield emissions are serious 23 problems among military personnel and war vet- 24 erans. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 589 •HR 6637 IH (10) Significant and rapid improvements in 1 lung cancer mortality can be expected through great- 2 er use and access to lung cancer screening tests for 3 at-risk individuals. 4 (11) Recent research has shown that screening 5 with low-dose computed tomography scan reduced 6 lung cancer death mortality by 20 percent for those 7 with a high risk of lung cancer through early detec- 8 tion. The Centers for Medicare & Medicaid Services 9 supports annual lung cancer screening for high-risk 10 patients with low-dose computed tomography. 11 (12) Additional strategies are necessary to fur- 12 ther enhance the existing tests and therapies avail- 13 able to diagnose and treat lung cancer in the future. 14 (13) The August 2001 Report of the Lung 15 Cancer Progress Review Group of the National Can- 16 cer Institute stated that funding for lung cancer re- 17 search was ‘‘far below the levels characterized for 18 other common malignancies and far out of propor- 19 tion to its massive health impact’’. 20 (14) The Report of the Lung Cancer Progress 21 Review Group identified as its ‘‘highest priority’’ the 22 creation of integrated, multidisciplinary, multi-insti- 23 tutional research consortia organized around the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 590 •HR 6637 IH problem of lung cancer rather than around specific 1 research disciplines. 2 (15) The United States must enhance its re- 3 sponse to the issues raised in the Report of the 4 Lung Cancer Progress Review Group, and this can 5 be accomplished through the establishment of a co- 6 ordinated effort designed to reduce the lung cancer 7 mortality rate by 50 percent by 2020 and targeted 8 funding to support this coordinated effort. 9 (c) SENSE OF CONGRESS CONCERNING INVESTMENT 10 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 11 gress that— 12 (1) lung cancer mortality reduction should be 13 made a national public health priority; and 14 (2) a comprehensive mortality reduction pro- 15 gram coordinated by the Secretary of Health and 16 Human Services is justified and necessary to ade- 17 quately address and reduce lung cancer mortality. 18 (d) LUNG CANCER MORTALITY REDUCTION PRO- 19 GRAM.— 20 (1) IN GENERAL.—Subpart 1 of part C of title 21 IV of the Public Health Service Act (42 U.S.C. 285 22 et seq.) is amended by adding at the end the fol- 23 lowing: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 591 •HR 6637 IH ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 1 GRAM. 2 ‘‘(a) IN GENERAL.—Not later than 6 months after 3 the date of the enactment of the Health Equity and Ac- 4 countability Act of 2020, the Secretary, in consultation 5 with the Secretary of Defense, the Secretary of Veterans 6 Affairs, the Director of the National Institutes of Health, 7 the Director of the Centers for Disease Control and Pre- 8 vention, the Commissioner of Food and Drugs, the Admin- 9 istrator of the Centers for Medicare & Medicaid Services, 10 the Director of the National Institute on Minority Health 11 and Health Disparities, and other members of the Lung 12 Cancer Advisory Board established under section 701 of 13 the Health Equity and Accountability Act of 2020, shall 14 implement a comprehensive program, to be known as the 15 Lung Cancer Mortality Reduction Program, to achieve a 16 reduction of at least 25 percent in the mortality rate of 17 lung cancer by 2020. 18 ‘‘(b) REQUIREMENTS.—The Program shall include at 19 least the following: 20 ‘‘(1) With respect to the National Institutes of 21 Health— 22 ‘‘(A) a strategic review and prioritization 23 by the National Cancer Institute of research 24 grants to achieve the goal of the Lung Cancer 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 592 •HR 6637 IH Mortality Reduction Program in reducing lung 1 cancer mortality; 2 ‘‘(B) the provision of funds to enable the 3 Airway Biology and Disease Branch of the Na- 4 tional Heart, Lung, and Blood Institute to ex- 5 pand its research programs to include pre- 6 dispositions to lung cancer, the interrelationship 7 between lung cancer and other pulmonary and 8 cardiac disease, and the diagnosis and treat- 9 ment of those interrelationships; 10 ‘‘(C) the provision of funds to enable the 11 National Institute of Biomedical Imaging and 12 Bioengineering to expedite the development of 13 computer-assisted diagnostic, surgical, treat- 14 ment, and drug-testing innovations to reduce 15 lung cancer mortality, such as through expan- 16 sion of the Institute’s Quantum Grant Program 17 and Image-Guided Interventions programs; and 18 ‘‘(D) the provision of funds to enable the 19 National Institute of Environmental Health 20 Sciences to implement research programs rel- 21 ative to the lung cancer incidence. 22 ‘‘(2) With respect to the Food and Drug Ad- 23 ministration— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 593 •HR 6637 IH ‘‘(A) activities under section 529B of the 1 Federal Food, Drug, and Cosmetic Act; and 2 ‘‘(B) activities under section 561 of the 3 Federal Food, Drug, and Cosmetic Act to ex- 4 pand access to investigational drugs and devices 5 for the diagnosis, monitoring, or treatment of 6 lung cancer. 7 ‘‘(3) With respect to the Centers for Disease 8 Control and Prevention, the establishment of an 9 early disease research and management program 10 under section 1511. 11 ‘‘(4) With respect to the Agency for Healthcare 12 Research and Quality, the conduct of a biannual re- 13 view of lung cancer screening, diagnostic, and treat- 14 ment protocols, and the issuance of updated guide- 15 lines. 16 ‘‘(5) The promotion (including education) of 17 lung cancer screening within minority and rural pop- 18 ulations and the study of the effectiveness of efforts 19 to increase such screening. 20 ‘‘(6) The cooperation and coordination of all 21 minority and health disparity programs within the 22 Department of Health and Human Services to en- 23 sure that all aspects of the Lung Cancer Mortality 24 Reduction Program under this section adequately 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 594 •HR 6637 IH address the burden of lung cancer on minority and 1 rural populations. 2 ‘‘(7) The cooperation and coordination of all to- 3 bacco control and cessation programs within agen- 4 cies of the Department of Health and Human Serv- 5 ices to achieve the goals of the Lung Cancer Mor- 6 tality Reduction Program under this section with 7 particular emphasis on the coordination of drug and 8 other cessation treatments with early detection pro- 9 tocols.’’. 10 (2) FEDERAL FOOD, DRUG, AND COSMETIC 11 ACT.—Subchapter B of chapter V of the Federal 12 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 13 seq.) is amended by adding at the end the following: 14 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 15 ‘‘(a) IN GENERAL.—The provisions of this sub- 16 chapter shall apply to a drug described in subsection (b) 17 to the same extent and in the same manner as such provi- 18 sions apply to a drug for a rare disease or condition. 19 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 20 subsection is— 21 ‘‘(1) a chemoprevention drug for precancerous 22 conditions of the lung; 23 ‘‘(2) a drug for targeted therapeutic treat- 24 ments, including any vaccine, for lung cancer; or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 595 •HR 6637 IH ‘‘(3) a drug to curtail or prevent nicotine addic- 1 tion. 2 ‘‘(c) BOARD.—The Board established under section 3 701 of the Health Equity and Accountability Act of 2020 4 shall monitor the program implemented under this sec- 5 tion.’’. 6 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 7 tion 561(e) of the Federal Food, Drug, and Cos- 8 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 9 serting before the period the following: ‘‘and shall 10 include expanding access to drugs under section 11 529B, with substantial consideration being given to 12 whether the totality of information available to the 13 Secretary regarding the safety and effectiveness of 14 an investigational drug, as compared to the risk of 15 morbidity and death from the disease, indicates that 16 a patient may obtain more benefit than risk if treat- 17 ed with the drug’’. 18 (4) CDC.—Title XV of the Public Health Serv- 19 ice Act (42 U.S.C. 300k et seq.) is amended by add- 20 ing at the end the following: 21 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 22 PROGRAM. 23 ‘‘The Secretary shall establish and implement an 24 early disease research and management program targeted 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 596 •HR 6637 IH at the high incidence and mortality rates of lung cancer 1 among minority and low-income populations.’’. 2 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 3 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 4 and the Secretary of Veterans Affairs, each in coordina- 5 tion with the Secretary of Health and Human Services, 6 shall engage— 7 (1) in the implementation within the Depart- 8 ment of Defense and the Department of Veterans 9 Affairs of an early detection and disease manage- 10 ment research program for military personnel and 11 veterans whose smoking history and exposure to car- 12 cinogens during active duty service has increased 13 their risk for lung cancer; and 14 (2) in the implementation of coordinated care 15 programs for military personnel and veterans diag- 16 nosed with lung cancer. 17 (f) LUNG CANCER ADVISORY BOARD.— 18 (1) IN GENERAL.—The Secretary of Health and 19 Human Services shall convene a Lung Cancer Advi- 20 sory Board (referred to in this section as the 21 ‘‘Board’’)— 22 (A) to monitor the programs established 23 under this section (and the amendments made 24 by this section); and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 597 •HR 6637 IH (B) to provide annual reports to the Con- 1 gress concerning benchmarks, expenditures, 2 lung cancer statistics, and the public health im- 3 pact of such programs. 4 (2) COMPOSITION.—The Board shall be com- 5 prised of— 6 (A) the Secretary of Health and Human 7 Services; 8 (B) the Secretary of Defense; 9 (C) the Secretary of Veterans Affairs; and 10 (D) 2 representatives each from the fields 11 of clinical medicine focused on lung cancer, 12 lung cancer research, imaging, drug develop- 13 ment, and lung cancer advocacy, to be ap- 14 pointed by the Secretary of Health and Human 15 Services. 16 (g) AUTHORIZATION OF APPROPRIATIONS.— 17 (1) IN GENERAL.—To carry out this section 18 (and the amendments made by this section), there 19 are authorized to be appropriated $75,000,0000 for 20 fiscal year 2021 and such sums as may be necessary 21 for each of fiscal years 2022 through 2025. 22 (2) LUNG CANCER MORTALITY REDUCTION PRO- 23 GRAM.—The amounts appropriated under paragraph 24 (1) shall be allocated as follows: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 598 •HR 6637 IH (A) $25,000,000 for fiscal year 2021, and 1 such sums as may be necessary for each of fis- 2 cal years 2022 through 2025, for the activities 3 described in section 417H(b)(1)(B) of the Pub- 4 lic Health Service Act, as added by subsection 5 (d); 6 (B) $25,000,000 for fiscal year 2021, and 7 such sums as may be necessary for each of fis- 8 cal years 2022 through 2025, for the activities 9 described in section 417H(b)(1)(C) of the Pub- 10 lic Health Service Act; 11 (C) $10,000,000 for fiscal year 2021, and 12 such sums as may be necessary for each of fis- 13 cal years 2022 through 2025, for the activities 14 described in section 417H(b)(1)(D) of the Pub- 15 lic Health Service Act; and 16 (D) $15,000,000 for fiscal year 2021, and 17 such sums as may be necessary for each of fis- 18 cal years 2022 through 2025, for the activities 19 described in section 417H(b)(3) of the Public 20 Health Service Act. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 599 •HR 6637 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 2020’’ 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 2018, an estimated 164,690 men will be 12 diagnosed with prostate cancer and more than 13 29,000 will die from this disease. 14 (3) Roughly 2,000,000 to 3,000,000 people in 15 the United States are living with a diagnosis of pros- 16 tate cancer and its consequences. 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; African Americans 24 have prostate cancer mortality rates that are more 25 than double those in the White population. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 600 •HR 6637 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 such as the extent to which known disparities are at- 16 tributable to disease etiology, access to care, or edu- 17 cation and awareness in the community. 18 (10) Causes of prostate cancer are not known. 19 There is not good information regarding how to dif- 20 ferentiate accurately, early on, between aggressive 21 and indolent forms of the disease. As a result, there 22 is significant overtreatment in prostate cancer. 23 There are no treatments that can durably arrest 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 601 •HR 6637 IH growth or cure prostate cancer once it has metasta- 1 sized. 2 (11) A significant proportion (about 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 under title XVIII of the Social Security Act 11 (42 U.S.C. 1395 et seq.) as one of 8 high-volume, 12 high-cost areas in the Resource Utilization Report 13 Program established under the Medicare Improve- 14 ments for Patients and Providers Act of 2008 (Pub- 15 lic Law 110–275). 16 (12) Prostate cancer research and health care 17 programs across Federal agencies should be coordi- 18 nated to improve accountability and actively encour- 19 age the translation of research into practice, to iden- 20 tify and implement best practices, in order to foster 21 an integrated and consistent focus on effective pre- 22 vention, diagnosis, and treatment of this disease. 23 (c) PROSTATE CANCER COORDINATION AND EDU- 24 CATION.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 602 •HR 6637 IH (1) INTERAGENCY PROSTATE CANCER COORDI- 1 NATION AND EDUCATION TASK FORCE.—Not later 2 than 180 days after the date of the enactment of 3 this section, the Secretary of Veterans Affairs, in co- 4 operation with the Secretary of Defense and the Sec- 5 retary of Health and Human Services, shall estab- 6 lish an Interagency Prostate Cancer Coordination 7 and Education Task Force (in this section referred 8 to as the ‘‘Prostate Cancer Task Force’’). 9 (2) DUTIES.—The Prostate Cancer Task Force 10 shall— 11 (A) develop a summary of advances in 12 prostate cancer research supported or con- 13 ducted by Federal agencies relevant to the diag- 14 nosis, prevention, and treatment of prostate 15 cancer, including psychosocial impairments re- 16 lated to prostate cancer treatment, and compile 17 a list of best practices that warrant broader 18 adoption in health care programs; 19 (B) consider establishing, and advocating 20 for, a guidance to enable physicians to allow 21 screening of men who are over age 74, on a 22 case-by-case basis, taking into account quality 23 of life and family history of prostate cancer; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 603 •HR 6637 IH (C) share and coordinate information on 1 Federal research and health care program ac- 2 tivities, including activities related to— 3 (i) determining how to improve re- 4 search and health care programs, including 5 psychosocial impairments related to pros- 6 tate cancer treatment; 7 (ii) identifying any gaps in the overall 8 research inventory and in health care pro- 9 grams; 10 (iii) identifying opportunities to pro- 11 mote translation of research into practice; 12 and 13 (iv) maximizing the effects of Federal 14 efforts by identifying opportunities for col- 15 laboration and leveraging of resources in 16 research and health care programs that 17 serve individuals who are susceptible to or 18 diagnosed with prostate cancer; 19 (D) develop a comprehensive interagency 20 strategy and advise relevant Federal agencies in 21 the solicitation of proposals for collaborative, 22 multidisciplinary research and health care pro- 23 grams, including proposals to evaluate factors 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 604 •HR 6637 IH that may be related to the etiology of prostate 1 cancer, that would— 2 (i) result in innovative approaches to 3 study emerging scientific opportunities or 4 eliminate knowledge gaps in research to 5 improve the prostate cancer research port- 6 folio of the Federal Government; 7 (ii) outline key research questions, 8 methodologies, and knowledge gaps; and 9 (iii) ensure consistent action, as out- 10 lined by section 402(b) of the Public 11 Health Service Act; 12 (E) develop a coordinated message related 13 to screening and treatment for prostate cancer 14 to be reflected in educational and beneficiary 15 materials for Federal health programs as such 16 documents are updated; and 17 (F) not later than 2 years after the date 18 of the establishment of the Prostate Cancer 19 Task Force, submit to the Expert Advisory 20 Panel to be reviewed and returned within 30 21 days, and then within 90 days submitted to 22 Congress recommendations— 23 (i) regarding any appropriate changes 24 to research and health care programs, in- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 605 •HR 6637 IH cluding recommendations to improve the 1 research portfolio of the Department of 2 Veterans Affairs, the Department of De- 3 fense, National Institutes of Health, and 4 other Federal agencies to ensure that sci- 5 entifically based strategic planning is im- 6 plemented in support of research and 7 health care program priorities; 8 (ii) designed to ensure that the re- 9 search and health care programs and ac- 10 tivities of the Department of Veterans Af- 11 fairs, the Department of Defense, the De- 12 partment of Health and Human Services, 13 and other Federal agencies are free of un- 14 necessary duplication; 15 (iii) regarding public participation in 16 decisions relating to prostate cancer re- 17 search and health care programs to in- 18 crease the involvement of patient advo- 19 cates, community organizations, and med- 20 ical associations representing a broad geo- 21 graphical area; 22 (iv) on how to best disseminate infor- 23 mation on prostate cancer research and 24 progress achieved by health care programs; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 606 •HR 6637 IH (v) about how to expand partnerships 1 between public entities, including Federal 2 agencies, and private entities to encourage 3 collaborative, cross-cutting research and 4 health care delivery; 5 (vi) assessing any cost savings and ef- 6 ficiencies realized through the efforts iden- 7 tified and supported in this section and 8 recommending expansion of those efforts 9 that have proved most promising while also 10 ensuring against any conflicts in directives 11 from other congressional or statutory man- 12 dates or enabling statutes; 13 (vii) identifying key priority action 14 items from among the recommendations; 15 and 16 (viii) with respect to the level of fund- 17 ing needed by each agency to implement 18 the recommendations contained in the re- 19 port. 20 (3) MEMBERS OF THE PROSTATE CANCER TASK 21 FORCE.—The Prostate Cancer Task Force described 22 in this subsection shall be comprised of representa- 23 tives from such Federal agencies, as each head of 24 such applicable agencies determines necessary, to co- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 607 •HR 6637 IH ordinate a uniform message relating to prostate can- 1 cer screening and treatment where appropriate, in- 2 cluding representatives of the following: 3 (A) The Department of Veterans Affairs, 4 including representatives of each relevant pro- 5 gram area of the Department of Veterans Af- 6 fairs. 7 (B) The Prostate Cancer Research Pro- 8 gram of the Congressionally Directed Medical 9 Research program of the Department of De- 10 fense. 11 (C) The Department of Health and 12 Human Services, including at a minimum rep- 13 resentatives of each of the following: 14 (i) The National Institutes of Health. 15 (ii) National research institutes and 16 centers, including the National Cancer In- 17 stitute, the National Institute of Allergy 18 and Infectious Diseases, and the Office of 19 Minority Health. 20 (iii) The Centers for Medicare & Med- 21 icaid Services. 22 (iv) The Food and Drug Administra- 23 tion. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 608 •HR 6637 IH (v) The Centers for Disease Control 1 and Prevention. 2 (vi) The Agency for Healthcare Re- 3 search and Quality. 4 (vii) The Health Resources and Serv- 5 ices Administration. 6 (4) APPOINTING EXPERT ADVISORY PANELS.— 7 The Prostate Cancer Task Force shall appoint ex- 8 pert advisory panels, as such task force determines 9 appropriate, to provide input and concurrence from 10 individuals and organizations from the medical, 11 prostate cancer patient and advocate, research, and 12 delivery communities with expertise in prostate can- 13 cer diagnosis, treatment, and research, including 14 practicing urologists, primary care providers, and 15 others and individuals with expertise in education 16 and outreach to underserved populations affected by 17 prostate cancer. 18 (5) MEETINGS.—The Prostate Cancer Task 19 Force shall convene not less than twice a year, or 20 more frequently as the Secretary of Veterans Affairs 21 determines to be appropriate. 22 (6) FEDERAL ADVISORY COMMITTEE ACT.— 23 (A) IN GENERAL.—Except as provided in 24 subparagraph (B), the Federal Advisory Com- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 609 •HR 6637 IH mittee Act (5 U.S.C. App.) shall apply to the 1 Prostate Cancer Task Force. 2 (B) EXCEPTION.—Section 14(a)(2)(B) of 3 such Act (relating to the termination of advi- 4 sory committees) shall not apply to the Prostate 5 Cancer Task Force. 6 (7) SUNSET DATE.—The Prostate Cancer Task 7 Force shall terminate on September 30, 2025. 8 (d) PROSTATE CANCER RESEARCH.— 9 (1) RESEARCH COORDINATION.—The Secretary 10 of Veterans Affairs, in coordination with the Sec- 11 retary of Defense and the Secretary of Health and 12 Human Services, shall establish and carry out a pro- 13 gram to coordinate and intensify prostate cancer re- 14 search. Such research program shall— 15 (A) develop advances in diagnostic and 16 prognostic methods and tests, including bio- 17 markers and an improved prostate cancer 18 screening blood test, including improvements or 19 alternatives to the prostate specific antigen test 20 and additional tests to distinguish indolent from 21 aggressive disease; 22 (B) develop better understanding of the 23 etiology of the disease (including an analysis of 24 lifestyle factors proven to be involved in higher 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 610 •HR 6637 IH rates of prostate cancer, such as obesity and 1 diet, and in different ethnic, racial, and socio- 2 economic groups, such as the African-American, 3 Latino or Hispanic, and American Indian popu- 4 lations and men with a family history of pros- 5 tate cancer) to improve prevention efforts; 6 (C) expand basic research into prostate 7 cancer, including studies of fundamental molec- 8 ular and cellular mechanisms; 9 (D) identify and provide clinical testing of 10 novel agents for the prevention and treatment 11 of prostate cancer; 12 (E) establish clinical registries for prostate 13 cancer; 14 (F) use the National Institute of Bio- 15 medical Imaging and Bioengineering and the 16 National Cancer Institute for assessment of ap- 17 propriate imaging modalities; and 18 (G) address such other matters relating to 19 prostate cancer research as may be identified by 20 the Federal agencies participating in the pro- 21 gram under this subsection. 22 (2) PROSTATE CANCER ADVISORY BOARD.— 23 There is established in the Office of the Chief Sci- 24 entist of the Food and Drug Administration a Pros- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 611 •HR 6637 IH tate Cancer Scientific Advisory Board. Such board 1 shall be responsible for accelerating real-time shar- 2 ing of the latest research data and accelerating 3 movement of new medicines to patients. 4 (3) UNDERSERVED MINORITY GRANT PRO- 5 GRAM.—In carrying out such program, the Secretary 6 shall— 7 (A) award grants to eligible entities to 8 carry out components of the research outlined 9 in paragraph (1); 10 (B) integrate and build upon existing 11 knowledge gained from comparative effective- 12 ness research; and 13 (C) recognize and address— 14 (i) the racial and ethnic disparities in 15 the incidence and mortality rates of pros- 16 tate cancer and men with a family history 17 of prostate cancer; 18 (ii) any barriers in access to care and 19 participation in clinical trials that are spe- 20 cific to racial, ethnic, and other under- 21 served minorities and men with a family 22 history of prostate cancer; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 612 •HR 6637 IH (iii) outreach and educational efforts 1 to raise awareness among the populations 2 described in clause (ii); and 3 (iv) appropriate access and utilization 4 of imaging modalities. 5 (e) TELEHEALTH AND RURAL ACCESS PILOT 6 PROJECTS.— 7 (1) IN GENERAL.—The Secretary of Veterans 8 Affairs, in cooperation with the Secretary of Defense 9 and the Secretary of Health and Human Services 10 (referred to in this section collectively as the ‘‘Secre- 11 taries’’) shall establish 4-year telehealth pilot 12 projects for the purpose of analyzing the clinical out- 13 comes and cost-effectiveness associated with tele- 14 health services in a variety of geographic areas that 15 contain high proportions of medically underserved 16 populations, including African Americans, Latinos or 17 Hispanics, American Indians or Alaska Natives, and 18 those in rural areas. Such projects shall promote ef- 19 ficient use of specialist care through better coordina- 20 tion of primary care and physician extender teams 21 in underserved areas and more effectively employ 22 tumor boards to better counsel patients. 23 (2) ELIGIBLE ENTITIES.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 613 •HR 6637 IH (A) IN GENERAL.—The Secretaries shall 1 select eligible entities to participate in the pilot 2 projects under this section. 3 (B) PRIORITY.—In selecting eligible enti- 4 ties to participate in the pilot projects under 5 this section, the Secretaries shall give priority 6 to such entities located in medically under- 7 served areas, particularly those that include Af- 8 rican Americans, Latinos and Hispanics, and 9 facilities of the Indian Health Service, including 10 Indian Health Service-operated facilities, trib- 11 ally operated facilities, and Urban Indian Clin- 12 ics, and those in rural areas. 13 (3) EVALUATION.—The Secretaries shall, 14 through the pilot projects, evaluate— 15 (A) the effective and economic delivery of 16 care in diagnosing and treating prostate cancer 17 with the use of telehealth services in medically 18 underserved and Tribal areas including collabo- 19 rative uses of health professionals and integra- 20 tion of the range of telehealth and other tech- 21 nologies; 22 (B) the effectiveness of improving the ca- 23 pacity of nonmedical providers and nonspecial- 24 ized medical providers to provide health services 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 614 •HR 6637 IH for prostate cancer in medically underserved 1 and Tribal areas, including the exploration of 2 innovative medical home models with collabora- 3 tion between urologists, other relevant medical 4 specialists, including oncologists, radiologists, 5 and primary care teams and coordination of 6 care through the efficient use of primary care 7 teams and physician extenders; and 8 (C) the effectiveness of using telehealth 9 services to provide prostate cancer treatment in 10 medically underserved areas, including the use 11 of tumor boards to facilitate better patient 12 counseling. 13 (4) REPORT.—Not later than 1 year after the 14 completion of the pilot projects under this sub- 15 section, the Secretaries shall submit to Congress a 16 report describing the outcomes of such pilot projects, 17 including any cost savings and efficiencies realized, 18 and providing recommendations, if any, for expand- 19 ing the use of telehealth services. 20 (f) EDUCATION AND AWARENESS.— 21 (1) IN GENERAL.—The Secretary of Veterans 22 Affairs (referred to in this subsection as the ‘‘Sec- 23 retary’’) shall develop a national education campaign 24 for prostate cancer. Such campaign shall involve the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 615 •HR 6637 IH use of written educational materials and public serv- 1 ice announcements consistent with the findings of 2 the Prostate Cancer Task Force under subsection 3 (c), that are intended to encourage men to seek 4 prostate cancer screening when appropriate. 5 (2) RACIAL DISPARITIES AND THE POPULATION 6 OF MEN WITH A FAMILY HISTORY OF PROSTATE 7 CANCER.—In developing the national campaign 8 under paragraph (1), the Secretary shall ensure that 9 such educational materials and public service an- 10 nouncements are more readily available in commu- 11 nities experiencing racial disparities in the incidence 12 and mortality rates of prostate cancer and by men 13 of any race classification with a family history of 14 prostate cancer. 15 (3) GRANTS.—In carrying out the national 16 campaign under this section, the Secretary shall 17 award grants to nonprofit private entities to enable 18 such entities to test alternative outreach and edu- 19 cation strategies. 20 (g) AUTHORIZATION OF APPROPRIATIONS.— 21 (1) IN GENERAL.—There is authorized to be 22 appropriated to carry out this section for the period 23 of fiscal years 2021 through 2025 an amount equal 24 to the savings described in paragraph (2). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 616 •HR 6637 IH (2) CORRESPONDING REDUCTION.—The savings 1 described in this paragraph is the amount author- 2 ized to be appropriated by provisions of law other 3 than this section for the period of fiscal years 2021 4 through 2025 for Federal research and health care 5 program activities related to prostate cancer, re- 6 duced by the amount of Federal savings projected to 7 be achieved over such period by implementation of 8 this section. 9 SEC. 703. PROSTATE RESEARCH, IMAGING, AND MEN’S EDU- 10 CATION (PRIME). 11 (a) SHORT TITLE.—This section may be cited as the 12 ‘‘Prostate Research, Imaging, and Men’s Education Act 13 of 2020’’ or the ‘‘PRIME Act of 2020’’. 14 (b) FINDINGS.—Congress makes the following find- 15 ings: 16 (1) Prostate cancer has reached epidemic pro- 17 portions, particularly among African-American men, 18 and strikes and kills men in numbers comparable to 19 the number of women who lose their lives from 20 breast cancer. 21 (2) Life-saving breakthroughs in screening, di- 22 agnosis, and treatment of breast cancer resulted 23 from the development of advanced imaging tech- 24 nologies led by the Federal Government. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 617 •HR 6637 IH (3) Men should have accurate and affordable 1 prostate cancer screening exams and minimally 2 invasive treatment tools, similar to what women have 3 for breast cancer. 4 (4) While it is important for men to take ad- 5 vantage of current prostate cancer screening tech- 6 niques, a recent NCI-funded study demonstrated 7 that the most common available methods of detect- 8 ing prostate cancer (PSA blood test and physical 9 exams) are not foolproof, causing numerous false 10 alarms and false reassurances. 11 (5) The absence of advanced imaging tech- 12 nologies for prostate cancer causes the lack of accu- 13 rate information critical for clinical decisions, result- 14 ing in missed cancers and lost lives, as well as un- 15 necessary and costly medical procedures, with re- 16 lated complications. 17 (6) With prostate imaging tools, men and their 18 families would face less physical, psychological, fi- 19 nancial and emotional trauma and billions of dollars 20 could be saved in private and public health care sys- 21 tems. 22 (c) RESEARCH AND DEVELOPMENT OF PROSTATE 23 CANCER IMAGING TECHNOLOGIES.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 618 •HR 6637 IH (1) EXPANSION OF RESEARCH.—The Secretary 1 of Health and Human Services (referred to in this 2 section as the ‘‘Secretary’’), acting through the Di- 3 rector of the National Institutes of Health and the 4 Administrator of the Health Resources and Services 5 Administration, and in consultation with the Sec- 6 retary of Defense, shall carry out a program to ex- 7 pand and intensify research to develop innovative 8 advanced imaging technologies for prostate cancer 9 detection, diagnosis, and treatment comparable to 10 state-of-the-art mammography technologies. 11 (2) EARLY STAGE RESEARCH.—In imple- 12 menting the program under paragraph (1), the Sec- 13 retary, acting through the Administrator of the 14 Health Resources and Services Administration, shall 15 carry out a grant program to encourage the early 16 stages of research in prostate imaging to develop 17 and implement new ideas, proof of concepts, and 18 pilot studies for high-risk technologic innovation in 19 prostate cancer imaging that would have a high po- 20 tential impact for improving patient care, including 21 individualized care, quality of life, and cost-effective- 22 ness. 23 (3) LARGE-SCALE LATER STAGE RESEARCH.— 24 In implementing the program under paragraph (1), 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 619 •HR 6637 IH the Secretary, acting through the Director of the 1 National Institutes of Health, shall utilize the Na- 2 tional Institute of Biomedical Imaging and Bio- 3 engineering and the National Cancer Institute for 4 advanced stages of research in prostate imaging, in- 5 cluding technology development and clinical trials for 6 projects determined by the Secretary to have dem- 7 onstrated promising preliminary results and proof of 8 concept. 9 (4) INTERDISCIPLINARY PRIVATE-PUBLIC PART- 10 NERSHIPS.—In developing the program under para- 11 graph (1), the Secretary, acting through the Admin- 12 istrator of the Health Resources and Services Ad- 13 ministration, shall establish interdisciplinary private- 14 public partnerships to develop and implement re- 15 search strategies for expedited innovation in imaging 16 and image-guided treatment and to conduct such re- 17 search. 18 (5) RACIAL DISPARITIES.—In developing the 19 program under paragraph (1), the Secretary shall 20 recognize and address— 21 (A) the racial disparities in the incidences 22 of prostate cancer and mortality rates with re- 23 spect to such disease; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 620 •HR 6637 IH (B) any barriers in access to care and par- 1 ticipation in clinical trials that are specific to 2 racial minorities. 3 (6) AUTHORIZATION OF APPROPRIATIONS.— 4 (A) IN GENERAL.—Subject to subpara- 5 graph (B), there is authorized to be appro- 6 priated to carry out this section $100,000,000 7 for each of the fiscal years 2021 through 2025. 8 (B) SPECIFIC ALLOCATIONS.—Of the 9 amount authorized to be appropriated under 10 subparagraph (A) for each of the fiscal years 11 described in such paragraph— 12 (i) no less than 10 percent may be ap- 13 propriated to carry out the grant program 14 under paragraph (2); and 15 (ii) no more than 1 percent may be 16 appropriated to carry out paragraph (4). 17 (d) PUBLIC AWARENESS AND EDUCATION CAM- 18 PAIGN.— 19 (1) NATIONAL CAMPAIGN.—The Secretary shall 20 carry out a national campaign to increase the aware- 21 ness and knowledge of Americans with respect to the 22 need for prostate cancer screening and for improved 23 detection technologies. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 621 •HR 6637 IH (2) REQUIREMENTS.—The national campaign 1 conducted shall include— 2 (A) roles for the Health Resources Services 3 Administration, the Office on Minority Health 4 of the Department of Health and Human Serv- 5 ices, the Centers for Disease Control and Pre- 6 vention, and the Office of Minority Health of 7 the Centers for Disease Control and Prevention; 8 and 9 (B) the development and distribution of 10 written educational materials, and the develop- 11 ment and placing of public service announce- 12 ments, that are intended to encourage men to 13 seek prostate cancer screening and to create 14 awareness of the need for improved imaging 15 technologies for prostate cancer screening and 16 diagnosis, including in-vitro blood testing and 17 imaging technologies. 18 (3) RACIAL DISPARITIES.—In developing the 19 national campaign under paragraph (1), the Sec- 20 retary shall recognize and address— 21 (A) the racial disparities in the incidences 22 of prostate cancer and mortality rates with re- 23 spect to such disease; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 622 •HR 6637 IH (B) any barriers in access to care and par- 1 ticipation in clinical trials that are specific to 2 racial minorities. 3 (4) GRANTS.—The Secretary shall establish a 4 program to award grants to nonprofit private enti- 5 ties to enable such entities to test alternative out- 6 reach and education strategies to increase the 7 awareness and knowledge of Americans with respect 8 to the need for prostate cancer screening and im- 9 proved imaging technologies. 10 (5) AUTHORIZATION OF APPROPRIATIONS.— 11 There is authorized to be appropriated to carry out 12 this section $10,000,000 for each of the fiscal years 13 2021 through 2025. 14 (e) IMPROVING PROSTATE CANCER SCREENING 15 BLOOD TESTS.— 16 (1) IN GENERAL.—The Secretary, in coordina- 17 tion with the Secretary of Defense, shall carry out 18 research to develop an improved prostate cancer 19 screening blood test using in-vitro detection. 20 (2) AUTHORIZATION OF APPROPRIATIONS.— 21 There is authorized to be appropriated to carry out 22 this section, $20,000,000 for each of fiscal years 23 2021 through 2025. 24 (f) REPORTING AND COMPLIANCE.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 623 •HR 6637 IH (1) REPORT AND STRATEGY.—Not later than 1 12 months after the date of the enactment of this 2 Act, the Secretary shall submit to Congress a report 3 that details the strategy of the Secretary for imple- 4 menting the requirements of this section and the 5 status of such efforts. 6 (2) FULL COMPLIANCE.—Not later than 36 7 months after the date of the enactment of this Act, 8 and annually thereafter, the Secretary shall submit 9 to Congress a report that— 10 (A) describes the research and development 11 and public awareness and education campaigns 12 funded under this section; 13 (B) provides evidence that projects involv- 14 ing high-risk, high-impact technologic innova- 15 tion, proof of concept, and pilot studies are 16 prioritized; 17 (C) provides evidence that the Secretary 18 recognizes and addresses any barriers in access 19 to care and participation in clinical trials that 20 are specific to racial minorities in the imple- 21 mentation of this section; 22 (D) contains assurances that all the other 23 provisions of this section are fully implemented; 24 and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 624 •HR 6637 IH (E) certifies compliance with the provisions 1 of this section, or in the case of a Federal agen- 2 cy that has not complied with any of such pro- 3 visions, an explanation as to such failure to 4 comply. 5 SEC. 704. PROSTATE CANCER DETECTION RESEARCH AND 6 EDUCATION. 7 (a) SHORT TITLE.—This section may be cited as the 8 ‘‘Prostate Cancer Detection Research and Education 9 Act’’. 10 (b) PLAN TO DEVELOP AND VALIDATE A TEST OR 11 TESTS FOR PROSTATE CANCER.— 12 (1) IN GENERAL.—The Secretary of Health and 13 Human Services (referred to in this section as the 14 ‘‘Secretary’’), acting through the Director of the Na- 15 tional Institutes of Health, shall establish an advi- 16 sory council on prostate cancer (referred to in this 17 section as the ‘‘advisory council’’) to draft a plan for 18 the development and validation of an accurate test 19 or tests, such as biomarkers or imaging, to detect 20 and diagnose prostate cancer. 21 (2) ADVISORY COUNCIL.— 22 (A) MEMBERSHIP.— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 625 •HR 6637 IH (i) FEDERAL MEMBERS.—The advi- 1 sory council shall be comprised of the fol- 2 lowing experts: 3 (I) A designee of the Centers for 4 Disease Control and Prevention. 5 (II) A designee of the Centers for 6 Medicare & Medicaid Services. 7 (III) A designee of the Office of 8 the Director of the National Cancer 9 Institute. 10 (IV) A designee of the Director 11 of the Department of Defense Con- 12 gressionally Directed Medical Re- 13 search Program. 14 (V) A designee of the Director of 15 the National Institute of Biomedical 16 Imaging and Bioengineering. 17 (VI) A designee of the Director 18 of the National Institute of General 19 Medical Sciences. 20 (VII) A designee of the Director 21 of the National Institute on Minority 22 Health and Health Disparities. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 626 •HR 6637 IH (VIII) A designee of the Office of 1 the Director of the National Institutes 2 of Health. 3 (IX) A designee of the Food and 4 Drug Administration. 5 (X) A designee of the Agency for 6 Healthcare Research and Quality. 7 (XI) A designee of the Director 8 of the Telemedicine and Advanced 9 Technology Research Center of the 10 Department of Defense. 11 (ii) NON-FEDERAL MEMBERS.—In ad- 12 dition to the members described in clause 13 (i), the advisory council shall include 8 ex- 14 pert members from outside the Federal 15 Government to be appointed by the Sec- 16 retary, which shall include— 17 (I) 2 prostate cancer patient ad- 18 vocates; 19 (II) 2 health care providers with 20 a range of expertise and experience in 21 prostate cancer; and 22 (III) 4 leading researchers with 23 prostate cancer-related expertise in a 24 range of clinical disciplines. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 627 •HR 6637 IH (B) MEETINGS.—The advisory council 1 shall meet quarterly and such meetings shall be 2 open to the public. 3 (C) ADVICE.—The advisory council shall 4 advise the Secretary or the Secretary’s des- 5 ignee. 6 (D) ANNUAL REPORT.—Not later than 1 7 year after the date of enactment of this Act, the 8 advisory council shall provide to the Secretary, 9 or the Secretary’s designee, and Congress— 10 (i) an initial evaluation of all federally 11 funded efforts in prostate cancer research 12 relating to the development and validation 13 of an accurate test or tests to detect and 14 diagnose prostate cancer; 15 (ii) a plan for the development and 16 validation of a reliable test or tests for the 17 detection and accurate diagnosis of pros- 18 tate cancer; and 19 (iii) a set of standards for prostate 20 cancer screening, developed in coordination 21 with the United States Preventive Services 22 Task Force, to ensure that any tools for 23 screening, detection, and diagnosis devel- 24 oped in accordance with the plan under 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 628 •HR 6637 IH clause (ii) will meet the requirements of 1 the Task Force for recommendation as a 2 proven preventive or diagnostic service. 3 (E) TERMINATION.—The advisory council 4 shall terminate on December 31, 2024. 5 (3) FUNDING.—The Secretary may make avail- 6 able $1,000,000 from amounts appropriated to the 7 National Institutes of Health for each of fiscal years 8 2021 through 2025 to carry out this subsection. 9 (c) COORDINATION AND INTENSIFICATION OF PROS- 10 TATE CANCER RESEARCH.— 11 (1) IN GENERAL.—The Director of the National 12 Institutes of Health, in consultation with the Sec- 13 retary of Defense, shall coordinate and intensify re- 14 search in accordance with the plan, with particular 15 attention provided to leveraging existing research to 16 develop and validate a test or tests, such as bio- 17 markers or imaging, to detect and accurately diag- 18 nose prostate cancer in order to improve quality of 19 life for millions of Americans, and decrease health 20 care system costs. 21 (2) FUNDING.—The Secretary may make avail- 22 able $30,000,000 from amounts appropriated to the 23 National Institutes of Health for each of fiscal years 24 2022 through 2026 to carry out this subsection. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 629 •HR 6637 IH (d) PUBLIC AWARENESS AND EDUCATION CAM- 1 PAIGN.— 2 (1) NATIONAL CAMPAIGN.—The Secretary, in 3 coordination with the Director of the National Insti- 4 tutes of Health and the Director of the Centers for 5 Disease Control and Prevention, shall carry out a 6 national campaign to increase the awareness and 7 knowledge of prostate cancer. 8 (2) REQUIREMENTS.—The national campaign 9 conducted under paragraph (1) shall include— 10 (A) roles for the National Cancer Institute, 11 the National Institute on Minority Health and 12 Health Disparities, the Office on Minority 13 Health of the Department of Health and 14 Human Services, and the Office of Minority 15 Health of the Centers for Disease Control and 16 Prevention; and 17 (B) the development and distribution of 18 written educational materials, and the develop- 19 ment and placing of public service announce- 20 ments, that are intended to encourage men to 21 seek prostate cancer screening when symptoms 22 are present, when they have a family history of 23 prostate cancer, or if they belong to a high-risk 24 population. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 630 •HR 6637 IH (3) RACIAL DISPARITIES.—In developing the 1 national campaign under paragraph (1), the Sec- 2 retary shall recognize and address— 3 (A) the racial disparities in the incidences 4 of prostate cancer and mortality rates with re- 5 spect to such disease; and 6 (B) any barriers in access to patient care 7 and participation in clinical trials that are spe- 8 cific to racial minorities. 9 (4) GRANTS.—The Secretary shall establish a 10 program to award grants to nonprofit private enti- 11 ties to enable such entities to test alternative out- 12 reach and education strategies to increase the 13 awareness and knowledge of Americans with respect 14 to prostate cancer. 15 (5) AUTHORIZATION OF APPROPRIATIONS.— 16 There is authorized to be appropriated to carry out 17 this subsection $5,000,000 for each of fiscal years 18 2021 through 2025. 19 SEC. 705. NATIONAL PROSTATE CANCER COUNCIL. 20 (a) SHORT TITLE.—This section may be cited as the 21 ‘‘National Prostate Cancer Plan Act’’. 22 (b) NATIONAL PROSTATE CANCER COUNCIL.— 23 (1) ESTABLISHMENT.—There is established in 24 the Office of the Secretary of Health and Human 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 631 •HR 6637 IH Services (referred to in this section as the ‘‘Sec- 1 retary’’) the National Prostate Cancer Council on 2 Screening, Early Detection, Assessment, and Moni- 3 toring of Prostate Cancer (referred to in this section 4 as the ‘‘Council’’). 5 (2) PURPOSE OF THE COUNCIL.—The Council 6 shall— 7 (A) develop and implement a national stra- 8 tegic plan for the accelerated creation, advance- 9 ment, and testing of diagnostic tools to improve 10 screening, early detection, assessment, and 11 monitoring of prostate cancer, including— 12 (i) early detection of aggressive pros- 13 tate cancer to save lives; 14 (ii) monitoring of tumor response to 15 treatment, including recurrence and pro- 16 gression; and 17 (iii) accurate assessment and surveil- 18 lance of indolent disease to reduce unnec- 19 essary biopsies and treatment; 20 (B) provide information and coordination 21 of prostate cancer research and services across 22 all Federal agencies; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 632 •HR 6637 IH (C) review diagnostic tools and their over- 1 all effectiveness at screening, detecting, assess- 2 ing, and monitoring of prostate cancer; 3 (D) evaluate all programs in prostate can- 4 cer that are in existence on the date of enact- 5 ment of this Act, including Federal budget re- 6 quests and approvals and public-private part- 7 nerships; 8 (E) submit an annual report to the Sec- 9 retary and Congress on the creation and imple- 10 mentation of the national strategic plan under 11 subparagraph (A); and 12 (F) ensure the inclusion of men at high 13 risk for prostate cancer, including men from 14 ethnic and racial populations and men who are 15 least likely to receive care, in clinical, research, 16 and service efforts, with the purpose of decreas- 17 ing health disparities. 18 (3) MEMBERSHIP.— 19 (A) FEDERAL MEMBERS.—The Council 20 shall be led by the Secretary or designee and 21 comprised of the following experts: 22 (i) Two representatives of the Na- 23 tional Institutes of Health, including 1 rep- 24 resentative of the National Institute of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 633 •HR 6637 IH Biomedical Imaging and Bioengineering 1 and 1 representative of the National Can- 2 cer Institute. 3 (ii) A representative of the Centers 4 for Disease Control and Prevention. 5 (iii) A representative of the Centers 6 for Medicare & Medicaid Services. 7 (iv) A designee of the Director of the 8 Department of Defense Congressionally 9 Directed Medical Research Program. 10 (v) A designee of the Director of the 11 Office of Minority Health. 12 (vi) A representative of the Food and 13 Drug Administration. 14 (vii) A representative of the Agency 15 for Healthcare Research and Quality. 16 (B) NON-FEDERAL MEMBERS.—In addi- 17 tion to the members described in subparagraph 18 (A), the Council shall include 14 expert mem- 19 bers from outside the Federal Government, 20 which shall include— 21 (i) 6 prostate cancer patient advo- 22 cates, including— 23 (I) 2 patient-survivors; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 634 •HR 6637 IH (II) 2 caregivers of prostate can- 1 cer patients; and 2 (III) 2 representatives from na- 3 tional prostate cancer disease organi- 4 zations that fund research or have 5 demonstrated experience in providing 6 assistance to patients, families, and 7 medical professionals, including infor- 8 mation on health care options, edu- 9 cation, and referral; and 10 (ii) 8 health care stakeholders with 11 specific expertise in prostate cancer re- 12 search in the critical areas of clinical ex- 13 pertise, including medical oncology, radi- 14 ology, radiation oncology, urology, and pa- 15 thology. 16 (4) MEETINGS.—The Council shall meet quar- 17 terly and meetings shall be open to the public. 18 (5) ADVICE.—The Council shall advise the Sec- 19 retary, or the Secretary’s designee. 20 (6) ANNUAL REPORT.—The Council shall sub- 21 mit annual reports, beginning not later than 1 year 22 after the date of enactment of this Act, to the Sec- 23 retary or the Secretary’s designee and to Congress. 24 The annual report shall include— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 635 •HR 6637 IH (A) in the first year— 1 (i) an evaluation of all federally fund- 2 ed efforts in prostate cancer research and 3 gaps relating to the development and vali- 4 dation of diagnostic tools for prostate can- 5 cer; and 6 (ii) recommendations for priority ac- 7 tions to expand, eliminate, coordinate, or 8 condense programs based on the perform- 9 ance, mission, and purpose of the pro- 10 grams; and 11 (B) annually thereafter for 5 years— 12 (i) an outline for the development and 13 implementation of a national research plan 14 for creation and validation of accurate di- 15 agnostic tools to improve prostate cancer 16 care in accordance with paragraph (1); 17 (ii) roles for the National Cancer In- 18 stitute, National Institute on Minority 19 Health and Health Disparities, and the Of- 20 fice on Minority Health of the Department 21 of Health and Human Services; 22 (iii) an analysis of the disparities in 23 the incidence and mortality rates of pros- 24 tate cancer in men at high risk of the dis- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 636 •HR 6637 IH ease, including individuals with family his- 1 tory, increasing age, or African-American 2 heritage; and 3 (iv) a review of the progress towards 4 the realization of the proposed strategic 5 plan. 6 (7) TERMINATION.—The Council shall termi- 7 nate on December 31, 2025. 8 SEC. 706. IMPROVED MEDICAID COVERAGE FOR CERTAIN 9 BREAST AND CERVICAL CANCER PATIENTS 10 IN THE TERRITORIES. 11 (a) ELIMINATION OF FUNDING LIMITATIONS.— 12 (1) IN GENERAL.—Section 1108(g)(4) of the 13 Social Security Act (42 U.S.C. 1308(g)(4)) is 14 amended by adding at the end the following: ‘‘With 15 respect to fiscal years beginning with fiscal year 16 2021, payment for medical assistance for individuals 17 who are eligible for such assistance only on the basis 18 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 19 taken into account in applying subsection (f) (as in- 20 creased in accordance with paragraphs (1), (2), (3), 21 and (5) of this subsection) to Puerto Rico, the Vir- 22 gin Islands, Guam, the Northern Mariana Islands, 23 or American Samoa for such fiscal year.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 637 •HR 6637 IH (2) TECHNICAL AMENDMENT.—Such section is 1 further amended by striking ‘‘(3), and (4)’’ and in- 2 serting ‘‘(3), and (5)’’. 3 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 4 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 5 1396d(b)) is amended by adding at the end the following: 6 ‘‘Notwithstanding the first sentence of this subsection, 7 with respect to medical assistance described in clause (4) 8 of such sentence that is furnished in Puerto Rico, the Vir- 9 gin Islands, Guam, the Northern Mariana Islands, or 10 American Samoa in a fiscal year, the Federal medical as- 11 sistance percentage is equal to the highest such percentage 12 applied under such clause for such fiscal year for any of 13 the 50 States or the District of Columbia that provides 14 such medical assistance for any portion of such fiscal 15 year.’’ 16 (c) EFFECTIVE DATE.—The amendments made by 17 this section shall apply to payment for medical assistance 18 for items and services furnished on or after October 1, 19 2021. 20 SEC. 707. CANCER PREVENTION AND TREATMENT DEM- 21 ONSTRATION FOR ETHNIC AND RACIAL MI- 22 NORITIES. 23 (a) DEMONSTRATION.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 638 •HR 6637 IH (1) IN GENERAL.—The Secretary of Health and 1 Human Services (referred to in this section as the 2 ‘‘Secretary’’) shall conduct demonstration projects 3 for the purpose of developing models and evaluating 4 methods that— 5 (A) improve the quality of items and serv- 6 ices provided to target individuals in order to 7 facilitate reduced disparities in early detection 8 and treatment of cancer; 9 (B) improve clinical outcomes, satisfaction, 10 quality of life, appropriate use of items and 11 services covered under the Medicare program 12 under title XVIII of the Social Security Act (42 13 U.S.C. 1395 et seq.), and referral patterns with 14 respect to target individuals with cancer; 15 (C) eliminate disparities in the rate of pre- 16 ventive cancer screening measures, such as Pap 17 smears, prostate cancer screenings, colon cancer 18 screenings, breast cancer screenings, and com- 19 puted tomography scans, for lung cancer among 20 target individuals; 21 (D) promote collaboration with community- 22 based organizations to ensure cultural com- 23 petency of health care professionals and lin- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 639 •HR 6637 IH guistic access for target individuals who are 1 persons with limited English proficiency; and 2 (E) encourage the incorporation of commu- 3 nity health workers to increase the efficiency 4 and appropriateness of cancer screening pro- 5 grams. 6 (2) COMMUNITY HEALTH WORKER DEFINED.— 7 In this section, the term ‘‘community health worker’’ 8 includes a community health advocate, a lay health 9 worker, a community health representative, a peer 10 health promoter, a community health outreach work- 11 er, and a promotore de salud, who promotes health 12 or nutrition within the community in which the indi- 13 vidual resides. 14 (3) TARGET INDIVIDUAL DEFINED.—In this 15 section, the term ‘‘target individual’’ means an indi- 16 vidual of a racial and ethnic minority group, as de- 17 fined in section 1707(g)(1) of the Public Health 18 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 19 tled to benefits under part A, and enrolled under 20 part B, of title XVIII of the Social Security Act. 21 (b) PROGRAM DESIGN.— 22 (1) INITIAL DESIGN.—Not later than 1 year 23 after the date of the enactment of this Act, the Sec- 24 retary shall evaluate best practices in the private 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 640 •HR 6637 IH sector, community programs, and academic research 1 of methods that reduce disparities among individuals 2 of racial and ethnic minority groups in the preven- 3 tion and treatment of cancer and shall design the 4 demonstration projects based on such evaluation. 5 (2) NUMBER AND PROJECT AREAS.—Not later 6 than 2 years after the date of the enactment of this 7 Act, the Secretary shall implement at least 9 dem- 8 onstration projects, including the following: 9 (A) Two projects, each of which shall tar- 10 get different ethnic subpopulations, for each of 11 the 4 following major racial and ethnic minority 12 groups: 13 (i) American Indians and Alaska Na- 14 tives, Eskimos, and Aleuts. 15 (ii) Asian Americans. 16 (iii) Blacks and African Americans. 17 (iv) Latinos and Hispanics. 18 (v) Native Hawaiians and other Pa- 19 cific Islanders. 20 (B) One project within the Pacific Islands 21 or United States insular areas. 22 (C) At least one project in a rural area. 23 (D) At least one project in an inner-city 24 area. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 641 •HR 6637 IH (3) EXPANSION OF PROJECTS; IMPLEMENTA- 1 TION OF DEMONSTRATION PROJECT RESULTS.—The 2 Secretary shall continue the existing demonstration 3 projects and may expand the number of demonstra- 4 tion projects if the initial report under subsection (c) 5 contains an evaluation that demonstration 6 projects— 7 (A) reduce expenditures under the Medi- 8 care program under title XVIII of the Social 9 Security Act (42 U.S.C. 1395 et seq.); or 10 (B) do not increase expenditures under 11 such Medicare program and reduce racial and 12 ethnic health disparities in the quality of health 13 care services provided to target individuals and 14 increase satisfaction of Medicare beneficiaries 15 and health care providers. 16 (c) REPORT TO CONGRESS.— 17 (1) IN GENERAL.—Not later than 2 years after 18 the date the Secretary implements the initial dem- 19 onstration projects, and biannually thereafter, the 20 Secretary shall submit to Congress a report regard- 21 ing the demonstration projects. 22 (2) CONTENT OF REPORT.—Each report under 23 paragraph (1) shall include the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 642 •HR 6637 IH (A) A description of the demonstration 1 projects. 2 (B) An evaluation of— 3 (i) the cost-effectiveness of the dem- 4 onstration projects; 5 (ii) the quality of the health care serv- 6 ices provided to target individuals under 7 the demonstration projects; and 8 (iii) beneficiary and health care pro- 9 vider satisfaction under the demonstration 10 projects. 11 (C) Any other information regarding the 12 demonstration projects that the Secretary de- 13 termines to be appropriate. 14 (d) WAIVER AUTHORITY.—The Secretary shall waive 15 compliance with the requirements of title XVIII of the So- 16 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 17 and for such period as the Secretary determines is nec- 18 essary to conduct demonstration projects. 19 SEC. 708. REDUCING CANCER DISPARITIES WITHIN MEDI- 20 CARE. 21 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 22 IN QUALITY OF CANCER CARE.— 23 (1) DEVELOPMENT OF MEASURES.—The Sec- 24 retary of Health and Human Services (in this sec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 643 •HR 6637 IH tion referred to as the ‘‘Secretary’’) shall enter into 1 an agreement with an entity that specializes in de- 2 veloping quality measures for cancer care under 3 which the entity shall develop a uniform set of meas- 4 ures to evaluate disparities in the quality of cancer 5 care and annually update such set of measures. 6 (2) MEASURES TO BE INCLUDED.—Such set of 7 measures shall include, with respect to the treatment 8 of cancer, measures of patient outcomes, the process 9 for delivering medical care related to such treat- 10 ment, patient counseling and engagement in deci- 11 sionmaking, patient experience of care, resource use, 12 and practice capabilities, such as care coordination. 13 (b) ESTABLISHMENT OF REPORTING PROCESS.— 14 (1) IN GENERAL.—The Secretary shall establish 15 a reporting process that requires and provides for a 16 method for health care providers specified under 17 paragraph (2) to submit to the Secretary and make 18 public data on the performance of such providers 19 during each reporting period through use of the 20 measures developed pursuant to subsection (a). Such 21 data shall be submitted in a form and manner and 22 at a time specified by the Secretary. 23 (2) SPECIFICATION OF PROVIDERS TO REPORT 24 ON MEASURES.—The Secretary shall specify the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 644 •HR 6637 IH classes of Medicare providers of services and sup- 1 pliers, including hospitals, cancer centers, physi- 2 cians, primary care providers, and specialty pro- 3 viders, that will be required under such process to 4 publicly report on the measures specified under sub- 5 section (a). 6 (3) ASSESSMENT OF CHANGES.—Under such 7 reporting process, the Secretary shall establish a for- 8 mat that assesses changes in both the absolute and 9 relative disparities in cancer care over time. These 10 measures shall be presented in an easily comprehen- 11 sible format, such as those presented in the final 12 publications relating to Healthy People 2010 or the 13 National Healthcare Disparities Report. 14 (4) INITIAL IMPLEMENTATION.—The Secretary 15 shall implement the reporting process under this 16 subsection for reporting periods beginning not later 17 than 6 months after the date that measures are first 18 established under subsection (a). 19 SEC. 709. CANCER CLINICAL TRIALS. 20 (a) SHORT TITLE.—This section may be cited as the 21 ‘‘Henrietta Lacks Enhancing Cancer Research Act of 22 2020’’. 23 (b) FINDINGS.—Congress finds as follows: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 645 •HR 6637 IH (1) Only a small percent of patients participate 1 in cancer clinical trials, even though most express an 2 interest in clinical research. There are several obsta- 3 cles that restrict individuals from participating in- 4 cluding lack of available local trials, restrictive eligi- 5 bility criteria, transportation to trial sites, taking 6 time off from work, and potentially increased med- 7 ical and nonmedical costs. Ultimately, about 1 in 5 8 cancer clinical trials fail because of lack of patient 9 enrollment. 10 (2) Groups that are generally underrepresented 11 in clinical trials include racial and ethnic minorities 12 and older, rural, and lower-income individuals. 13 (3) Henrietta Lacks, an African-American 14 woman, was diagnosed with cervical cancer at the 15 age of 31, and despite receiving painful radium 16 treatments, passed away on October 4, 1951. 17 (4) Medical researchers took samples of Hen- 18 rietta Lacks’ tumor during her treatment and the 19 HeLa cell line from her tumor proved remarkably 20 resilient. 21 (5) HeLa cells were the first immortal line of 22 human cells. Henrietta Lacks’ cells were unique, 23 growing by the millions, commercialized and distrib- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 646 •HR 6637 IH uted worldwide to researchers, resulting in advances 1 in medicine. 2 (6) Henrietta Lacks’ prolific cells continue to 3 grow and contribute to remarkable advances in med- 4 icine, including the development of the polio vaccine, 5 as well as drugs for treating the effects of cancer, 6 HIV/AIDS, hemophilia, leukemia, and Parkinson’s 7 disease. These cells have been used in research that 8 has contributed to our understanding of the effects 9 of radiation and zero gravity on human cells. These 10 immortal cells have informed research on chromo- 11 somal conditions, cancer, gene mapping, and preci- 12 sion medicine. 13 (7) Henrietta Lacks and her immortal cells 14 have made a significant contribution to global 15 health, scientific research, quality of life, and patient 16 rights. 17 (8) For more than 20 years, the advances made 18 possible by Henrietta Lacks’ cells were without her 19 or her family’s consent, and the revenues they gen- 20 erated were not known to or shared with her family. 21 (9) Henrietta Lacks and her family’s experience 22 is fundamental to modern and future bioethics poli- 23 cies and informed consent laws that benefit patients 24 nationwide by building patient trust; promoting eth- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 647 •HR 6637 IH ical research that benefits all individuals, including 1 traditionally underrepresented populations; and pro- 2 tecting research participants. 3 (c) GAO STUDY ON BARRIERS TO PARTICIPATION IN 4 FEDERALLY FUNDED CANCER CLINICAL TRIALS BY POP- 5 ULATIONS THAT HAVE BEEN TRADITIONALLY UNDER- 6 REPRESENTED IN SUCH TRIALS.— 7 (1) IN GENERAL.—Not later than 2 years after 8 the date of enactment of this Act, the Comptroller 9 General of the United States shall— 10 (A) complete a study that— 11 (i) reviews what actions Federal agen- 12 cies have taken to help to address barriers 13 to participation in federally funded cancer 14 clinical trials by populations that have 15 been traditionally underrepresented in such 16 trials, and identifies challenges, if any, in 17 implementing such actions; and 18 (ii) identifies additional actions that 19 can be taken by Federal agencies to ad- 20 dress barriers to participation in federally 21 funded cancer clinical trials by populations 22 that have been traditionally underrep- 23 resented in such trials; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 648 •HR 6637 IH (B) submit a report to the Congress on the 1 results of such study, including recommenda- 2 tions on potential changes in practices and poli- 3 cies to improve participation in such trials by 4 such populations. 5 (2) INCLUSION OF CLINICAL TRIALS.—The 6 study under paragraph (1)(A) should include review 7 of cancer clinical trials that are largely funded by 8 Federal agencies, including the National Institutes 9 of Health, the Department of Defense, the Depart- 10 ment of Veterans Affairs, the Agency for Health Re- 11 search and Quality, the Food and Drug Administra- 12 tion, and such other Federal agencies as the Comp- 13 troller General of the United States may identify. 14 Subtitle B—Viral Hepatitis and 15 Liver Cancer Control and Pre- 16 vention 17 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 18 AND PREVENTION. 19 (a) SHORT TITLE.—This subtitle may be cited as the 20 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 21 Act of 2020’’. 22 (b) FINDINGS.—Congress finds the following: 23 (1) In the United States, nearly 5,000,000 per- 24 sons are living with the hepatitis B virus (referred 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 649 •HR 6637 IH to in this section as ‘‘HBV’’) or the hepatitis C virus 1 (referred to in this section as ‘‘HCV’’). 2 (2) In the United States, chronic HBV and 3 HCV are the most common causes of liver cancer, 4 the second deadliest and fastest growing cancer in 5 this country. Such viruses are the most common 6 cause of chronic liver disease, liver cirrhosis, and the 7 most common indications for liver transplantation. 8 At least 21,000 deaths per year in the United States 9 can be attributed to chronic HBV and HCV. Chron- 10 ic HCV is also a leading cause of death in Ameri- 11 cans living with HIV/AIDS; many of those living 12 with HIV/AIDS are coinfected with chronic HBV, 13 chronic HCV, or both. 14 (3) According to the Centers for Disease Con- 15 trol and Prevention (referred to in this section as 16 the ‘‘CDC’’), approximately 2 percent of the popu- 17 lation of the United States is living with chronic 18 HBV, chronic HCV, or both. The CDC has recog- 19 nized HCV as the Nation’s most common chronic 20 bloodborne virus infection and HBV as the deadliest 21 vaccine-preventable disease. 22 (4) HBV is transmitted through contact with 23 infectious blood, semen, or other bodily fluids and is 24 100 times more infectious than HIV. HCV is trans- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 650 •HR 6637 IH mitted by contact with infectious blood, particularly 1 through percutaneous exposures (such as puncture 2 through the skin). 3 (5) The CDC estimates that in 2016, more 4 than 41,000 people in the United States were newly 5 infected with HCV and nearly 21,000 people in the 6 United States were newly infected with HBV. These 7 estimates could be much higher due to many rea- 8 sons, including lack of screening education and 9 awareness, and perceived marginalization of the pop- 10 ulations at risk. 11 (6) In 2012, CDC released new guidelines rec- 12 ommending every person born between 1945 and 13 1965 receive a one-time test for HCV. Among the 14 estimated 102,000,000 (1,600,000 chronically HCV- 15 infected) eligible for screening, birth-cohort screen- 16 ing leads to 84,000 fewer cases of decompensated 17 cirrhosis, 46,000 fewer cases of hepatocellular car- 18 cinoma, 10,000 fewer liver transplants, and 78,000 19 fewer HCV-related deaths gained versus risk-based 20 screening. 21 (7) In 2013, the United States Preventive Serv- 22 ices Task Force (referred to in this section as the 23 ‘‘USPSTF’’) issued a Grade B rating for screening 24 for HCV infection in persons at high risk for infec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 651 •HR 6637 IH tion and adults born between 1945 and 1965. In 1 2014, the USPSTF issued a Grade B for screening 2 for HBV in persons at high risk of hepatitis B infec- 3 tion. In 2009, the USPSTF issued a Grade A for 4 screening pregnant women for HBV during their 5 first prenatal visit, and in 2019, reaffirmed this 6 grade. 7 (8) There were 59 outbreaks (24 of HBV and 8 36 of HCV, including one of both HBV and HCV) 9 reported to CDC for investigation from 2008 10 through 2016 related to health care-associated infec- 11 tion of HBV and HCV, 56 of which occurred in non- 12 hospital settings. There were more than 115,983 pa- 13 tients potentially exposed to one of the viruses. 14 (9) Chronic HBV and chronic HCV usually do 15 not cause symptoms early in the course of the dis- 16 ease, but after many years of a clinically ‘‘silent’’ 17 phase, CDC estimates show more than 33 percent of 18 infected individuals will develop cirrhosis, end-stage 19 liver disease, or liver cancer. Since most individuals 20 with chronic HBV, HCV, or both are unaware of 21 their infection, they do not know to take precautions 22 to prevent the spread of their infection and can un- 23 knowingly exacerbate their own disease progression. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 652 •HR 6637 IH (10) HBV and HCV disproportionately affect 1 certain populations in the United States. Although 2 representing only about 6 percent of the population, 3 Asian Americans and Pacific Islanders account for 4 half of all chronic HBV cases in the United States. 5 Baby Boomers (those born between 1945 and 1965) 6 account for approximately 75 percent of domestic 7 chronic HCV cases. In addition, African Americans, 8 Latinos, and American Indian and Native Alaskans 9 are among the groups which have disproportionately 10 high rates of HBV or HCV infections in the United 11 States. 12 (11) For both chronic HBV and chronic HCV, 13 behavioral changes and appropriate medical care can 14 slow disease progression if diagnosis is made early. 15 Early diagnosis, which is determined through simple 16 blood tests, can reduce the risk of transmission and 17 disease progression through education and vaccina- 18 tion of household members and other susceptible 19 persons at risk. 20 (12) Advancements have led to the development 21 of improved diagnostic tests for viral hepatitis. 22 These tests, including rapid, point-of-care testing 23 and others in development, can facilitate testing, no- 24 tification of results and post-test counseling, and re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 653 •HR 6637 IH ferral to care at the time of the testing visit. In par- 1 ticular, these tests are also advantageous because 2 they can be used simultaneously with HIV rapid 3 testing for persons at risk for both HCV and HIV 4 infections. 5 (13) For those chronically infected with HBV 6 or HCV, regular monitoring can lead to the early de- 7 tection of liver cancer at a stage where a cure is still 8 possible. Liver cancer is the second deadliest cancer 9 in the United States; however, liver cancer has re- 10 ceived little funding for research, prevention, or 11 treatment. 12 (14) Treatment for chronic HCV can eradicate 13 the disease in approximately 90 percent of those cur- 14 rently treated. While there is no cure for chronic 15 HBV, available treatments can effectively suppress 16 viral replication in the overwhelming majority of 17 those treated, thereby reducing the risk of trans- 18 mission and progression to liver scarring or liver 19 cancer. 20 (15) To combat the viral hepatitis epidemic in 21 the United States, in February 2017, the Depart- 22 ment of Health and Human Services released its 23 ‘‘National Viral Hepatitis Action Plan 2017–2020’’ 24 (referred to in this section as the ‘‘HHS Action 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 654 •HR 6637 IH Plan’’). In March 2017, the National Academies of 1 Sciences, Engineering, and Medicine released a re- 2 port entitled, ‘‘A National Strategy for the Elimi- 3 nation of Hepatitis B and C: Phase Two Report’’ 4 (referred to in this section as the ‘‘NAS report’’), 5 recommending specific actions to eliminate viral hep- 6 atitis as public health problems in the United States 7 by 2030. 8 (16) The annual health care costs attributable 9 to HBV and HCV in the United States are signifi- 10 cant. For HBV, it is estimated to be approximately 11 $2,500,000,000 ($2,000 per infected person). In 12 2000, the lifetime cost of HBV—before the avail- 13 ability of most current therapies—was approximately 14 $80,000 per chronically infected person, totaling 15 more than $100,000,000,000. For HCV, medical 16 costs for patients are expected to increase from 17 $30,000,000,000 in 2009 to over $85,000,000,000 18 in 2024. Avoiding these costs by screening and diag- 19 nosing individuals earlier—and connecting them to 20 appropriate treatment and care, will save lives and 21 critical health care dollars. Currently, without a 22 comprehensive screening, testing, and diagnosis pro- 23 gram, most patients are diagnosed too late when 24 they need a liver transplant costing at least 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 655 •HR 6637 IH $314,000 for uncomplicated cases or when they have 1 liver cancer or end-stage liver disease which costs 2 $30,980 to $110,576 per hospital admission. As 3 health care costs continue to grow, it is critical that 4 the Federal Government invests in effective mecha- 5 nisms to avoid documented cost drivers. 6 (17) According to the NAS report in 2010, 7 chronic HBV and HCV infections cause substantial 8 morbidity and mortality despite being preventable 9 and treatable. Deficiencies in the implementation of 10 established guidelines for the prevention, diagnosis, 11 and medical management of chronic HBV and HCV 12 infections perpetuate personal and economic bur- 13 dens. Existing grants are not sufficient for the scale 14 of the health burden presented by HBV and HCV. 15 (18) Screening and testing for HBV and HCV 16 is aligned with the goal of Healthy People 2020 to 17 increase immunization rates and reduce preventable 18 infectious diseases. Awareness of disease and access 19 to prevention and treatment remain essential compo- 20 nents for reducing infectious disease transmission. 21 (19) Federal support is necessary to increase 22 knowledge and awareness of HBV and HCV and to 23 assist State and local prevention and control efforts 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 656 •HR 6637 IH in reducing the morbidity and mortality of these 1 epidemics. 2 (20) The Centers for Disease Control and Pre- 3 vention reported a 233 percent increase in hepatitis 4 C cases from 2010 to 2016, stemming from the 5 opioid, heroin, and overdose epidemics affecting com- 6 munities nationwide. From 2014 to 2015, the num- 7 ber of reported cases of acute hepatitis B infection 8 in the United States rose for the first time since 9 2006, increasing by 20.7 percent, which is also 10 largely attributable to the opioid epidemic. 11 (21) The Secretary of Health and Human Serv- 12 ices has the discretion to carry out this subtitle (in- 13 cluding the amendments made by this subtitle) di- 14 rectly and through whichever of the agencies of the 15 Public Health Service the Secretary determines to be 16 appropriate, which may (in the Secretary’s discre- 17 tion) include the Centers for Disease Control and 18 Prevention, the Health Resources and Services Ad- 19 ministration, the Substance Abuse and Mental 20 Health Services Administration, the National Insti- 21 tutes of Health (including the National Institute on 22 Minority Health and Health Disparities), and other 23 agencies of such Service. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 657 •HR 6637 IH (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 1 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 2 AND MEDICAL MANAGEMENT PLAN.—Title III of the 3 Public Health Service Act (42 U.S.C. 241 et seq.), as 4 amended by title V, is further amended— 5 (1) by striking section 317N (42 U.S.C. 247b– 6 15); and 7 (2) by adding after part W, as added by section 8 508, the following: 9 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 10 TITIS B AND HEPATITIS C PREVENTION, EDU- 11 CATION, RESEARCH, AND MEDICAL MANAGE- 12 MENT PLAN 13 ‘‘SEC. 399PP. BIENNIAL UPDATE OF THE PLAN. 14 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 15 ennial assessment of the Secretary’s plan for the preven- 16 tion, control, and medical management of, and education 17 and research relating to, hepatitis B and hepatitis C, for 18 the purposes of— 19 ‘‘(1) incorporating into such plan new knowl- 20 edge or observations relating to hepatitis B and hep- 21 atitis C (such as knowledge and observations that 22 may be derived from clinical, laboratory, and epide- 23 miological research and disease detection, preven- 24 tion, and surveillance outcomes); 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 658 •HR 6637 IH ‘‘(2) addressing gaps in the coverage or effec- 1 tiveness of the plan; and 2 ‘‘(3) evaluating and, if appropriate, updating 3 recommendations, guidelines, or educational mate- 4 rials of the Centers for Disease Control and Preven- 5 tion or the National Institutes of Health for health 6 care providers or the public on viral hepatitis in 7 order to be consistent with the plan. 8 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 9 Not later than October 1 of the first even-numbered year 10 beginning after the date of the enactment of this part, 11 and October 1 of each even-numbered year thereafter, the 12 Secretary shall publish in the Federal Register a notice 13 of the results of the assessments conducted under para- 14 graph (1). Such notice shall include— 15 ‘‘(1) a description of any revisions to the plan 16 referred to in subsection (a) as a result of the as- 17 sessment; 18 ‘‘(2) an explanation of the basis for any such 19 revisions, including the ways in which such revisions 20 can reasonably be expected to further promote the 21 original goals and objectives of the plan; and 22 ‘‘(3) in the case of a determination by the Sec- 23 retary that the plan does not need revision, an expla- 24 nation of the basis for such determination. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 659 •HR 6637 IH ‘‘SEC. 399PP–1. ELEMENTS OF PROGRAM. 1 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 2 Secretary, acting through the Director of the Centers for 3 Disease Control and Prevention, the Administrator of the 4 Health Resources and Services Administration, and the 5 Administrator of the Substance Abuse and Mental Health 6 Services Administration, and in accordance with the plan 7 referred to in section 399PP(a), shall implement programs 8 to increase awareness and enhance knowledge and under- 9 standing of hepatitis B and hepatitis C. Such programs 10 shall include— 11 ‘‘(1) the conduct of culturally and linguistically 12 appropriate health education in primary and sec- 13 ondary schools, college campuses, public awareness 14 campaigns, and community outreach activities (espe- 15 cially to the ethnic communities with high rates of 16 chronic hepatitis B and chronic hepatitis C and 17 other high-risk groups) to promote public awareness 18 and knowledge about the value of hepatitis A and 19 hepatitis B immunization; risk factors, transmission, 20 and prevention of hepatitis B and hepatitis C; the 21 value of screening for the early detection of hepatitis 22 B and hepatitis C; and options available for the 23 treatment of chronic hepatitis B and chronic hepa- 24 titis C; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 660 •HR 6637 IH ‘‘(2) the promotion of immunization programs 1 that increase awareness and access to hepatitis A 2 and hepatitis B vaccines for susceptible adults and 3 children; 4 ‘‘(3) the training of health care professionals 5 regarding the importance of vaccinating individuals 6 infected with hepatitis C and individuals who are at 7 risk for hepatitis C infection against hepatitis A and 8 hepatitis B; 9 ‘‘(4) the training of health care professionals 10 regarding the importance of vaccinating individuals 11 chronically infected with hepatitis B and individuals 12 who are at risk for chronic hepatitis B infection 13 against the hepatitis A virus; 14 ‘‘(5) the training of health care professionals 15 and health educators to make them aware of the 16 high rates of chronic hepatitis B and chronic hepa- 17 titis C in certain adult ethnic populations, and the 18 importance of prevention, detection, and medical 19 management of hepatitis B and hepatitis C and of 20 liver cancer screening; 21 ‘‘(6) the development and distribution of health 22 education curricula (including information relating 23 to the special needs of individuals infected with or 24 at risk of hepatitis B and hepatitis C, such as the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 661 •HR 6637 IH importance of prevention and early intervention, reg- 1 ular monitoring, the recognition of psychosocial 2 needs, appropriate treatment, and liver cancer 3 screening) for individuals providing hepatitis B and 4 hepatitis C counseling; and 5 ‘‘(7) support for the implementation curricula 6 described in paragraph (6) by State and local public 7 health agencies. 8 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 9 PROGRAMS.— 10 ‘‘(1) IN GENERAL.—The Secretary, acting 11 through the Director of the Centers for Disease 12 Control and Prevention, shall support the integra- 13 tion of activities described in paragraph (3) into ex- 14 isting clinical and public health programs at State, 15 local, territorial, and Tribal levels (including commu- 16 nity health clinics, programs for the prevention and 17 treatment of HIV/AIDS, sexually transmitted infec- 18 tions, and substance abuse, and programs for indi- 19 viduals in correctional settings). 20 ‘‘(2) COORDINATION OF DEVELOPMENT OF 21 FEDERAL SCREENING GUIDELINES.— 22 ‘‘(A) REFERENCES.—For purposes of this 23 subsection, the term ‘CDC Director’ means the 24 Director of the Centers for Disease Control and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 662 •HR 6637 IH Prevention, and the term ‘AHRQ Director’ 1 means the Director of the Agency for 2 Healthcare Research and Quality. 3 ‘‘(B) AGENCY FOR HEALTHCARE RE- 4 SEARCH AND QUALITY.—Due to the rapidly 5 evolving standard of care associated with diag- 6 nosing and treating viral hepatitis infection, the 7 AHRQ Director shall convene the Preventive 8 Services Task Force under section 915(a) to re- 9 view its recommendation for screening for HBV 10 and HCV infection every 3 years. 11 ‘‘(3) ACTIVITIES.— 12 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 13 ‘‘(i) IN GENERAL.—The Secretary 14 shall establish a mechanism by which to 15 support and promote the development of 16 State, local, territorial, and tribal vol- 17 untary hepatitis B and hepatitis C testing 18 programs to screen the high-prevalence 19 populations to aid in the early identifica- 20 tion of chronically infected individuals. 21 ‘‘(ii) CONFIDENTIALITY OF THE TEST 22 RESULTS.—The Secretary shall prohibit 23 the use of the results of a hepatitis B or 24 hepatitis C test conducted by a testing pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 663 •HR 6637 IH gram developed or supported under this 1 subparagraph for any of the following: 2 ‘‘(I) Issues relating to health in- 3 surance. 4 ‘‘(II) To screen or determine 5 suitability for employment. 6 ‘‘(III) To discharge a person 7 from employment. 8 ‘‘(B) COUNSELING REGARDING VIRAL HEP- 9 ATITIS.—The Secretary shall support State, 10 local, territorial, and tribal programs in a wide 11 variety of settings, including those providing 12 primary and specialty health care services in 13 nonprofit private and public sectors, to— 14 ‘‘(i) provide individuals with ongoing 15 risk factors for hepatitis B and hepatitis C 16 infection with client-centered education 17 and counseling which concentrates on— 18 ‘‘(I) promoting testing of individ- 19 uals that have been exposed to their 20 blood, family members, and their sex- 21 ual partners; and 22 ‘‘(II) changing behaviors that 23 place individuals at risk for infection; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 664 •HR 6637 IH ‘‘(ii) provide individuals chronically in- 1 fected with hepatitis B or hepatitis C with 2 education, health information, and coun- 3 seling to reduce their risk of— 4 ‘‘(I) dying from end-stage liver 5 disease and liver cancer; and 6 ‘‘(II) transmitting viral hepatitis 7 to others; and 8 ‘‘(iii) provide women chronically in- 9 fected with hepatitis B or hepatitis C who 10 are pregnant or of childbearing age with 11 culturally and linguistically appropriate 12 health information, such as how to prevent 13 hepatitis B perinatal infection, and to al- 14 leviate fears associated with pregnancy or 15 raising a family. 16 ‘‘(C) IMMUNIZATION.—The Secretary shall 17 support State, local, territorial, and tribal ef- 18 forts to expand the current vaccination pro- 19 grams to protect every child in the Nation and 20 all susceptible adults, particularly those infected 21 with hepatitis C and high-prevalence ethnic 22 populations and other high-risk groups, from 23 the risks of acute and chronic hepatitis B infec- 24 tion by— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 665 •HR 6637 IH ‘‘(i) ensuring continued funding for 1 hepatitis B vaccination for all children 18 2 years of age or younger through the Vac- 3 cines for Children program; 4 ‘‘(ii) ensuring that the recommenda- 5 tions of the Advisory Committee on Immu- 6 nization Practices of the Centers for Dis- 7 ease Control and Prevention are followed 8 regarding the birth dose of hepatitis B vac- 9 cinations for newborns; 10 ‘‘(iii) requiring proof of hepatitis B 11 vaccination for entry into public or private 12 daycare, preschool, elementary school, sec- 13 ondary school, and institutions of higher 14 education; 15 ‘‘(iv) expanding the availability of 16 hepatitis B vaccination for all adults to 17 protect them from becoming acutely or 18 chronically infected, including ethnic and 19 other populations with high prevalence 20 rates of chronic hepatitis B infection; 21 ‘‘(v) expanding the availability of hep- 22 atitis B vaccination for all adults, particu- 23 larly those of reproductive age (women and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 666 •HR 6637 IH men less than 45 years of age), to protect 1 them from the risk of hepatitis B infection; 2 ‘‘(vi) ensuring the vaccination of indi- 3 viduals infected, or at risk for infection, 4 with hepatitis C against hepatitis A, hepa- 5 titis B, and other infectious diseases, as 6 appropriate, for which such individuals 7 may be at increased risk; and 8 ‘‘(vii) ensuring the vaccination of indi- 9 viduals infected, or at risk for infection, 10 with hepatitis B against hepatitis A virus 11 and other infectious diseases, as appro- 12 priate, for which such individuals may be 13 at increased risk. 14 ‘‘(D) MEDICAL REFERRAL.—The Secretary 15 shall support State, local, territorial, and tribal 16 programs that support— 17 ‘‘(i) referral of persons chronically in- 18 fected with hepatitis B or hepatitis C— 19 ‘‘(I) for medical evaluation to de- 20 termine the appropriateness for 21 antiviral treatment to reduce the risk 22 of progression to cirrhosis and liver 23 cancer; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 667 •HR 6637 IH ‘‘(II) for ongoing medical man- 1 agement including regular monitoring 2 of liver function and screening for 3 liver cancer; and 4 ‘‘(ii) referral of persons infected with 5 acute or chronic hepatitis B infection or 6 acute or chronic hepatitis C infection for 7 drug and alcohol abuse treatment where 8 appropriate. 9 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL 10 HEPATITIS PREVENTION COORDINATORS.—The Sec- 11 retary, acting through the CDC Director, shall pro- 12 vide increased support to adult viral hepatitis pre- 13 vention coordinators in State, local, territorial, and 14 tribal health departments in order to enhance the 15 additional management, networking, and technical 16 expertise needed to ensure successful integration of 17 hepatitis B and hepatitis C prevention and control 18 activities into existing public health programs. 19 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 20 ‘‘(1) IN GENERAL.—The Secretary, acting 21 through the Director of the Centers for Disease 22 Control and Prevention, shall support the establish- 23 ment and maintenance of a national chronic and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 668 •HR 6637 IH acute hepatitis B and hepatitis C surveillance pro- 1 gram, in order to identify— 2 ‘‘(A) trends in the incidence of acute and 3 chronic hepatitis B and acute and chronic hepa- 4 titis C; 5 ‘‘(B) trends in the prevalence of acute and 6 chronic hepatitis B and acute and chronic hepa- 7 titis C infection among groups that may be dis- 8 proportionately affected; and 9 ‘‘(C) trends in liver cancer and end-stage 10 liver disease incidence and deaths, caused by 11 chronic hepatitis B and chronic hepatitis C in 12 the high-risk ethnic populations. 13 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 14 STUDIES.—The Secretary, acting through the Direc- 15 tor of the Centers for Disease Control and Preven- 16 tion, shall prepare a report outlining the population- 17 based seroprevalence studies currently underway, fu- 18 ture planned studies, the criteria involved in deter- 19 mining which seroprevalence studies to conduct, 20 defer, or suspend, and the scope of those studies, the 21 economic and clinical impact of hepatitis B and hep- 22 atitis C, and the impact of chronic hepatitis B and 23 chronic hepatitis C infections on the quality of life. 24 Not later than one year after the date of the enact- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 669 •HR 6637 IH ment of this part, the Secretary shall submit the re- 1 port to the Committee on Health, Education, Labor, 2 and Pensions of the Senate and the Committee on 3 Energy and Commerce of the House of Representa- 4 tives. 5 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 6 not disclose any individually identifiable information 7 identified under paragraph (1) or derived through 8 studies under paragraph (2). 9 ‘‘(d) RESEARCH.—The Secretary, acting through the 10 Director of the Centers for Disease Control and Preven- 11 tion, the Director of the National Cancer Institute, and 12 the Director of the National Institutes of Health, shall— 13 ‘‘(1) conduct epidemiologic and community- 14 based research to develop, implement, and evaluate 15 best practices for hepatitis B and hepatitis C pre- 16 vention especially in the ethnic populations with high 17 rates of chronic hepatitis B and chronic hepatitis C 18 and other high-risk groups; 19 ‘‘(2) conduct research on hepatitis B and hepa- 20 titis C natural history, pathophysiology, improved 21 treatments and prevention (such as the hepatitis C 22 vaccine), and noninvasive tests that help to predict 23 the risk of progression to liver cirrhosis and liver 24 cancer; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 670 •HR 6637 IH ‘‘(3) conduct research that will lead to better 1 noninvasive or blood tests to screen for liver cancer, 2 and more effective treatments of liver cancer caused 3 by chronic hepatitis B and chronic hepatitis C; and 4 ‘‘(4) conduct research comparing the effective- 5 ness of screening, diagnostic, management, and 6 treatment approaches for chronic hepatitis B, chron- 7 ic hepatitis C, and liver cancer in the affected com- 8 munities. 9 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 10 FECTED POPULATIONS.—In carrying out this section, the 11 Secretary shall provide expanded support for individuals 12 with limited access to health education, testing, and health 13 care services and groups that may be disproportionately 14 affected by hepatitis B and hepatitis C. 15 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 16 shall develop benchmarks for evaluating the effectiveness 17 of the programs and activities conducted under this sec- 18 tion and make determinations as to whether such bench- 19 marks have been achieved. 20 ‘‘SEC. 399PP–2. GRANTS. 21 ‘‘(a) IN GENERAL.—The Secretary may award grants 22 to, or enter into contracts or cooperative agreements with, 23 States, political subdivisions of States, territories, Indian 24 tribes, or nonprofit entities that have special expertise re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 671 •HR 6637 IH lating to hepatitis B, hepatitis C, or both, to carry out 1 activities under this part. 2 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 3 tract, or cooperative agreement under subsection (a), an 4 entity shall prepare and submit to the Secretary an appli- 5 cation at such time, in such manner, and containing such 6 information as the Secretary may require. 7 ‘‘SEC. 399PP–3. AUTHORIZATION OF APPROPRIATIONS. 8 ‘‘There are authorized to be appropriated to carry out 9 this part $90,000,000 for fiscal year 2021, $90,000,000 10 for fiscal year 2022, $110,000,000 for fiscal year 2023, 11 $130,000,000 for fiscal year 2024, and $150,000,000 for 12 fiscal year 2025.’’. 13 Subtitle C—Acquired Bone Marrow 14 Failure Diseases 15 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 16 (a) SHORT TITLE.—This subtitle may be cited as the 17 ‘‘Bone Marrow Failure Disease Research and Treatment 18 Act of 2020’’. 19 (b) FINDINGS.—The Congress finds the following: 20 (1) Between 20,000 and 30,000 people in the 21 United States are diagnosed each year with 22 myelodysplastic syndromes, aplastic anemia, parox- 23 ysmal nocturnal hemoglobinuria, and other acquired 24 bone marrow failure diseases. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 672 •HR 6637 IH (2) Acquired bone marrow failure diseases have 1 a debilitating and often fatal impact on those diag- 2 nosed with these diseases. 3 (3) While some treatments for acquired bone 4 marrow failure diseases can prolong and improve the 5 quality of patients’ lives, there is no single cure for 6 these diseases. 7 (4) The prevalence of acquired bone marrow 8 failure diseases in the United States will continue to 9 grow as the general public ages. 10 (5) Evidence exists suggesting that acquired 11 bone marrow failure diseases occur more often in 12 minority populations, particularly in Asian-American 13 and Latino or Hispanic populations. 14 (6) The National Heart, Lung, and Blood Insti- 15 tute and the National Cancer Institute have con- 16 ducted important research into the causes of and 17 treatments for acquired bone marrow failure dis- 18 eases. 19 (7) The National Marrow Donor Program Reg- 20 istry has made significant contributions to the fight 21 against bone marrow failure diseases by connecting 22 millions of potential marrow donors with individuals 23 and families suffering from these conditions. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 673 •HR 6637 IH (8) Despite these advances, a more comprehen- 1 sive Federal strategic effort among numerous Fed- 2 eral agencies is needed to discover a cure for ac- 3 quired bone marrow failure disorders. 4 (9) Greater Federal surveillance of acquired 5 bone marrow failure diseases is needed to gain a bet- 6 ter understanding of the causes of acquired bone 7 marrow failure diseases. 8 (10) The Federal Government should increase 9 its research support for and engage with public and 10 private organizations in developing a comprehensive 11 approach to combat and cure acquired bone marrow 12 failure diseases. 13 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 14 DISEASE REGISTRY.—Title III of the Public Health Serv- 15 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 16 after section 317V (as added by section 110) the following: 17 ‘‘SEC. 317W. NATIONAL ACQUIRED BONE MARROW FAILURE 18 DISEASE REGISTRY. 19 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 20 ‘‘(1) IN GENERAL.—Not later than 6 months 21 after the date of the enactment of this section, the 22 Secretary, acting through the Director of the Cen- 23 ters for Disease Control and Prevention, shall— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 674 •HR 6637 IH ‘‘(A) develop a system to collect data on 1 acquired bone marrow failure diseases; and 2 ‘‘(B) establish and maintain a national and 3 publicly available registry, to be known as the 4 National Acquired Bone Marrow Failure Dis- 5 ease Registry, in accordance with paragraph 6 (3). 7 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 8 MITTEE.—In carrying out this subsection, the Sec- 9 retary shall take into consideration the recommenda- 10 tions of the Advisory Committee on Acquired Bone 11 Marrow Failure Diseases established under sub- 12 section (b). 13 ‘‘(3) PURPOSES OF REGISTRY.—The National 14 Acquired Bone Marrow Failure Disease Registry 15 shall— 16 ‘‘(A) identify the incidence and prevalence 17 of acquired bone marrow failure diseases in the 18 United States; 19 ‘‘(B) be used to collect and store data on 20 acquired bone marrow failure diseases, includ- 21 ing data concerning— 22 ‘‘(i) the age, race or ethnicity, general 23 geographic location, sex, and family history 24 of individuals who are diagnosed with ac- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 675 •HR 6637 IH quired bone marrow failure diseases, and 1 any other characteristics of such individ- 2 uals determined appropriate by the Sec- 3 retary; 4 ‘‘(ii) the genetic and environmental 5 factors that may be associated with devel- 6 oping acquired bone marrow failure dis- 7 eases; 8 ‘‘(iii) treatment approaches for deal- 9 ing with acquired bone marrow failure dis- 10 eases; 11 ‘‘(iv) outcomes for individuals treated 12 for acquired bone marrow failure diseases, 13 including outcomes for recipients of stem 14 cell therapeutic products as contained in 15 the database established pursuant to sec- 16 tion 379A; and 17 ‘‘(v) any other factors pertaining to 18 acquired bone marrow failure diseases de- 19 termined appropriate by the Secretary; and 20 ‘‘(C) be made available— 21 ‘‘(i) to the general public; and 22 ‘‘(ii) to researchers to facilitate fur- 23 ther research into the causes of, and treat- 24 ments for, acquired bone marrow failure 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 676 •HR 6637 IH diseases in accordance with standard prac- 1 tices of the Centers for Disease Control 2 and Preventions. 3 ‘‘(b) ADVISORY COMMITTEE.— 4 ‘‘(1) ESTABLISHMENT.—Not later than 6 5 months after the date of the enactment of this sec- 6 tion, the Secretary, acting through the Director of 7 the Centers for Disease Control and Prevention, 8 shall establish an advisory committee, to be known 9 as the Advisory Committee on Acquired Bone Mar- 10 row Failure Diseases. 11 ‘‘(2) MEMBERS.—The members of the Advisory 12 Committee on Acquired Bone Marrow Failure Dis- 13 eases shall be appointed by the Secretary, acting 14 through the Director of the Centers for Disease 15 Control and Prevention, and shall include at least 16 one representative from each of the following: 17 ‘‘(A) A national patient advocacy organiza- 18 tion with experience advocating on behalf of pa- 19 tients suffering from acquired bone marrow 20 failure diseases. 21 ‘‘(B) The National Institutes of Health, in- 22 cluding at least one representative from each 23 of— 24 ‘‘(i) the National Cancer Institute; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 677 •HR 6637 IH ‘‘(ii) the National Heart, Lung, and 1 Blood Institute; and 2 ‘‘(iii) the Office of Rare Diseases. 3 ‘‘(C) The Centers for Disease Control and 4 Prevention. 5 ‘‘(D) Clinicians with experience in— 6 ‘‘(i) diagnosing or treating acquired 7 bone marrow failure diseases; or 8 ‘‘(ii) medical data registries. 9 ‘‘(E) Epidemiologists who have experience 10 with data registries. 11 ‘‘(F) Publicly or privately funded research- 12 ers who have experience researching acquired 13 bone marrow failure diseases. 14 ‘‘(G) The entity operating the C.W. Bill 15 Young Cell Transplantation Program estab- 16 lished pursuant to section 379 and the entity 17 operating the C.W. Bill Young Cell Transplan- 18 tation Program Outcomes Database. 19 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 20 mittee on Acquired Bone Marrow Failure Diseases 21 shall provide recommendations to the Secretary on 22 the establishment and maintenance of the National 23 Acquired Bone Marrow Failure Disease Registry, in- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 678 •HR 6637 IH cluding recommendations on the collection, mainte- 1 nance, and dissemination of data. 2 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 3 shall make the recommendations of the Advisory 4 Committee on Acquired Bone Marrow Failure Dis- 5 ease publicly available. 6 ‘‘(c) GRANTS.—The Secretary, acting through the 7 Director of the Centers for Disease Control and Preven- 8 tion, may award grants to, and enter into contracts and 9 cooperative agreements with, public or private nonprofit 10 entities for the management of, as well as the collection, 11 analysis, and reporting of data to be included in, the Na- 12 tional Acquired Bone Marrow Failure Disease Registry. 13 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 14 quired bone marrow failure disease’ means— 15 ‘‘(1) myelodysplastic syndromes; 16 ‘‘(2) aplastic anemia; 17 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 18 ‘‘(4) pure red cell aplasia; 19 ‘‘(5) acute myeloid leukemia that has pro- 20 gressed from myelodysplastic syndromes; or 21 ‘‘(6) large granular lymphocytic leukemia. 22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 $3,000,000 for each of fiscal years 2021 through 2025.’’. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 679 •HR 6637 IH (d) PILOT STUDIES THROUGH THE AGENCY FOR 1 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 2 (1) PILOT STUDIES.—The Secretary of Health 3 and Human Services, acting through the Director of 4 the Agency for Toxic Substances and Disease Reg- 5 istry, shall conduct pilot studies to determine which 6 environmental factors, including exposure to toxins, 7 may cause acquired bone marrow failure diseases. 8 (2) COLLABORATION WITH THE RADIATION IN- 9 JURY TREATMENT NETWORK.—In carrying out the 10 directives of this section, the Secretary may collabo- 11 rate with the Radiation Injury Treatment Network 12 of the C.W. Bill Young Cell Transplantation Pro- 13 gram established pursuant to section 379 of the 14 Public Health Service Act (42 U.S.C. 274k) to— 15 (A) augment data for the pilot studies au- 16 thorized by this section; 17 (B) access technical assistance that may be 18 provided by the Radiation Injury Treatment 19 Network; or 20 (C) perform joint research projects. 21 (3) AUTHORIZATION OF APPROPRIATIONS.— 22 There is authorized to be appropriated to carry out 23 this section $1,000,000 for each of fiscal years 2021 24 through 2025. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 680 •HR 6637 IH (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 1 BONE MARROW FAILURE DISEASES.—Title XVII of the 2 Public Health Service Act (42 U.S.C. 300u et seq.) is 3 amended by inserting after section 1707A the following: 4 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC- 5 QUIRED BONE MARROW FAILURE DISEASE. 6 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 7 ‘‘(1) IN GENERAL.—Not later than 6 months 8 after the date of the enactment of this section, the 9 Secretary, acting through the Deputy Assistant Sec- 10 retary for Minority Health, shall establish and co- 11 ordinate outreach and informational programs tar- 12 geted to minority populations affected by acquired 13 bone marrow failure diseases. 14 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 15 cused outreach and informational programs author- 16 ized by this section at the National Minority Health 17 Resource Center supported under section 1707(b)(8) 18 (including by means of the Center’s website, through 19 appropriate locations such as the Center’s knowledge 20 center, and through appropriate programs such as 21 the Center’s resource persons network) and through 22 minority health consultants located at each Depart- 23 ment of Health and Human Services regional of- 24 fice— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 681 •HR 6637 IH ‘‘(A) shall make information about treat- 1 ment options and clinical trials for acquired 2 bone marrow failure diseases publicly available; 3 and 4 ‘‘(B) shall provide referral services for 5 treatment options and clinical trials. 6 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 7 ISLANDER OUTREACH.— 8 ‘‘(1) IN GENERAL.—The Secretary, acting 9 through the Deputy Assistant Secretary for Minority 10 Health, shall undertake a coordinated outreach ef- 11 fort to connect Hispanic, Asian-American, and Pa- 12 cific Islander communities with comprehensive serv- 13 ices focused on treatment of, and information about, 14 acquired bone marrow failure diseases. 15 ‘‘(2) COLLABORATION.—In carrying out this 16 subsection, the Secretary may collaborate with public 17 health agencies, nonprofit organizations, community 18 groups, and online entities to disseminate informa- 19 tion about treatment options and clinical trials for 20 acquired bone marrow failure diseases. 21 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 22 ‘‘(1) IN GENERAL.—Not later than 6 months 23 after the date of the enactment of this section, the 24 Secretary, acting through the Deputy Assistant Sec- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 682 •HR 6637 IH retary for Minority Health, shall award grants to, or 1 enter into cooperative agreements with, entities to 2 perform research on acquired bone marrow failure 3 diseases. 4 ‘‘(2) REQUIREMENT.—Grants and cooperative 5 agreements authorized by this subsection shall be 6 awarded or entered into on a competitive, peer-re- 7 viewed basis. 8 ‘‘(3) SCOPE OF RESEARCH.—Research funded 9 under this section shall examine factors affecting the 10 incidence of acquired bone marrow failure diseases 11 in minority populations. 12 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 13 quired bone marrow failure disease’ has the meaning given 14 to such term in section 317W(d). 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 $2,000,000 for each of fiscal years 2021 through 2025.’’. 18 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 19 QUIRED BONE MARROW FAILURE DISEASES.— 20 (1) GRANTS.—The Secretary of Health and 21 Human Services, acting through the Director of the 22 Agency for Healthcare Research and Quality, shall 23 award grants to entities to improve diagnostic prac- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 683 •HR 6637 IH tices and quality of care with respect to patients 1 with acquired bone marrow failure diseases. 2 (2) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this section $2,000,000 for each of fiscal years 2021 5 through 2025. 6 (g) DEFINITION.—In this section, the term ‘‘acquired 7 bone marrow failure disease’’ has the meaning given such 8 term in section 317W(d) of the Public Health Service Act, 9 as added by subsection (c). 10 Subtitle D—Cardiovascular Dis- 11 ease, Chronic Disease, Obesity, 12 and Other Disease Issues 13 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 14 NORITY PATIENTS. 15 (a) IN GENERAL.—The Secretary, acting through the 16 Director of the Agency for Healthcare Research and Qual- 17 ity, shall convene a series of meetings to develop guidelines 18 for disease screening for minority patient populations that 19 have a higher than average risk for many chronic diseases 20 and cancers. 21 (b) PARTICIPANTS.—In convening meetings under 22 subsection (a), the Secretary shall ensure that meeting 23 participants include representatives of— 24 (1) professional societies and associations; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 684 •HR 6637 IH (2) minority health organizations; 1 (3) health care researchers and providers, in- 2 cluding those with expertise in minority health; 3 (4) Federal health agencies, including the Of- 4 fice of Minority Health, the National Institute on 5 Minority Health and Health Disparities, and the 6 National Institutes of Health; and 7 (5) other experts as the Secretary determines 8 appropriate. 9 (c) DISEASES.—Screening guidelines for minority 10 populations shall be developed as appropriate under sub- 11 section (a) for— 12 (1) hypertension; 13 (2) hypercholesterolemia; 14 (3) diabetes; 15 (4) cardiovascular disease; 16 (5) cancers, including breast, prostate, colon, 17 cervical, and lung cancer; 18 (6) other pulmonary problems including sleep 19 apnea; 20 (7) asthma; 21 (8) diabetes; 22 (9) kidney diseases; 23 (10) eye diseases and disorders, including glau- 24 coma; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 685 •HR 6637 IH (11) HIV/AIDS and sexually transmitted infec- 1 tions; 2 (12) uterine fibroids; 3 (13) autoimmune disease; 4 (14) mental health conditions; 5 (15) dental health conditions and oral diseases, 6 including oral cancer; 7 (16) environmental and related health illnesses 8 and conditions; 9 (17) sickle cell disease and sickle cell trait; 10 (18) violence and injury prevention and control; 11 (19) genetic and related conditions; 12 (20) heart disease and stroke; 13 (21) tuberculosis; 14 (22) chronic obstructive pulmonary disease; 15 (23) musculoskeletal diseases, arthritis, and 16 obesity; and 17 (24) other diseases determined appropriate by 18 the Secretary. 19 (d) DISSEMINATION.—Not later than 2 years after 20 the date of enactment of this Act, the Secretary shall pub- 21 lish and disseminate to health care provider organizations 22 the guidelines developed under subsection (a). 23 (e) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 686 •HR 6637 IH such sums as may be necessary for each of fiscal years 1 2021 through 2025. 2 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 3 Section 1509 of the Public Health Service Act (42 4 U.S.C. 300n–4a) is amended— 5 (1) in subsection (a)— 6 (A) by striking the heading and inserting 7 ‘‘IN GENERAL.—’’; and 8 (B) in the matter preceding paragraph (1), 9 by striking ‘‘may make grants’’ and all that fol- 10 lows through ‘‘purpose’’ and inserting the fol- 11 lowing: ‘‘may make grants to such States for 12 the purpose’’; and 13 (2) in subsection (d)(1), by striking ‘‘there are 14 authorized’’ and all that follows through the period 15 and inserting ‘‘there are authorized to be appro- 16 priated $23,000,000 for fiscal year 2021, 17 $25,300,000 for fiscal year 2022, $27,800,000 for 18 fiscal year 2023, $30,800,000 for fiscal year 2024, 19 and $34,000,000 for fiscal year 2025.’’. 20 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 21 AND MINORITIES. 22 Part P of title III of the Public Health Service Act 23 (42 U.S.C. 280g et seq.), as amended by section 531, is 24 further amended by adding at the end the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 687 •HR 6637 IH ‘‘SEC. 399V–8. REPORT ON CARDIOVASCULAR CARE FOR 1 WOMEN AND MINORITIES. 2 ‘‘Not later than September 30, 2021, and annually 3 thereafter, the Secretary shall prepare and submit to Con- 4 gress a report on the quality of and access to care for 5 women and minorities with heart disease, stroke, and 6 other cardiovascular diseases. The report shall contain rec- 7 ommendations for eliminating disparities in, and improv- 8 ing the treatment of, heart disease, stroke, and other car- 9 diovascular diseases in women, racial and ethnic minori- 10 ties, those for whom English is not their primary lan- 11 guage, and individuals with disabilities.’’. 12 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES- 13 SATION SERVICES IN MEDICAID AND PRI- 14 VATE HEALTH INSURANCE. 15 (a) REQUIRING MEDICAID COVERAGE OF COUN- 16 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO- 17 BACCO USE.—Section 1905 of the Social Security Act (42 18 U.S.C. 1396d) is amended— 19 (1) in subsection (a)(4)(D), by striking ‘‘by 20 pregnant women’’; and 21 (2) in subsection (bb)— 22 (A) by striking ‘‘by pregnant women’’ each 23 place it appears; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 688 •HR 6637 IH (B) in paragraph (1), in the matter before 1 subparagraph (A), by inserting ‘‘by individuals’’ 2 before ‘‘who use tobacco’’; and 3 (C) in paragraph (2)(A), by striking ‘‘with 4 respect to pregnant women’’. 5 (b) EXCEPTION FROM OPTIONAL RESTRICTION 6 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 7 Section 1927(d)(2)(F) of the Social Security Act (42 8 U.S.C. 1396r–8(d)(2)(F)) is amended— 9 (1) by striking ‘‘in the case of pregnant 10 women’’; and 11 (2) by striking ‘‘under the over-the-counter 12 monograph process’’. 13 (c) STATE MONITORING AND PROMOTING OF COM- 14 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 15 MEDICAID.—Section 1902(a) of the Social Security Act 16 (42 U.S.C. 1396a(a)), as amended by section 462(a), is 17 amended— 18 (1) by striking ‘‘and’’ at the end of paragraph 19 (85); 20 (2) by striking the period at the end of para- 21 graph (86) and inserting ‘‘; and’’; and 22 (3) by inserting after paragraph (86) the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 689 •HR 6637 IH ‘‘(87) provide for the State to monitor and pro- 1 mote the use of comprehensive tobacco cessation 2 services under the State plan, including conducting 3 an outreach campaign to increase awareness of, and 4 the benefits of using, such services among— 5 ‘‘(A) individuals entitled to medical assist- 6 ance under the State plan who use tobacco 7 products; and 8 ‘‘(B) clinicians and others who provide 9 services to individuals entitled to medical assist- 10 ance under the State plan.’’. 11 (d) FEDERAL REIMBURSEMENT FOR MEDICAID OUT- 12 REACH CAMPAIGN TO INCREASE AWARENESS.—Section 13 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) 14 is amended— 15 (1) by striking the period at the end of para- 16 graph (7) and inserting ‘‘; plus’’; and 17 (2) by inserting after paragraph (7) the fol- 18 lowing new paragraph: 19 ‘‘(8) an amount equal to 90 percent of the 20 sums expended during each quarter which are attrib- 21 utable to the development, implementation, and eval- 22 uation of an outreach campaign to— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 690 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 691 •HR 6637 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 pharmacother- 5 apy for cessation of tobacco use by pregnant 6 women (as defined in section 1905(bb) of this 7 title) and covered outpatient drugs (as defined 8 in subsection (k)(2) of section 1927 and includ- 9 ing nonprescription drugs described in sub- 10 section (d)(2) of such section) that are pre- 11 scribed for purposes of promoting, and when 12 used to promote, tobacco cessation by pregnant 13 women in accordance with the Guideline re- 14 ferred to in section 1905(bb)(2)(A)’’ each place 15 it appears; and 16 (B) in each of subsections (a)(2)(B) and 17 (b)(2)(B) by inserting ‘‘and counseling and 18 pharmacotherapy for cessation of tobacco use 19 (as defined in section 1905d(bb) of this title) 20 and covered outpatient drugs (as defined in 21 subsection (k)(2) of section 1927 and including 22 nonprescription drugs described in subsection 23 (d)(2) of such section) that are prescribed for 24 purposes of promoting, and when used to pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 692 •HR 6637 IH mote, tobacco cessation in accordance with the 1 Guideline referred to in section 2 1905(bb)(2)(A)’’ after ‘‘(or at the option of the 3 State, any services furnished to pregnant 4 women’’. 5 (2) APPLICATION TO ALTERNATIVE COST SHAR- 6 ING.—Section 1916A(b)(3)(B) of such Act (42 7 U.S.C. 1396o–1(b)(3)(B)) is amended— 8 (A) in clause (iii), by striking ‘‘, and coun- 9 seling and pharmacotherapy for cessation of to- 10 bacco use by pregnant women (as defined in 11 section 1905(bb))’’; and 12 (B) by adding at the end the following: 13 ‘‘(xi) Counseling and pharmacothera- 14 py for cessation of tobacco use (as defined 15 in section 1905(bb)) and covered out- 16 patient drugs (as defined in subsection 17 (k)(2) of section 1927 and including non- 18 prescription drugs described in subsection 19 (d)(2) of such section) that are prescribed 20 for purposes of promoting, and when used 21 to promote, tobacco cessation in accord- 22 ance with the Guideline referred to in sec- 23 tion 1396d (bb)(2)(A) of this title.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 693 •HR 6637 IH (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES- 1 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 2 the Social Security Act (42 U.S.C. 1396r–8) is amended— 3 (1) by striking in paragraph (1)(A) ‘‘A State’’ 4 and inserting ‘‘Except as otherwise provided in para- 5 graph (6), a State’’; 6 (2) by redesignating paragraphs (6) and (7) as 7 paragraphs (7) and (8), respectively; and 8 (3) by inserting after paragraph (5) the fol- 9 lowing: 10 ‘‘(6) NO PRIOR AUTHORIZATION PROGRAMS FOR 11 TOBACCO CESSATION DRUGS.—A State plan under 12 this title shall not require, as a condition of coverage 13 or payment for a covered outpatient drug for which 14 Federal financial participation is available in accord- 15 ance with this section, the approval of an agent 16 when used to promote smoking cessation, including 17 agents approved by the Food and Drug Administra- 18 tion for the purposes of promoting, and when used 19 to promote, tobacco cessation.’’. 20 (g) COMPREHENSIVE COVERAGE OF TOBACCO CES- 21 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 22 Section 2713 of the Public Health Service Act (42 U.S.C. 23 300gg–3) is amended by adding at the end the following: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 694 •HR 6637 IH ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 1 plan and a health insurance issuer offering group or indi- 2 vidual health insurance coverage shall not impose any 3 prior authorization requirement for tobacco cessation 4 counseling and pharmacotherapy that has in effect a rat- 5 ing of ‘A’ or ‘B’ in the current recommendations of the 6 United States Preventive Services Task Force.’’. 7 (h) EFFECTIVE DATE.—The amendments made by 8 this section shall apply to items and services furnished on 9 or after January 1, 2021. 10 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 11 HEALTH. 12 (a) IN GENERAL.—The Secretary of Health and 13 Human Services shall expand and intensify the conduct 14 and support of the research activities of the National In- 15 stitutes of Health and the National Institute of Dental 16 and Craniofacial Research to improve the oral health of 17 the population through the prevention and management 18 of oral diseases and conditions. 19 (b) INCLUDED RESEARCH ACTIVITIES.—Research 20 activities under subsection (a) shall include— 21 (1) comparative effectiveness research and clin- 22 ical disease management research addressing early 23 childhood caries and oral cancer; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 695 •HR 6637 IH (2) awarding of grants and contracts to support 1 the training and development of health services re- 2 searchers, comparative effectiveness researchers, and 3 clinical researchers whose research improves the oral 4 health of the population. 5 SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 6 APPROVED CLINICAL TRIALS. 7 (a) IN GENERAL.—Title XIX of the Social Security 8 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 9 section 1943 the following new section: 10 ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 11 TRIAL. 12 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO- 13 CIATED WITH APPROVED CLINICAL TRIALS.— 14 ‘‘(1) INCLUSION.—Subject to paragraph (2), 15 routine patient costs shall include all items and serv- 16 ices consistent with the medical assistance provided 17 under the State plan that would otherwise be pro- 18 vided to the individual under such State plan if such 19 individual was not enrolled in an approved clinical 20 trial, including any items or services related to the 21 prevention, detection, and treatment of any medical 22 complications that arise as a result of participation 23 in the approved clinical trial. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 696 •HR 6637 IH ‘‘(2) EXCLUSION.—For purposes of paragraph 1 (1), routine patient costs does not include— 2 ‘‘(A) the investigational item, device, or 3 service itself; 4 ‘‘(B) items and services that are provided 5 solely to satisfy data collection and analysis 6 needs and that are not used in the direct clin- 7 ical management of the patient; or 8 ‘‘(C) a service that is clearly inconsistent 9 with widely accepted and established standards 10 of care for a particular diagnosis. 11 ‘‘(3) INFORMATION CONCERNING CLINICAL 12 TRIALS.— 13 ‘‘(A) IN GENERAL.—Subject to subpara- 14 graph (B), the Secretary, in consultation with 15 relevant stakeholders, shall develop a single 16 standardized electronic form for use by the indi- 17 vidual or the referring health care provider to 18 submit to the State agency administering the 19 State plan in order to verify that the clinical 20 trial meets the conditions established for an ap- 21 proved clinical trial (as defined in subsection 22 (c)). 23 ‘‘(B) EXCLUDED INFORMATION.—For pur- 24 poses of subparagraph (A) or any such request 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 697 •HR 6637 IH by the State agency for information regarding 1 a clinical trial, an individual or referring health 2 care provider shall not be required to submit— 3 ‘‘(i) the clinical protocol document for 4 the clinical trial; or 5 ‘‘(ii) subject to subparagraph (C), any 6 additional information other than such in- 7 formation as is required pursuant to the 8 form described in subparagraph (A). 9 ‘‘(C) OPTIONAL INFORMATION.—For pur- 10 poses of subparagraphs (A) and (B)(ii), the 11 form may include a requirement that the refer- 12 ring health care provider attest that the indi- 13 vidual is eligible to participate in the clinical 14 trial pursuant to the trial protocol and that in- 15 dividual participation in such trial would be ap- 16 propriate. 17 ‘‘(D) REVIEW OF INFORMATION.— 18 ‘‘(i) IN GENERAL.—A State plan 19 under this title shall establish a process for 20 timely review by the State agency of the 21 form and information submitted pursuant 22 to subparagraph (A) and, not later than 23 48 hours after receipt of such form, con- 24 firmation that the information provided in 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 698 •HR 6637 IH such form satisfies the requirements estab- 1 lished under such subparagraph, with such 2 process to include establishment and oper- 3 ation of a 24-hour, toll-free telephone num- 4 ber and email address to provide for expe- 5 dited communication. 6 ‘‘(ii) FAILURE TO RESPOND.—If an 7 individual or the referring health care pro- 8 vider does not receive a response or re- 9 quest for additional information from the 10 State agency following the 48-hour period 11 described in clause (i), the information 12 provided in the form may be presumed to 13 satisfy the requirements established under 14 this paragraph. 15 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 16 PROVED CLINICAL TRIALS.— 17 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 18 For purposes of participation in an approved clinical 19 trial by an individual eligible for medical assistance 20 under this title, the State agency administering the 21 State plan shall make reasonable efforts to ensure 22 that the individual is provided with access to a pro- 23 vider who is— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 699 •HR 6637 IH ‘‘(A) participating in the approved clinical 1 trial; 2 ‘‘(B) located not more than 25 miles from 3 the residence of the individual (or, if no such 4 provider is available, as close as possible to the 5 residence of the individual); and 6 ‘‘(C) a participating provider under the 7 State plan or has been deemed to be a partici- 8 pating provider under the State plan for pur- 9 poses of providing medical assistance to the in- 10 dividual during their participation in the ap- 11 proved clinical trial. 12 ‘‘(2) INFORMATIONAL MATERIALS.—The State 13 agency administering the plan approved under this 14 title shall develop informational materials and pro- 15 grams to encourage participating providers to make 16 appropriate referrals to physicians and other appro- 17 priate health care professionals who can provide in- 18 dividuals with access to approved clinical trials. 19 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 20 The term ‘approved clinical trial’ has the same meaning 21 as provided under subsection (d) of the section 2709 of 22 the Public Health Service Act that relates to coverage for 23 individuals participating in approved clinical trials.’’. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 700 •HR 6637 IH (b) CONFORMING AMENDMENT.—Section 1902(a) of 1 the Social Security Act (42 U.S.C. 1396a(a)), as amended 2 by section 734(c), is amended— 3 (1) by striking ‘‘and’’ at the end of paragraph 4 (86); 5 (2) by striking the period at the end of para- 6 graph (87) and inserting ‘‘; and’’; and 7 (3) by inserting after paragraph (87) the fol- 8 lowing new paragraph: 9 ‘‘(88) provide that participation in an approved 10 clinical trial and coverage of routine patient costs 11 associated with such trial for an individual eligible 12 for medical assistance under this title is conducted 13 in accordance with the requirements under section 14 1944.’’. 15 (c) EFFECTIVE DATE.— 16 (1) IN GENERAL.—Except as provided in para- 17 graph (2), the amendments made by this section 18 shall apply to calendar quarters beginning on or 19 after October 1, 2020. 20 (2) DELAY PERMITTED FOR STATE PLAN 21 AMENDMENT.—In the case of a State plan for med- 22 ical assistance under title XIX of the Social Security 23 Act (42 U.S.C. 1396 et seq.) which the Secretary of 24 Health and Human Services determines requires 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 701 •HR 6637 IH State legislation (other than legislation appro- 1 priating funds) in order for the plan to meet the ad- 2 ditional requirements imposed by the amendments 3 made by this section, the State plan shall not be re- 4 garded as failing to comply with the requirements of 5 such title solely on the basis of its failure to meet 6 these additional requirements before the first day of 7 the first calendar quarter beginning after the close 8 of the first regular session of the State legislature 9 that begins after the date of enactment of this Act. 10 For purposes of the previous sentence, in the case 11 of a State that has a 2-year legislative session, each 12 year of such session shall be deemed to be a sepa- 13 rate regular session of the State legislature. 14 SEC. 737. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 15 PUBLIC HEALTH DEPARTMENT OBESITY PRE- 16 VENTION PROGRAMS. 17 (a) DEVELOPMENT AND DISSEMINATION OF AN EVI- 18 DENCE-BASED STRATEGIES GUIDE.—The Secretary of 19 Health and Human Services (referred to in this section 20 as the ‘‘Secretary’’), acting through the Director of the 21 Centers for Disease Control and Prevention, not later than 22 2 years after the date of enactment of this Act, shall— 23 (1) develop a guide on evidence-based strategies 24 for State, territorial, and local health departments to 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 702 •HR 6637 IH use to build and maintain effective obesity preven- 1 tion and reduction programs, and, in consultation 2 with stakeholders that have expertise in Tribal 3 health, a guide on such evidence-based strategies 4 with respect to Indian Tribes and Tribal organiza- 5 tions for such Indian Tribes and Tribal organiza- 6 tions to use for such purpose, both of which guides 7 shall— 8 (A) describe an integrated program struc- 9 ture for implementing interventions proven to 10 be effective in preventing and reducing the inci- 11 dence of obesity; and 12 (B) recommend— 13 (i) optimal resources, including staff- 14 ing and infrastructure, for promoting nu- 15 trition and obesity prevention and reduc- 16 tion; and 17 (ii) strategies for effective obesity pre- 18 vention programs for State and local 19 health departments, Indian Tribes, and 20 Tribal organizations, including strategies 21 related to— 22 (I) the application of evidence- 23 based and evidence-informed practices 24 to prevent and reduce obesity rates; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 703 •HR 6637 IH (II) the development, implemen- 1 tation, and evaluation of obesity pre- 2 vention and reduction strategies for 3 specific communities and populations; 4 (III) demonstrated knowledge of 5 obesity prevention practices that re- 6 duce associated preventable diseases, 7 health conditions, death, and health 8 care costs; 9 (IV) best practices for the coordi- 10 nation of efforts to prevent and re- 11 duce obesity and related chronic dis- 12 eases; 13 (V) addressing the underlying 14 risk factors and social determinants of 15 health that impact obesity rates; and 16 (VI) interdisciplinary coordina- 17 tion between relevant public health of- 18 ficials specializing in fields such as 19 nutrition, physical activity, epidemi- 20 ology, communications, and policy im- 21 plementation, and collaboration be- 22 tween public health officials and com- 23 munity-based organizations; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 704 •HR 6637 IH (2) disseminate the guides and current re- 1 search, evidence-based practices, tools, and edu- 2 cational materials related to obesity prevention, con- 3 sistent with the guide, to State and local health de- 4 partments, Indian Tribes, and Tribal organizations. 5 (b) TECHNICAL ASSISTANCE.—The Secretary, acting 6 through the Director of the Centers for Disease Control 7 and Prevention, shall provide technical assistance to State 8 and local health departments, Indian Tribes, and Tribal 9 organizations to support such health departments in im- 10 plementing the guide developed under subsection (a)(1). 11 (c) INDIAN TRIBES; TRIBAL ORGANIZATIONS.—In 12 this section, the terms ‘‘Indian Tribe’’ and ‘‘Tribal organi- 13 zation’’ have the meanings given the terms ‘‘Indian tribe’’ 14 and ‘‘tribal organization’’, respectively, in section 4 of the 15 Indian Self-Determination and Education Assistance Act 16 (25 U.S.C. 5304). 17 Subtitle E—HIV/AIDS 18 SEC. 741. STATEMENT OF POLICY. 19 It is the policy of the United States to achieve an 20 AIDS-free generation, and to— 21 (1) expand access to lifesaving antiretroviral 22 therapy for people living with HIV and immediately 23 link people to continuous and coordinated high-qual- 24 ity care when they learn they are living with HIV; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 705 •HR 6637 IH (2) expand targeted efforts to prevent HIV in- 1 fection using a combination of effective, evidence- 2 based approaches, including routine HIV screening, 3 and universal access to HIV prevention tools in com- 4 munities disproportionately impacted by HIV, par- 5 ticularly communities of color; 6 (3) ensure laws, policies, and regulations do not 7 impede access to prevention, treatment, and care for 8 people living with HIV or disproportionately im- 9 pacted by HIV; 10 (4) accelerate research for more efficacious HIV 11 prevention and treatments tools, a cure, and a vac- 12 cine; and 13 (5) respect the human rights and dignity of 14 persons living with HIV. 15 SEC. 742. FINDINGS. 16 The Congress finds the following: 17 (1) Over 1,100,000 people are estimated to be 18 living with HIV in the United States according to 19 the Centers for Disease Control and Prevention, 14 20 percent of whom are unaware they are living with 21 HIV. 22 (2) Annually there are about 37,600 new HIV 23 infections and 15,800 deaths in people with an HIV 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 706 •HR 6637 IH diagnoses in 50 States and 6 dependent areas of the 1 United States. 2 (3) The Centers for Disease Control and Pre- 3 vention estimates that, in 2017, there were approxi- 4 mately 38,700 people newly diagnosed with HIV. 5 The estimated number of annual new HIV infections 6 declined 9 percent from 2010 to 2016. However, the 7 number of new infections is increasing among cer- 8 tain populations, such as Latino gay and bisexual 9 men, where annual infections increase 21 percent. 10 (4) HIV disproportionately affects certain popu- 11 lations in the United States. Though African Ameri- 12 cans represent approximately 12 percent of the pop- 13 ulation, African Americans account for almost half 14 (42 percent) of all people living with HIV in the 15 United States. African-American men who have sex 16 with men account for 26 percent of all new HIV in- 17 fections and have remained stable from 2010 to 18 2016. 19 (5) Disparities continue to exist among Latinos 20 and Hispanics; in 2017, Latinos and Hispanics 21 made up 18 percent of the United States population 22 and 26 percent of new infections. 23 (6) Though the rate of new infections among 24 American Indians and Alaska Natives (referred to in 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 707 •HR 6637 IH this section as ‘‘AI/AN’’) is proportional to their 1 population size, from 2010 to 2016, the annual 2 number of HIV diagnoses increased 46 percent 3 among AI/AN overall and 81 percent among AI/AN 4 gay and bisexual men. 5 (7) Asian Americans account for about 2 per- 6 cent of new HIV infections, but in 2013, 22 percent 7 were undiagnosed, the highest rate of undiagnosed 8 HIV among any race or ethnicity. Between 2010 9 and 2016, the number of Asians receiving an HIV 10 diagnosis increased by 42 percent. 11 (8) The latest data from the Centers for Dis- 12 ease Control and Prevention indicates that new in- 13 fections among women declined 21 percent between 14 2010 and 2016. 15 (9) The history of HIV shows that culturally 16 relevant and gender-responsive supportive services, 17 including psychosocial support, treatment literacy, 18 case management, and transportation are necessary 19 strategies to reach and engage women and girls in 20 medical care. 21 (10) Among the 3 million HIV testing events 22 reported to the Centers for Disease Control and Pre- 23 vention in 2017, the percentage of transgender peo- 24 ple who received a new HIV diagnosis was 3 times 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 708 •HR 6637 IH the national average. A 2019 systematic review and 1 meta-analysis found that an estimated 14 percent of 2 transgender women have HIV. By race/ethnicity, an 3 estimated 44 percent of Black/African-American 4 transgender women, 26 percent of Hispanic/Latina 5 transgender women, and 7 percent of White 6 transgender women have HIV. The limited data 7 available on transgender individuals point to a dis- 8 proportionate burden of HIV infection. 9 (11) Stigma and discrimination contribute to 10 such disparities. 11 (12) The Centers for Disease Control and Pre- 12 vention has determined that increasing the propor- 13 tion of people who know their HIV status is an es- 14 sential component of comprehensive HIV treatment 15 and prevention efforts and that early diagnosis is 16 critical in order for people with HIV to receive life- 17 extending therapy. Additionally, the Centers for Dis- 18 ease Control and Prevention recommend routine 19 HIV screening in health care settings for all patients 20 aged 13 to 64, regardless of risk. 21 (13) In 1998, Congress created the National 22 Minority AIDS Initiative to provide technical assist- 23 ance, build capacity, and strengthen outreach efforts 24 among local institutions and community-based orga- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 709 •HR 6637 IH nizations that serve racial and ethnic minorities liv- 1 ing with or vulnerable to HIV. 2 (14) To combat the HIV epidemic in the United 3 States, the National HIV/AIDS Strategy (referred 4 to in this section as ‘‘NHAS’’) provides a framework 5 of increasing access to care, reducing new infections, 6 and eliminating HIV-related health disparities. The 7 vision of NHAS is ‘‘The United States will become 8 a place where new HIV infections are rare and when 9 they do occur, every person, regardless of age, gen- 10 der, race/ethnicity, gender identity, or socioeconomic 11 circumstance, will have unfettered access to high 12 quality, life-extending care, free from stigma and 13 discrimination.’’. 14 (15) In January 2019, the Department of 15 Health and Human Services began implementing the 16 ‘‘Ending the HIV Epidemic: A Plan for America’’. 17 The initiative seeks to reduce the number of new 18 HIV infections in the United States by 75 percent 19 by 2025, and then by at least 90 percent by 2030, 20 for an estimated 250,000 total HIV infection avert- 21 ed. 22 (16) At present, many States and United 23 States territories have criminal statutes based on 24 ‘‘exposure’’ to HIV. Most of these laws were adopted 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 710 •HR 6637 IH before the availability of effective antiretroviral 1 treatment for HIV/AIDS. 2 (17) Research shows that stable housing leads 3 to better health outcomes for those living with HIV. 4 Inadequate or unstable housing is not only a barrier 5 to effective treatment, but also increases the likeli- 6 hood of engaging in risky behaviors leading to HIV 7 infection. Insecure housing puts people with HIV/ 8 AIDS at risk of premature death from exposure to 9 other diseases, poor nutrition, and lack of medical 10 care. 11 (18) Due to advances in treatment, many peo- 12 ple living with HIV today are living healthy lives and 13 have the ability and desire to fully participate in all 14 aspects of community life, including employment. 15 Research associates being employed with tremendous 16 economic, social, and health benefits for many people 17 living with HIV. 18 (19) The common benefits associated with em- 19 ployment include income, autonomy, productivity, 20 and status within society, daily structure, making a 21 contribution to one’s community, and increased skills 22 and self-esteem. Research also indicates that many 23 people with disabilities, including people living with 24 HIV, report perceiving themselves as being less dis- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 711 •HR 6637 IH abled or not disabled at all, when working. Further- 1 more, some studies link working with better physical 2 and mental health outcomes for people living with 3 HIV when compared to those who are not working. 4 Preliminary data also suggest that transitioning to 5 employment is associated with reduced HIV-related 6 health risk behavior for many people. 7 (20) In July 2012, the Food and Drug Admin- 8 istration approved the first drug to be used as pre- 9 exposure prophylaxis (PrEP). PrEP reduces the risk 10 of HIV infection in HIV-negative individuals. Stud- 11 ies have shown that PrEP reduces HIV transmission 12 from sex by about 99 percent when taken consist- 13 ently. Despite increases in PrEP uptake, PrEP use 14 remains low among gay and bisexual men of color. 15 The Centers for Disease Control and Prevention 16 found that uptake was lower among African-Amer- 17 ican (26 percent) and Latino (30 percent) men com- 18 pared with White men (42 percent). Similarly, PrEP 19 awareness was lower among African-American (86 20 percent) and Latino (87 percent) men compared 21 with White men (95 percent). While clinical research 22 on transgender populations and PrEP is currently 23 limited, the Centers for Disease Control and Preven- 24 tion recommends PrEP use in transgender popu- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 712 •HR 6637 IH lations. In September 2019, the Food and Drug Ad- 1 ministration approved the second drug to be used as 2 PrEP. 3 (21) Syringe service programs have been associ- 4 ated with lowered HIV infections, lower hepatitis C 5 infections, and increased linkage to substance use 6 treatment. 7 (22) There is now conclusive scientific evidence 8 that a person living with HIV who is on 9 antiretroviral therapy and is durably virally sup- 10 pressed (defined as having a consistent viral load of 11 less than <200 copies/ml) does not sexually trans- 12 mit HIV. The conclusive evidence about the highly 13 effective preventative benefits of antiretroviral ther- 14 apy provides an unprecedented opportunity to im- 15 prove the lives of people living with HIV, improve 16 treatment uptake and adherence, and advocate for 17 expanded access to treatment and care. 18 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 19 ANCE PROGRAM TREATMENTS. 20 Section 2623 of the Public Health Service Act (42 21 U.S.C. 300ff–31b) is amended by adding at the end the 22 following: 23 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 24 SISTANCE PROGRAM TREATMENTS.—In addition to 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 713 •HR 6637 IH amounts otherwise authorized to be appropriated for car- 1 rying out this subpart, there are authorized to be appro- 2 priated such sums as may be necessary to carry out sec- 3 tions 2612(b)(3)(B) and 2616 for each of fiscal years 4 2021 through 2024.’’. 5 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 6 SYSTEM. 7 (a) GRANTS.—The Secretary of Health and Human 8 Services, acting through the Director of the Centers for 9 Disease Control and Prevention, shall make grants to 10 States to support integration of public health surveillance 11 systems into all electronic health records in order to allow 12 rapid communications between the clinical setting and 13 health departments, by means that include— 14 (1) providing technical assistance and policy 15 guidance to State and local health departments, clin- 16 ical providers, and other agencies serving individuals 17 with HIV to improve the interoperability of data sys- 18 tems relevant to monitoring HIV care and sup- 19 portive services; 20 (2) capturing longitudinal data pertaining to 21 the initiation and ongoing prescription or dispensing 22 of antiretroviral therapy for individuals diagnosed 23 with HIV (such as through pharmacy-based report- 24 ing); 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 714 •HR 6637 IH (3) obtaining information— 1 (A) on a voluntary basis, on sexual orienta- 2 tion and gender identity; and 3 (B) on sources of coverage (or the lack of 4 coverage) for medical treatment (including cov- 5 erage through the Medicaid program, the Medi- 6 care program, the program under title XXVI of 7 the Public Health Service Act (42 U.S.C. 8 300ff–11 et seq.); commonly referred to as the 9 ‘‘Ryan White HIV/AIDS Program’’), other pub- 10 lic funding, private insurance, and health main- 11 tenance organizations); and 12 (4) obtaining and using current geographic 13 markers of residence (such as current address, zip 14 code, partial zip code, and census block). 15 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 16 rying out this section, the Secretary of Health and Human 17 Services shall ensure that appropriate privacy and security 18 safeguards are met to prevent unauthorized disclosure of 19 protected health information and compliance with the 20 HIPAA privacy and security law (as defined in section 21 3009 of the Public Health Service Act (42 U.S.C. 300jj– 22 19)) and other relevant laws and regulations. 23 (c) PROHIBITION AGAINST IMPROPER USE OF 24 DATA.—No grant under this section may be used to allow 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 715 •HR 6637 IH or facilitate the collection or use of surveillance or clinical 1 data or records— 2 (1) for punitive measures of any kind, civil or 3 criminal, against the subject of such data or records; 4 or 5 (2) for imposing any requirement or restriction 6 with respect to an individual without the individual’s 7 written consent. 8 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 9 out this section, there are authorized to be appropriated 10 such sums as may be necessary for each of fiscal years 11 2021 through 2024. 12 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 13 LINKAGE TO AND RETENTION IN APPRO- 14 PRIATE CARE. 15 (a) STRATEGIES.—The Secretary of Health and 16 Human Services, in collaboration with the Director of the 17 Centers for Disease Control and Prevention, the Assistant 18 Secretary for Mental Health and Substance Use, the Di- 19 rector of the Office of AIDS Research, the Administrator 20 of the Health Resources and Services Administration, and 21 the Administrator of the Centers for Medicare & Medicaid 22 Services, shall— 23 (1) identify evidence-based strategies most ef- 24 fective at addressing the multifaceted issues that im- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 716 •HR 6637 IH pede disease status awareness and linkage to and re- 1 tention in appropriate care, taking into consideration 2 health care systems issues, clinic and provider 3 issues, and individual psychosocial, environmental, 4 and other contextual factors; 5 (2) support the wide-scale implementation of 6 the evidence-based strategies identified pursuant to 7 paragraph (1), including through incorporating such 8 strategies into health care coverage supported by the 9 Medicaid program under title XIX of the Social Se- 10 curity Act (42 U.S.C. 1396 et seq.), the program 11 under title XXVI of the Public Health Service Act 12 (42 U.S.C. 300ff–11 et seq.; commonly referred to 13 as the ‘‘Ryan White HIV/AIDS Program’’), and 14 health plans purchased through an American Health 15 Benefit Exchange established pursuant to section 16 1311 of the Patient Protection and Affordable Care 17 Act (42 U.S.C. 18031); and 18 (3) not later than 1 year after the date of the 19 enactment of this Act, submit a report to the Con- 20 gress on the status of activities under paragraphs 21 (1) and (2). 22 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 23 out this section, there are authorized to be appropriated 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 717 •HR 6637 IH such sums as may be necessary for fiscal years 2021 1 through 2024. 2 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 3 CARE AND ANTIRETROVIRAL ADHERENCE 4 FOR PERSONS WITH HIV. 5 (a) SENSE OF CONGRESS.—It is the sense of Con- 6 gress that AIDS research has led to scientific advance- 7 ments that have— 8 (1) saved the lives of millions of people living 9 with HIV; 10 (2) prevented millions from new diagnoses; and 11 (3) had broad benefits that extend far beyond 12 helping people at risk for or living with HIV. 13 (b) IN GENERAL.—The Secretary of Health and 14 Human Services, acting through the Director of the Na- 15 tional Institutes of Health, shall expand, intensify, and co- 16 ordinate operational and translational research and other 17 activities of the National Institutes of Health regarding 18 methods— 19 (1) to increase adoption of evidence-based ad- 20 herence strategies within HIV care and treatment 21 programs; 22 (2) to increase HIV testing and case detection 23 rates; 24 (3) to reduce HIV-related health disparities; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 718 •HR 6637 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 prevention and care serv- 4 ices with mental health and substance use preven- 5 tion and treatment delivery systems; 6 (6) to increase knowledge on the implementa- 7 tion of preexposure prophylaxis (referred to in this 8 section as ‘‘PrEP’’), including 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 and 18 untransmittable when a person living with HIV who 19 is on antiretroviral therapy and is durably virally 20 suppressed (defined as having a consistent viral load 21 of less than <200 copies/ml) cannot sexually trans- 22 mit HIV. 23 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 24 out this section, there are authorized to be appropriated 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 719 •HR 6637 IH such sums as may be necessary for fiscal years 2021 1 through 2024. 2 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 3 ETHNIC MINORITY COMMUNITIES. 4 (a) IN GENERAL.—For the purpose of reducing new 5 HIV diagnoses in racial and ethnic minority communities, 6 the Secretary of Health and Human Services, acting 7 through the Deputy Assistant Secretary for Minority 8 Health, may make grants to public health agencies and 9 faith-based organizations to conduct— 10 (1) outreach activities related to HIV preven- 11 tion and testing activities; 12 (2) HIV prevention activities; and 13 (3) HIV testing activities. 14 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated 16 such sums as may be necessary for fiscal years 2021 17 through 2024. 18 SEC. 748. MINORITY AIDS INITIATIVE. 19 (a) EXPANDED FUNDING.—The Secretary of Health 20 and Human Services, in collaboration with the Deputy As- 21 sistant Secretary for Minority Health, the Director of the 22 Centers for Disease Control and Prevention, the Adminis- 23 trator of the Health Resources and Services Administra- 24 tion, and the Assistant Secretary for Mental Health and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 720 •HR 6637 IH Substance Use, shall provide funds and carry out activities 1 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 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 721 •HR 6637 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 2021 and such sums 5 as may be necessary for each of fiscal years 2022 through 6 2025. 7 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 8 VIDUALS WITH HIV. 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 to meet the demand for culturally competent care, 16 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. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 722 •HR 6637 IH (3) Training health care professionals to pro- 1 vide care to individuals living with HIV. 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 living with HIV, 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 living with HIV. 11 (5) Development and implementation of pro- 12 grams to increase the use of telehealth to respond to 13 HIV-specific health care needs in rural and minority 14 communities, with particular emphasis given to 15 medically underserved communities and insular 16 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 723 •HR 6637 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 and tuberculosis are 4 significant mutual comorbidities, and that a patient 5 who tests positive for one disease should be offered 6 and encouraged to receive testing for the other. 7 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 8 out this section, there are authorized to be appropriated 9 such sums as may be necessary for fiscal years 2021 10 through 2024. 11 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 12 GRAM. 13 (a) IN GENERAL.—The Secretary may enter into an 14 agreement with any physician, nurse practitioner, or phy- 15 sician assistant under which— 16 (1) the physician, nurse practitioner, or physi- 17 cian assistant agrees to serve as a medical provider 18 for a period of not less than 2 years— 19 (A) at a Ryan White-funded or title X- 20 funded facility with a critical shortage of doc- 21 tors (as determined by the Secretary); or 22 (B) in an area with a high incidence of 23 HIV; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 724 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 725 •HR 6637 IH (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub- 1 part III of part D of title III of the Public Health Service 2 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 3 with this section, apply to the program carried out under 4 this section in the same manner and to the same extent 5 as such provisions apply to the National Health Service 6 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 Congress a re- 10 port describing the program carried out under this section, 11 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 726 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 727 •HR 6637 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 2021 24 through 2024. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 728 •HR 6637 IH SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary may enter into an 3 agreement with any dentist under which— 4 (1) the dentist agrees to serve as a dentist for 5 a period of not less than 2 years at a facility with 6 a critical shortage of dentists (as determined by the 7 Secretary) in an area with a high incidence of HIV; 8 and 9 (2) the Secretary agrees to make payments in 10 accordance with subsection (b) on the dental edu- 11 cation loans of the dentist. 12 (b) MANNER OF PAYMENTS.—The payments de- 13 scribed in subsection (a) shall be made by the Secretary 14 as follows: 15 (1) Upon completion by the dentist for whom 16 the payments are to be made of the first year of the 17 service specified in the agreement entered into with 18 the Secretary under subsection (a), the Secretary 19 shall pay 30 percent of the principal of and the in- 20 terest on the dental education loans of the dentist. 21 (2) Upon completion by the dentist of the sec- 22 ond year of such service, the Secretary shall pay an- 23 other 30 percent of the principal of and the interest 24 on such loans. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 729 •HR 6637 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.—Sub- 5 part III of part D of title III of the Public Health Service 6 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 7 with this section, apply to the program carried out under 8 this section in the same manner and to the same extent 9 as such provisions apply to the National Health Service 10 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 730 •HR 6637 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 731 •HR 6637 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 2021 through 2024. 10 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 11 ING DRUG USERS. 12 (a) SENSE OF CONGRESS.—It is the sense of 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 732 •HR 6637 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 2021 3 through 2024. 4 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 5 POPULATIONS. 6 (a) IN GENERAL.—The Secretary shall submit to 7 Congress and the President an annual report on the im- 8 pact of HIV for racial and ethnic minority communities, 9 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 in racial and ethnic mi- 21 nority communities. 22 SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 23 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 24 of Congress that national observance days highlighting the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 733 •HR 6637 IH impact of HIV on communities of color include the fol- 1 lowing: 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 Congress 10 that the President should call on members of communities 11 of color— 12 (1) to become involved at the local community 13 level in HIV testing, policy, and advocacy; 14 (2) to become aware, engaged, and empowered 15 on the HIV epidemic within their communities; and 16 (3) to urge members of their communities to re- 17 duce risk factors, practice safe sex and other preven- 18 tive measures, be tested for HIV, and seek care 19 when appropriate. 20 SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 21 POLICIES, AND REGULATIONS REGARDING 22 THE CRIMINAL PROSECUTION OF INDIVID- 23 UALS FOR HIV-RELATED OFFENSES. 24 (a) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 734 •HR 6637 IH (1) HIV.—The term ‘‘HIV’’ has the meaning 1 given to the term in section 2689 of the Public 2 Health Service Act (42 U.S.C. 300ff–88). 3 (2) 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 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 8 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 9 It is the sense of Congress that Federal and State laws, 10 policies, and regulations regarding people living with 11 HIV— 12 (1) should not place unique or additional bur- 13 dens on such individuals solely as a result of their 14 HIV status; and 15 (2) should instead demonstrate a public health- 16 oriented, evidence-based, medically accurate, and 17 contemporary understanding of— 18 (A) the multiple factors that lead to HIV 19 transmission; 20 (B) the relative risk of HIV transmission 21 routes; 22 (C) the current health implications of liv- 23 ing with HIV; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 735 •HR 6637 IH (D) the associated benefits of treatment 1 and support services for people living with HIV; 2 (E) the impact of punitive HIV-specific 3 laws and policies on public health, on people liv- 4 ing with or affected by HIV, and on their fami- 5 lies and communities; and 6 (F) the current science on HIV prevention 7 and treatment, including pre-exposure prophy- 8 laxis (PrEP), post-exposure prophylaxis (PEP), 9 and viral suppression. 10 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 11 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 12 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 13 FENSES.— 14 (1) REVIEW OF FEDERAL AND STATE LAWS.— 15 (A) IN GENERAL.—Not later than 90 days 16 after the date of the enactment of this Act, the 17 Attorney General, the Secretary of Health and 18 Human Services, and the Secretary of Defense 19 acting jointly (in this paragraph and paragraph 20 (2) referred to as the ‘‘designated officials’’) 21 shall initiate a national review of Federal and 22 State laws, policies, regulations, and judicial 23 precedents and decisions regarding criminal and 24 related civil commitment cases involving people 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 736 •HR 6637 IH living with HIV, including in regards to the 1 Uniform Code of Military Justice. 2 (B) CONSULTATION.—In carrying out the 3 review under subparagraph (A), the designated 4 officials shall ensure diverse participation and 5 consultation from each State, including with— 6 (i) State attorneys general (or their 7 representatives); 8 (ii) State public health officials (or 9 their representatives); 10 (iii) State judicial and court system 11 officers, including judges, district attor- 12 neys, prosecutors, defense attorneys, law 13 enforcement, and correctional officers; 14 (iv) members of the United States 15 Armed Forces, including members of other 16 Federal services subject to the Uniform 17 Code of Military Justice; 18 (v) people living with HIV, particu- 19 larly those who have been subject to HIV- 20 related prosecution or who are from com- 21 munities whose members have been dis- 22 proportionately subject to HIV-specific ar- 23 rests and prosecutions; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 737 •HR 6637 IH (vi) legal advocacy and HIV service 1 organizations that work with people living 2 with HIV; 3 (vii) nongovernmental health organi- 4 zations that work on behalf of people living 5 with HIV; 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, including any such review conducted by 15 any Federal or State agency or any public 16 health, legal advocacy, or trade organization or 17 association if the designated officials determine 18 that such reviews were conducted in accordance 19 with the principles set forth in subsection (b). 20 (2) REPORT.—No later than 180 days after ini- 21 tiating the review required by paragraph (1), the At- 22 torney General shall transmit to Congress and make 23 publicly available a report containing the results of 24 the review, which includes the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 738 •HR 6637 IH (A) For each State and for the Uniform 1 Code of Military Justice, a summary of the rel- 2 evant laws, policies, regulations, and judicial 3 precedents and decisions regarding criminal 4 cases involving people living with HIV, includ- 5 ing, if applicable, the following: 6 (i) A determination of whether such 7 laws, policies, regulations, and judicial 8 precedents and decisions place any unique 9 or additional burdens upon people living 10 with HIV. 11 (ii) A determination of whether such 12 laws, policies, regulations, and judicial 13 precedents and decisions demonstrate a 14 public health-oriented, evidence-based, 15 medically accurate, and contemporary un- 16 derstanding of— 17 (I) the multiple factors that lead 18 to HIV transmission; 19 (II) the relative risk of HIV 20 transmission routes; 21 (III) the current health implica- 22 tions of living with HIV; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 739 •HR 6637 IH (IV) the associated benefits of 1 treatment and support services for 2 people living with HIV; 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; and 8 (VI) the current science on HIV 9 prevention and treatment, including 10 pre-exposure prophylaxis (PrEP), 11 post-exposure prophylaxis (PEP), and 12 viral suppression. 13 (iii) An analysis of the public health 14 and legal implications of such laws, poli- 15 cies, regulations, and judicial precedents, 16 including an analysis of the consequences 17 of having a similar penal scheme applied to 18 comparable situations involving other com- 19 municable diseases. 20 (iv) An analysis of the proportionality 21 of punishments imposed under HIV-spe- 22 cific laws, policies, regulations, and judicial 23 precedents, taking into consideration pen- 24 alties attached to violation of State laws 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 740 •HR 6637 IH against similar degrees of endangerment or 1 harm, such as driving while intoxicated or 2 transmission of other communicable dis- 3 eases, or more serious harms, such as ve- 4 hicular manslaughter offenses. 5 (B) An analysis of common elements 6 shared among State laws, policies, regulations, 7 and judicial precedents. 8 (C) A set of best practice recommendations 9 directed to State governments, including State 10 attorneys general, public health officials, and 11 judicial officers, in order to ensure that laws, 12 policies, regulations, and judicial precedents re- 13 garding people living with HIV are in accord- 14 ance with the principles set forth in subsection 15 (b). 16 (D) Recommendations for adjustments to 17 the Uniform Code of Military Justice, as may 18 be necessary, in order to ensure that laws, poli- 19 cies, regulations, and judicial precedents re- 20 garding people living with HIV are in accord- 21 ance with the principles set forth in subsection 22 (b). 23 (3) GUIDANCE.—Within 90 days of the release 24 of the report required by paragraph (2), the Attor- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 741 •HR 6637 IH ney General and the Secretary of Health and 1 Human Services, acting jointly, shall develop and 2 publicly release updated guidance for States based 3 on the set of best practice recommendations required 4 by paragraph (2)(C) in order to assist States dealing 5 with criminal and related civil commitment cases re- 6 garding people living with HIV. 7 (4) MONITORING AND EVALUATION SYSTEM.— 8 Within 60 days of the release of the guidance re- 9 quired by paragraph (3), the Attorney General and 10 the Secretary of Health and Human Services, acting 11 jointly, shall establish an integrated monitoring and 12 evaluation system which includes, where appropriate, 13 objective and quantifiable performance goals and in- 14 dicators to measure progress toward statewide im- 15 plementation in each State of the best practice rec- 16 ommendations required in paragraph (2)(C), includ- 17 ing to monitor, track, and evaluate the effectiveness 18 of assistance provided pursuant to subsection (d). 19 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 20 CIES, OR REGULATIONS.—Within 90 days of the re- 21 lease of the report required by paragraph (2), the 22 Attorney General, the Secretary of Health and 23 Human Services, and the Secretary of Defense, act- 24 ing jointly, shall develop and transmit to the Presi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 742 •HR 6637 IH dent and the Congress, and make publicly available, 1 such proposals as may be necessary to implement 2 adjustments to Federal laws, policies, or regulations, 3 including to the Uniform Code of Military Justice, 4 based on the recommendations required by para- 5 graph (2)(D), either through Executive order or 6 through changes to statutory law. 7 (6) AUTHORIZATION OF APPROPRIATIONS.— 8 (A) IN GENERAL.—There are authorized to 9 be appropriated such sums as may be necessary 10 for the purpose of carrying out this subsection. 11 Amounts authorized to be appropriated by the 12 preceding sentence are in addition to amounts 13 otherwise authorized to be appropriated for 14 such purpose. 15 (B) AVAILABILITY OF FUNDS.—Amounts 16 appropriated pursuant to the authorization of 17 appropriations in subparagraph (A) are author- 18 ized to remain available until expended. 19 (d) AUTHORIZATION TO PROVIDE GRANTS.— 20 (1) GRANTS BY ATTORNEY GENERAL.— 21 (A) IN GENERAL.—The Attorney General 22 may provide assistance to eligible State and 23 local entities and eligible nongovernmental orga- 24 nizations for the purpose of incorporating the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 743 •HR 6637 IH best practice recommendations developed under 1 subsection (c)(2)(C) within relevant State laws, 2 policies, regulations, and judicial decisions re- 3 garding people living with HIV. 4 (B) AUTHORIZED ACTIVITIES.—The assist- 5 ance authorized by subparagraph (A) may in- 6 clude— 7 (i) direct technical assistance to eligi- 8 ble State and local entities in order to de- 9 velop, disseminate, or implement State 10 laws, policies, regulations, or judicial deci- 11 sions that conform with the best practice 12 recommendations developed under sub- 13 section (c)(2)(C); 14 (ii) direct technical assistance to eligi- 15 ble nongovernmental organizations in order 16 to provide education and training, includ- 17 ing through classes, conferences, meetings, 18 and other educational activities, to eligible 19 State and local entities; and 20 (iii) subcontracting authority to allow 21 eligible State and local entities and eligible 22 nongovernmental organizations to seek 23 technical assistance from legal and public 24 health experts with a demonstrated under- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 744 •HR 6637 IH standing of the principles underlying the 1 best practice recommendations developed 2 under subsection (c)(2)(C). 3 (2) GRANTS BY SECRETARY OF HEALTH AND 4 HUMAN SERVICES.— 5 (A) IN GENERAL.—The Secretary of 6 Health and Human Services, acting through the 7 Director of the Centers for Disease Control and 8 Prevention, may provide assistance to State and 9 local public health departments and eligible 10 nongovernmental organizations for the purpose 11 of supporting eligible State and local entities to 12 incorporate the best practice recommendations 13 developed under subsection (c)(2)(C) within rel- 14 evant State laws, policies, regulations, and judi- 15 cial decisions regarding people living with HIV. 16 (B) AUTHORIZED ACTIVITIES.—The assist- 17 ance authorized by subparagraph (A) may in- 18 clude— 19 (i) direct technical assistance to State 20 and local public health departments in 21 order to support the development, dissemi- 22 nation, or implementation of State laws, 23 policies, regulations, or judicial decisions 24 that conform with the set of best practice 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 745 •HR 6637 IH recommendations developed under sub- 1 section (c)(2)(C); 2 (ii) direct technical assistance to eligi- 3 ble nongovernmental organizations in order 4 to provide education and training, includ- 5 ing through classes, conferences, meetings, 6 and other educational activities, to State 7 and local public health departments; and 8 (iii) subcontracting authority to allow 9 State and local public health departments 10 and eligible nongovernmental organizations 11 to seek technical assistance from legal and 12 public health experts with a demonstrated 13 understanding of the principles underlying 14 the best practice recommendations devel- 15 oped under subsection (c)(2)(C). 16 (3) LIMITATION.—As a condition of receiving 17 assistance through this subsection, eligible State and 18 local entities, State and local public health depart- 19 ments, and eligible nongovernmental organizations 20 shall agree— 21 (A) not to place any unique or additional 22 burdens on people living with HIV solely as a 23 result of their HIV status; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 746 •HR 6637 IH (B) that if the entity, department, or orga- 1 nization promulgates any laws, policies, regula- 2 tions, or judicial decisions regarding people liv- 3 ing with HIV, such actions shall demonstrate a 4 public health-oriented, evidence-based, medically 5 accurate, and contemporary understanding of— 6 (i) the multiple factors that lead to 7 HIV transmission; 8 (ii) the relative risk of HIV trans- 9 mission routes; 10 (iii) the current health implications of 11 living with HIV; 12 (iv) the associated benefits of treat- 13 ment and support services for people living 14 with HIV; 15 (v) the impact of punitive HIV-spe- 16 cific laws and policies on public health, on 17 people living with or affected by HIV, and 18 on their families and communities; and 19 (vi) the current science on HIV pre- 20 vention and treatment, including pre-expo- 21 sure prophylaxis (PrEP), post-exposure 22 prophylaxis (PEP), and viral suppression. 23 (4) REPORT.—No later than 1 year after the 24 date of the enactment of this Act, and annually 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 747 •HR 6637 IH thereafter, the Attorney General and the Secretary 1 of Health and Human Services, acting jointly, shall 2 transmit to Congress and make publicly available a 3 report describing, for each State, the impact and ef- 4 fectiveness of the assistance provided through this 5 section. Each such report shall include— 6 (A) a detailed description of the progress 7 each State has made, if any, in implementing 8 the best practice recommendations developed 9 under subsection (c)(2)(C) as a result of the as- 10 sistance provided under this subsection, and 11 based on the performance goals and indicators 12 established as part of the monitoring and eval- 13 uation system in subsection (c)(4); 14 (B) a brief summary of any outreach ef- 15 forts undertaken during the prior year by the 16 Attorney General and the Secretary of Health 17 and Human Services to encourage States to 18 seek assistance under this subsection in order 19 to implement the best practice recommenda- 20 tions developed under subsection (c)(2)(C); 21 (C) a summary of how assistance provided 22 through this subsection is being utilized by eli- 23 gible State and local entities, State and local 24 public health departments, and eligible non- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 748 •HR 6637 IH governmental organizations and, if applicable, 1 any contractors, including with respect to non- 2 governmental organizations, the type of tech- 3 nical assistance provided, and an evaluation of 4 the impact of such assistance on eligible State 5 and local entities; and 6 (D) a summary and description of eligible 7 State and local entities, State and local public 8 health departments, and eligible nongovern- 9 mental organizations receiving assistance 10 through this subsection, including if applicable, 11 a summary and description of any contractors 12 selected to assist in implementing such assist- 13 ance. 14 (5) DEFINITIONS.—For the purposes of this 15 subsection: 16 (A) ELIGIBLE STATE AND LOCAL ENTI- 17 TIES.—The term ‘‘eligible State and local enti- 18 ties’’ means the relevant individuals, offices, or 19 organizations that directly participate in the de- 20 velopment, dissemination, or implementation of 21 State laws, policies, regulations, or judicial deci- 22 sions, including— 23 (i) State governments, including State 24 attorneys general, State departments of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 749 •HR 6637 IH justice, and State National Guards, or 1 their equivalents; 2 (ii) State judicial and court systems, 3 including trial courts, appellate courts, 4 State supreme courts and courts of appeal, 5 and State correctional facilities, or their 6 equivalents; and 7 (iii) local governments, including city 8 and county governments, district attorneys, 9 and local law enforcement departments, or 10 their equivalents. 11 (B) STATE AND LOCAL PUBLIC HEALTH 12 DEPARTMENTS.—The term ‘‘State and local 13 public health departments’’ means the fol- 14 lowing: 15 (i) State public health departments, or 16 their equivalents, including the chief officer 17 of such departments and infectious disease 18 and communicable disease specialists with- 19 in such departments. 20 (ii) Local public health departments, 21 or their equivalents, including city and 22 county public health departments, the chief 23 officer of such departments, and infectious 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 750 •HR 6637 IH disease and communicable disease special- 1 ists within such departments. 2 (iii) Public health departments or offi- 3 cials, or their equivalents, within State or 4 local correctional facilities. 5 (iv) Public health departments or offi- 6 cials, or their equivalents, within State Na- 7 tional Guards. 8 (v) Any other recognized State or 9 local public health organization or entity 10 charged with carrying out official State or 11 local public health duties. 12 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 13 NIZATIONS.—The term ‘‘eligible nongovern- 14 mental organizations’’ means the following: 15 (i) Nongovernmental organizations, 16 including trade organizations or associa- 17 tions that represent— 18 (I) State attorneys general, or 19 their equivalents; 20 (II) State public health officials, 21 or their equivalents; 22 (III) State judicial and court offi- 23 cers, including judges, district attor- 24 neys, prosecutors, defense attorneys, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 751 •HR 6637 IH law enforcement, and correctional offi- 1 cers; 2 (IV) State National Guards; 3 (V) people living with HIV; 4 (VI) legal advocacy and HIV 5 service organizations that work with 6 people living with HIV; and 7 (VII) nongovernmental health or- 8 ganizations that work on behalf of 9 people living with HIV. 10 (ii) Nongovernmental organizations, 11 including trade organizations or associa- 12 tions that demonstrate a public-health ori- 13 ented, evidence-based, medically accurate, 14 and contemporary understanding of— 15 (I) the multiple factors that lead 16 to HIV transmission; 17 (II) the relative risk of HIV 18 transmission routes; 19 (III) the current health implica- 20 tions of living with HIV; 21 (IV) the associated benefits of 22 treatment and support services for 23 people living with HIV; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 752 •HR 6637 IH (V) the impact of punitive HIV- 1 specific laws and policies on public 2 health, on people living with or af- 3 fected by HIV, and on their families 4 and communities; and 5 (VI) the current science on HIV 6 prevention and treatment, including 7 pre-exposure prophylaxis (PrEP), 8 post-exposure prophylaxis (PEP), and 9 viral suppression. 10 (6) AUTHORIZATION OF APPROPRIATIONS.— 11 (A) IN GENERAL.—In addition to amounts 12 otherwise made available, there are authorized 13 to be appropriated to the Attorney General and 14 the Secretary of Health and Human Services 15 such sums as may be necessary to carry out 16 this subsection for each of the fiscal years 2021 17 through 2024. 18 (B) AVAILABILITY OF FUNDS.—Amounts 19 appropriated pursuant to the authorizations of 20 appropriations in subparagraph (A) are author- 21 ized to remain available until expended. 22 SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 23 ONS. 24 (a) DEFINITIONS.—For the purposes of this section: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 753 •HR 6637 IH (1) COMMUNITY ORGANIZATION.—The term 1 ‘‘community organization’’ means a public health 2 care facility or a nonprofit organization which pro- 3 vides health- or STI-related services according to es- 4 tablished public health standards. 5 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 6 The term ‘‘comprehensive sexuality education’’ 7 means sexuality education— 8 (A) that includes information about absti- 9 nence and about the proper use and disposal of 10 sexual barrier protection devices; and 11 (B) which is— 12 (i) evidence-based; 13 (ii) medically accurate; 14 (iii) age and developmentally appro- 15 priate; 16 (iv) gender and identity sensitive; 17 (v) culturally and linguistically appro- 18 priate; and 19 (vi) structured to promote critical 20 thinking, self-esteem, respect for others, 21 and the development of healthy attitudes 22 and relationships. 23 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 24 rectional facility’’ means any prison, penitentiary, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 754 •HR 6637 IH adult detention facility, juvenile detention facility, 1 jail, or other facility to which persons may be sent 2 after conviction of a crime or act of juvenile delin- 3 quency within the United States. 4 (4) INCARCERATED PERSON.—The term ‘‘incar- 5 cerated person’’ means any person who is serving a 6 sentence in a correctional facility after conviction of 7 a crime. 8 (5) SEXUALLY TRANSMITTED INFECTION.—The 9 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 10 means any disease or infection that is commonly 11 transmitted through sexual activity, including HIV, 12 gonorrhea, chlamydia, syphilis, genital herpes, viral 13 hepatitis, and human papillomavirus. 14 (6) SEXUAL BARRIER PROTECTION DEVICE.— 15 The term ‘‘sexual barrier protection device’’ means 16 any FDA-approved physical device which has not 17 been tampered with and which reduces the prob- 18 ability of STI transmission or infection between sex- 19 ual partners, including female condoms, male 20 condoms, and dental dams. 21 (7) STATE.—The term ‘‘State’’ includes the 22 District of Columbia, American Samoa, the Com- 23 monwealth of the Northern Mariana Islands, Guam, 24 Puerto Rico, and the United States Virgin Islands. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 755 •HR 6637 IH (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 1 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 2 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 3 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 4 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 5 later than 30 days after the date of enactment of 6 this Act, the Attorney General shall direct the Direc- 7 tor of the Bureau of Prisons to allow community or- 8 ganizations to, in accordance with all relevant Fed- 9 eral laws and regulations which govern visitation in 10 correctional facilities— 11 (A) distribute sexual barrier protection de- 12 vices in Federal correctional facilities; and 13 (B) engage in STI counseling and STI pre- 14 vention education in Federal correctional facili- 15 ties. 16 (2) INFORMATION REQUIREMENT.—Any com- 17 munity organization permitted to distribute sexual 18 barrier protection devices under paragraph (1) shall 19 ensure that the persons to whom the devices are dis- 20 tributed are informed about the proper use and dis- 21 posal of sexual barrier protection devices in accord- 22 ance with established public health practices. Any 23 community organization conducting STI counseling 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 756 •HR 6637 IH or STI prevention education under paragraph (1) 1 shall offer comprehensive sexuality education. 2 (3) POSSESSION OF DEVICE PROTECTED.—A 3 Federal correctional facility may not, because of the 4 possession or use of a sexual barrier protection de- 5 vice— 6 (A) take adverse action against an incar- 7 cerated person; or 8 (B) consider possession or use as evidence 9 of prohibited activity for the purpose of any 10 Federal correctional facility administrative pro- 11 ceeding. 12 (4) IMPLEMENTATION.—The Attorney General 13 and Bureau of Prisons shall implement this section 14 according to established public health practices in a 15 manner that protects the health, safety, and privacy 16 of incarcerated persons and of correctional facility 17 staff. 18 (c) SENSE OF CONGRESS REGARDING DISTRIBUTION 19 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 20 PRISON SYSTEMS.—It is the sense of the Congress that 21 States should allow for the legal distribution of sexual bar- 22 rier protection devices in State correctional facilities to re- 23 duce the prevalence and spread of STIs in those facilities. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 757 •HR 6637 IH (d) SURVEY OF AND REPORT ON CORRECTIONAL FA- 1 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 2 STIS.— 3 (1) SURVEY.—Not later than 180 days after 4 the date of enactment of this Act, and annually 5 thereafter for 5 years, the Attorney General, after 6 consulting with the Secretary of Health and Human 7 Services, State officials, and community organiza- 8 tions, shall, to the maximum extent practicable, con- 9 duct a survey of all Federal and State correctional 10 facilities, to determine the following: 11 (A) COUNSELING, TREATMENT, AND SUP- 12 PORTIVE SERVICES.—Whether the correctional 13 facility— 14 (i) requires incarcerated persons to 15 participate in counseling, treatment, and 16 supportive services related to STIs; or 17 (ii) offers such programs to incarcer- 18 ated persons. 19 (B) ACCESS TO SEXUAL BARRIER PROTEC- 20 TION DEVICES.—Whether incarcerated persons 21 can— 22 (i) possess sexual barrier protection 23 devices; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 758 •HR 6637 IH (ii) purchase sexual barrier protection 1 devices; 2 (iii) purchase sexual barrier protection 3 devices at a reduced cost; or 4 (iv) obtain sexual barrier protection 5 devices without cost. 6 (C) INCIDENCE OF SEXUAL VIOLENCE.— 7 The incidence of sexual violence and assault 8 committed by incarcerated persons and by cor- 9 rectional facility staff. 10 (D) PREVENTION EDUCATION OFFERED.— 11 The type of prevention education, information, 12 or training offered to incarcerated persons and 13 correctional facility staff regarding sexual vio- 14 lence and the spread of STIs, including whether 15 such education, information, or training— 16 (i) constitutes comprehensive sexuality 17 education; 18 (ii) is compulsory for new incarcerated 19 persons and for new staff; and 20 (iii) is offered on an ongoing basis. 21 (E) STI TESTING.—Whether the correc- 22 tional facility tests incarcerated persons for 23 STIs or gives them the option to undergo such 24 testing— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 759 •HR 6637 IH (i) at intake; 1 (ii) on a regular basis; and 2 (iii) prior to release. 3 (F) STI TEST RESULTS.—The number of 4 incarcerated persons who are tested for STIs 5 and the outcome of such tests at each correc- 6 tional facility, disaggregated to include results 7 for— 8 (i) the type of sexually transmitted in- 9 fection tested for; 10 (ii) the race and ethnicity of individ- 11 uals tested; 12 (iii) the age of individuals tested; and 13 (iv) the gender of individuals tested. 14 (G) PRERELEASE REFERRAL POLICY.— 15 Whether incarcerated persons are informed 16 prior to release about STI-related services or 17 other health services in their communities, in- 18 cluding free and low-cost counseling and treat- 19 ment options. 20 (H) PRERELEASE REFERRALS MADE.— 21 The number of referrals to community-based 22 organizations or public health facilities offering 23 STI-related or other health services provided to 24 incarcerated persons prior to release, and the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 760 •HR 6637 IH type of counseling or treatment for which the 1 referral was made. 2 (I) REINSTATEMENT OF MEDICAID BENE- 3 FITS.—Whether the correctional facility assists 4 incarcerated persons that were enrolled in the 5 State Medicaid program prior to their incarcer- 6 ation, in reinstating their enrollment upon re- 7 lease and whether such individuals receive refer- 8 rals as provided by subparagraph (G) to entities 9 that accept the State Medicaid program, includ- 10 ing if applicable— 11 (i) the number of such individuals, in- 12 cluding those diagnosed with HIV, that 13 have been reinstated; 14 (ii) a list of obstacles to reinstating 15 enrollment or to making determinations of 16 eligibility for reinstatement, if any; and 17 (iii) the number of individuals denied 18 enrollment. 19 (J) OTHER ACTIONS TAKEN.—Whether the 20 correctional facility has taken any other action, 21 in conjunction with community organizations or 22 otherwise, to reduce the prevalence and spread 23 of STIs in that facility. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 761 •HR 6637 IH (2) PRIVACY.—In conducting the survey under 1 paragraph (1), the Attorney General shall not re- 2 quest or retain the identity of any person who has 3 sought or been offered counseling, treatment, test- 4 ing, or prevention education information regarding 5 an STI (including information about sexual barrier 6 protection devices), or who has tested positive for an 7 STI. 8 (3) REPORT.— 9 (A) IN GENERAL.—The Attorney General 10 shall transmit to Congress and make publicly 11 available the results of the survey required 12 under paragraph (1), both for the United 13 States as a whole and disaggregated as to each 14 State and each correctional facility. 15 (B) DEADLINES.—To the maximum extent 16 possible, the Attorney General shall— 17 (i) issue the first report under sub- 18 paragraph (A) not later than 1 year after 19 the date of enactment of this Act; and 20 (ii) issue reports under subparagraph 21 (A) annually thereafter for 5 years. 22 (e) STRATEGY.— 23 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 24 Attorney General, in consultation with the Secretary 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 762 •HR 6637 IH of Health and Human Services, State officials, and 1 community organizations, shall develop and imple- 2 ment a 5-year strategy to reduce the prevalence and 3 spread of STIs in Federal and State correctional fa- 4 cilities. To the maximum extent possible, the strat- 5 egy shall be developed, transmitted to Congress, and 6 made publicly available no later than 180 days after 7 the transmission of the first report required under 8 subsection (d)(3). 9 (2) CONTENTS OF STRATEGY.—The strategy 10 developed under paragraph (1) shall include the fol- 11 lowing: 12 (A) PREVENTION EDUCATION.—A plan for 13 improving prevention education, information, 14 and training offered to incarcerated persons 15 and correctional facility staff, including infor- 16 mation and training on sexual violence and the 17 spread of STIs, and comprehensive sexuality 18 education. 19 (B) SEXUAL BARRIER PROTECTION DEVICE 20 ACCESS.—A plan for expanding access to sexual 21 barrier protection devices in correctional facili- 22 ties. 23 (C) SEXUAL VIOLENCE REDUCTION.—A 24 plan for reducing the incidence of sexual vio- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 763 •HR 6637 IH lence among incarcerated persons and correc- 1 tional facility staff, developed in consultation 2 with the National Prison Rape Elimination 3 Commission. 4 (D) COUNSELING AND SUPPORTIVE SERV- 5 ICES.—A plan for expanding access to coun- 6 seling and supportive services related to STIs in 7 correctional facilities. 8 (E) TESTING.—A plan for testing incarcer- 9 ated persons for STIs during intake, during 10 regular health exams, and prior to release, and 11 that— 12 (i) is conducted in accordance with 13 guidelines established by the Centers for 14 Disease Control and Prevention; 15 (ii) includes pretest counseling; 16 (iii) requires that incarcerated persons 17 are notified of their option to decline test- 18 ing at any time; 19 (iv) requires that incarcerated persons 20 are confidentially notified of their test re- 21 sults in a timely manner; and 22 (v) ensures that incarcerated persons 23 testing positive for STIs receive post-test 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 764 •HR 6637 IH counseling, care, treatment, and supportive 1 services. 2 (F) TREATMENT.—A plan for ensuring 3 that correctional facilities have the necessary 4 medicine and equipment to treat and monitor 5 STIs and for ensuring that incarcerated per- 6 sons living with or testing positive for STIs re- 7 ceive and have access to care and treatment 8 services. 9 (G) STRATEGIES FOR DEMOGRAPHIC 10 GROUPS.—A plan for developing and imple- 11 menting culturally appropriate, sensitive, and 12 specific strategies to reduce the spread of STIs 13 among demographic groups heavily impacted by 14 STIs. 15 (H) LINKAGES WITH COMMUNITIES AND 16 FACILITIES.—A plan for establishing and 17 strengthening linkages to local communities and 18 health facilities that— 19 (i) provide counseling, testing, care, 20 and treatment services; 21 (ii) may receive persons recently re- 22 leased from incarceration who are living 23 with STIs; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 765 •HR 6637 IH (iii) accept payment through the State 1 Medicaid program. 2 (I) ENROLLMENT IN STATE MEDICAID 3 PROGRAMS.—Plans to ensure that— 4 (i) incarcerated persons who were en- 5 rolled in their State Medicaid program 6 prior to incarceration in a correctional fa- 7 cility are automatically reenrolled in such 8 program upon their release; and 9 (ii) incarcerated persons who were not 10 enrolled in their State Medicaid program 11 prior to incarceration, and who are diag- 12 nosed with HIV while incarcerated in a 13 correctional facility, are automatically en- 14 rolled in such program upon their release. 15 (J) OTHER PLANS.—Any other plans de- 16 veloped by the Attorney General for reducing 17 the spread of STIs or improving the quality of 18 health care in correctional facilities. 19 (K) MONITORING SYSTEM.—A monitoring 20 system that establishes performance goals re- 21 lated to reducing the prevalence and spread of 22 STIs in correctional facilities and which, where 23 feasible, expresses such goals in quantifiable 24 form. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 766 •HR 6637 IH (L) MONITORING SYSTEM PERFORMANCE 1 INDICATORS.—Performance indicators that 2 measure or assess the achievement of the per- 3 formance goals described in subparagraph (K). 4 (M) COST ESTIMATE.—A detailed estimate 5 of the funding necessary to implement the 6 strategy at the Federal and State levels for all 7 5 years, including the amount of funds required 8 by community organizations to implement the 9 parts of the strategy in which they take part. 10 (3) REPORT.—Not later than 1 year after the 11 date of the enactment of this Act, and annually 12 thereafter, the Attorney General shall transmit to 13 Congress and make publicly available an annual 14 progress report regarding the implementation and 15 effectiveness of the strategy described in paragraph 16 (1). The progress report shall include an evaluation 17 of the implementation of the strategy using the mon- 18 itoring system and performance indicators provided 19 for in subparagraphs (K) and (L) of paragraph (2). 20 (f) AUTHORIZATION OF APPROPRIATIONS.— 21 (1) IN GENERAL.—There are authorized to be 22 appropriated such sums as may be necessary to 23 carry out this section for each of fiscal years 2021 24 through 2025. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 767 •HR 6637 IH (2) AVAILABILITY OF FUNDS.—Amounts made 1 available under paragraph (1) are authorized to re- 2 main available until expended. 3 SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 4 IN MEDICAID FOR PEOPLE WHO TEST POSI- 5 TIVE FOR HIV BEFORE REENTERING COMMU- 6 NITIES. 7 (a) IN GENERAL.—Section 1902(e) of the Social Se- 8 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 9 the end the following: 10 ‘‘(16) ENROLLMENT OF EX-OFFENDERS.— 11 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 12 STATEMENT.— 13 ‘‘(i) IN GENERAL.—The State plan 14 shall provide for the automatic enrollment 15 or reinstatement of enrollment of an eligi- 16 ble individual— 17 ‘‘(I) if such individual is sched- 18 uled to be released from a public insti- 19 tution due to the completion of sen- 20 tence, not less than 30 days prior to 21 the scheduled date of the release; and 22 ‘‘(II) if such individual is to be 23 released from a public institution on 24 parole or on probation, as soon as 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 768 •HR 6637 IH possible after the date on which the 1 determination to release such indi- 2 vidual was made, and before the date 3 such individual is released. 4 ‘‘(ii) EXCEPTION.—If a State makes a 5 determination that an individual is not eli- 6 gible to be enrolled under the State plan— 7 ‘‘(I) on or before the date by 8 which the individual would be enrolled 9 under clause (i), such clause shall not 10 apply to such individual; or 11 ‘‘(II) after such date, the State 12 may terminate the enrollment of such 13 individual. 14 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 15 PAYMENT FOR SERVICES.— 16 ‘‘(i) IN GENERAL.—Subject to sub- 17 paragraph (A)(ii), an eligible individual 18 who is enrolled, or whose enrollment is re- 19 instated, under subparagraph (A) shall be 20 eligible for all services for which medical 21 assistance is provided under the State plan 22 after the date that the eligible individual is 23 released from the public institution. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 769 •HR 6637 IH ‘‘(ii) RELATIONSHIP TO PAYMENT 1 PROHIBITION FOR INMATES.—No provision 2 of this paragraph may be construed to per- 3 mit payment for care or services for which 4 payment is excluded under subdivision (A) 5 following paragraph (29) of section 6 1905(a). 7 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 8 BILITY.— 9 ‘‘(i) SUSPENSION FOR INMATES.—Any 10 period of continuous eligibility under this 11 title shall be suspended on the date an in- 12 dividual enrolled under this title becomes 13 an inmate of a public institution (except as 14 a patient of a medical institution). 15 ‘‘(ii) DETERMINATION OF REMAINING 16 PERIOD.—Notwithstanding any changes to 17 State law related to continuous eligibility 18 during the time that an individual is an in- 19 mate of a public institution (except as a 20 patient of a medical institution), subject to 21 clause (iii), with respect to an eligible indi- 22 vidual who was subject to a suspension 23 under clause (i), on the date that such in- 24 dividual is released from a public institu- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 770 •HR 6637 IH tion the suspension of continuous eligibility 1 under such clause shall be lifted for a pe- 2 riod that is equal to the time remaining in 3 the period of continuous eligibility for such 4 individual on the date that such period was 5 suspended under such clause. 6 ‘‘(iii) EXCEPTION.—If a State makes 7 a determination that an individual is not 8 eligible to be enrolled under the State 9 plan— 10 ‘‘(I) on or before the date that 11 the suspension of continuous eligibility 12 is lifted under clause (ii), such clause 13 shall not apply to such individual; or 14 ‘‘(II) after such date, the State 15 may terminate the enrollment of such 16 individual. 17 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 18 STATEMENT OF ENROLLMENT DEFINED.—For 19 purposes of this paragraph, the term ‘automatic 20 enrollment or reinstatement of enrollment’ 21 means that the State determines eligibility for 22 medical assistance under the State plan without 23 a program application from, or on behalf of, the 24 eligible individual, but an individual can only be 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 771 •HR 6637 IH automatically enrolled in the State Medicaid 1 plan if the individual affirmatively consents to 2 being enrolled through affirmation in writing, 3 by telephone, orally, through electronic signa- 4 ture, or through any other means specified by 5 the Secretary. 6 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 7 For purposes of this paragraph, the term ‘eligi- 8 ble individual’ means an individual who is an 9 inmate of a public institution (except as a pa- 10 tient in a medical institution)— 11 ‘‘(i) who was enrolled under the State 12 plan for medical assistance immediately be- 13 fore becoming an inmate of such an insti- 14 tution; or 15 ‘‘(ii) who is diagnosed with human im- 16 munodeficiency virus.’’. 17 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 18 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 19 ICAID BENEFITS.— 20 (1) IN GENERAL.—Subject to paragraphs (3), 21 with respect to a State, for each of the first 4 cal- 22 endar quarters in which the State plan meets the re- 23 quirements of paragraph (16) of section 1902(e) of 24 the Social Security Act (42 U.S.C. 1396a(e)) (as 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 772 •HR 6637 IH added by subsection (a)), the Federal matching pay- 1 ments (including payments based on the Federal 2 medical assistance percentage) made to such State 3 under section 1903 of the Social Security Act (42 4 U.S.C. 1396b) for the State expenditures described 5 in paragraph (2) shall be increased by 5 percentage 6 points. 7 (2) EXPENDITURES.—The expenditures de- 8 scribed in this paragraph are the following: 9 (A) Expenditures for which payment is 10 available under section 1903 of the Social Secu- 11 rity Act (42 U.S.C. 1396b) and which are at- 12 tributable to strengthening the State’s enroll- 13 ment and administrative resources for the pur- 14 pose of improving processes for enrolling (or re- 15 instating the enrollment of) eligible individuals 16 (as such term is defined in subparagraph (E) of 17 paragraph (16) of section 1902(e) of the Social 18 Security Act (42 U.S.C. 1396a(e)) (as amended 19 by subsection (a)). 20 (B) Expenditures for medical assistance 21 (as such term is defined in section 1905(a) of 22 the Social Security Act (42 U.S.C. 1396d(a))) 23 provided to such eligible individuals. 24 (3) REQUIREMENTS; LIMITATION.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 773 •HR 6637 IH (A) REPORT.—A State is not eligible for 1 an increase in its Federal matching payments 2 under paragraph (1) unless the State agrees to 3 submit to the Secretary of Health and Human 4 Services, and make publicly available, a report 5 that contains the information required under 6 paragraph (4) by the end of the 1-year period 7 during which the State receives increased Fed- 8 eral matching payments in accordance with that 9 paragraph. 10 (B) MAINTENANCE OF ELIGIBILITY.— 11 (i) IN GENERAL.—Subject to clause 12 (ii), a State is not eligible for an increase 13 in its Federal matching payments under 14 paragraph (1) if eligibility standards, 15 methodologies, or procedures under its 16 State plan under title XIX of the Social 17 Security Act (42 U.S.C. 1396 et seq.), or 18 waiver of such a plan, are more restrictive 19 than the eligibility standards, methodolo- 20 gies, or procedures, respectively, under 21 such plan or waiver as in effect on the date 22 of enactment of this Act. 23 (ii) STATE REINSTATEMENT OF ELIGI- 24 BILITY PERMITTED.—A State that has re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 774 •HR 6637 IH stricted eligibility standards, methodolo- 1 gies, or procedures under its State plan 2 under title XIX of the Social Security Act 3 (42 U.S.C. 1396 et seq.), or a waiver of 4 such plan, after the date of enactment of 5 this Act, is no longer ineligible under 6 clause (i) beginning with the first calendar 7 quarter in which the State has reinstated 8 eligibility standards, methodologies, or pro- 9 cedures that are no more restrictive than 10 the eligibility standards, methodologies, or 11 procedures, respectively, under such plan 12 (or waiver) as in effect on such date. 13 (C) LIMITATION OF MATCHING PAYMENTS 14 TO 100 PERCENT.—In no case shall an increase 15 in Federal matching payments under paragraph 16 (1) result in Federal matching payments that 17 exceed 100 percent of State expenditures. 18 (4) REQUIRED REPORT INFORMATION.—The in- 19 formation that is required in the report under para- 20 graph (3)(A) shall include— 21 (A) the results of an evaluation of the im- 22 pact of the implementation of the requirements 23 of paragraph (16) of section 1902(e) of the So- 24 cial Security Act (42 U.S.C. 1396a(e)) on im- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 775 •HR 6637 IH proving the State’s processes for enrolling indi- 1 viduals who are released from public institu- 2 tions under the State Medicaid plan; 3 (B) the number of individuals who were 4 automatically enrolled (or whose enrollment was 5 reinstated) under such paragraph during the 1- 6 year period during which the State received in- 7 creased payments under this subsection; and 8 (C) any other information that is required 9 by the Secretary of Health and Human Serv- 10 ices. 11 (c) EFFECTIVE DATE.— 12 (1) IN GENERAL.—Except as provided in para- 13 graph (2), the amendments made by subsection (a) 14 shall take effect 180 days after the date of the en- 15 actment of this Act. 16 (2) RULE FOR CHANGES REQUIRING STATE 17 LEGISLATION.—In the case of a State plan for med- 18 ical assistance under title XIX of the Social Security 19 Act (42 U.S.C. 1396 et seq.) which the Secretary of 20 Health and Human Services determines requires 21 State legislation (other than legislation appro- 22 priating funds) in order for the plan to meet the ad- 23 ditional requirement imposed by the amendments 24 made by subsection (a), the State plan shall not be 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 776 •HR 6637 IH regarded as failing to comply with the requirements 1 of such title solely on the basis of its failure to meet 2 this additional requirement before the first day of 3 the first calendar quarter beginning after the close 4 of the first regular session of the State legislature 5 that begins after the date of the enactment of this 6 Act. For purposes of the previous sentence, in the 7 case of a State that has a 2-year legislative session, 8 each year of such session shall be deemed to be a 9 separate regular session of the State legislature. 10 SEC. 758. STOP HIV IN PRISON. 11 (a) SHORT TITLE.—This section may be cited as the 12 ‘‘Stop HIV in Prison Act’’. 13 (b) IN GENERAL.—The Director of the Bureau of 14 Prisons (referred to in this section as the ‘‘Director’’) shall 15 develop a comprehensive policy to provide HIV testing, 16 treatment, and prevention for inmates within the correc- 17 tional setting and upon reentry. 18 (c) PURPOSE.—The purposes of the policy required 19 to be developed under subsection (b) shall be as follows: 20 (1) To stop the spread of HIV among inmates. 21 (2) To protect prison guards and other per- 22 sonnel from HIV infection. 23 (3) To provide comprehensive medical treat- 24 ment to inmates who are living with HIV. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 777 •HR 6637 IH (4) To promote HIV awareness and prevention 1 among inmates. 2 (5) To encourage inmates to take personal re- 3 sponsibility for their health. 4 (6) To reduce the risk that inmates will trans- 5 mit HIV to other persons in the community fol- 6 lowing their release from prison. 7 (d) CONSULTATION.—The Director shall consult with 8 appropriate officials of the Department of Health and 9 Human Services, the Office of National Drug Control Pol- 10 icy, and the Centers for Disease Control and Prevention 11 regarding the development of the policy required under 12 subsection (b). 13 (e) TIME LIMIT.—Not later than 1 year after the 14 date of enactment of this Act, the Director shall draft ap- 15 propriate regulations to implement the policy required to 16 be developed under subsection (b). 17 (f) REQUIREMENTS FOR POLICY.—The policy re- 18 quired to be developed under subsection (b) shall provide 19 for the following: 20 (1) TESTING AND COUNSELING UPON IN- 21 TAKE.— 22 (A) Health care personnel shall provide 23 routine HIV testing to all inmates as a part of 24 a comprehensive medical examination imme- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 778 •HR 6637 IH diately following admission to a facility. Health 1 care personnel need not provide routine HIV 2 testing to an inmate who is transferred to a fa- 3 cility from another facility if the inmate’s med- 4 ical records are transferred with the inmate and 5 indicate that the inmate has been tested pre- 6 viously. 7 (B) To all inmates admitted to a facility 8 prior to the effective date of this policy, health 9 care personnel shall provide routine HIV testing 10 within no more than 6 months. HIV testing for 11 these inmates may be performed in conjunction 12 with other health services provided to these in- 13 mates by health care personnel. 14 (C) All HIV tests under this paragraph 15 shall comply with the opt-out provision. 16 (2) PRE-TEST AND POST-TEST COUNSELING.— 17 Health care personnel shall provide confidential pre- 18 test and post-test counseling to all inmates who are 19 tested for HIV. Counseling may be included with 20 other general health counseling provided to inmates 21 by health care personnel. 22 (3) HIV PREVENTION EDUCATION.— 23 (A) Health care personnel shall improve 24 HIV awareness through frequent educational 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 779 •HR 6637 IH programs for all inmates. HIV educational pro- 1 grams may be provided by community-based or- 2 ganizations, local health departments, and in- 3 mate peer educators. 4 (B) HIV educational materials shall be 5 made available to all inmates at orientation, at 6 health care clinics, at regular educational pro- 7 grams, and prior to release. Both written and 8 audiovisual materials shall be made available to 9 all inmates. 10 (C)(i) The HIV educational programs and 11 materials under this paragraph shall include in- 12 formation on— 13 (I) modes of transmission, including 14 transmission through tattooing, sexual con- 15 tact, and intravenous drug use; 16 (II) prevention methods; 17 (III) treatment; and 18 (IV) disease progression. 19 (ii) The programs and materials shall be 20 culturally sensitive, written or designed for low- 21 literacy levels, available in a variety of lan- 22 guages, and present scientifically accurate in- 23 formation in a clear and understandable man- 24 ner. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 780 •HR 6637 IH (4) HIV TESTING UPON REQUEST.— 1 (A) Health care personnel shall allow in- 2 mates to obtain HIV tests upon request once 3 per year or whenever an inmate has a reason to 4 believe the inmate may have been exposed to 5 HIV. Health care personnel shall, both orally 6 and in writing, inform inmates, during orienta- 7 tion and periodically throughout incarceration, 8 of their right to obtain HIV tests. 9 (B) Health care personnel shall encourage 10 inmates to request HIV tests if the inmate is 11 sexually active, has been raped, uses intra- 12 venous drugs, receives a tattoo, or if the inmate 13 is concerned that the inmate may have been ex- 14 posed to HIV. 15 (C) An inmate’s request for an HIV test 16 shall not be considered an indication that the 17 inmate has put him/herself at risk of infection 18 and/or committed a violation of prison rules. 19 (5) HIV TESTING OF PREGNANT WOMAN.— 20 (A) Health care personnel shall provide 21 routine HIV testing to all inmates who become 22 pregnant. 23 (B) All HIV tests under this paragraph 24 shall comply with the opt-out provision. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 781 •HR 6637 IH (6) COMPREHENSIVE TREATMENT.— 1 (A) Health care personnel shall provide all 2 inmates who test positive for HIV— 3 (i) timely, comprehensive medical 4 treatment; 5 (ii) confidential counseling on man- 6 aging their medical condition and pre- 7 venting its transmission to other persons; 8 and 9 (iii) voluntary partner notification 10 services. 11 (B) Health care provided under this para- 12 graph shall be consistent with current Depart- 13 ment of Health and Human Services guidelines 14 and standard medical practice. Health care per- 15 sonnel shall discuss treatment options, the im- 16 portance of adherence to antiretroviral therapy, 17 and the side effects of medications with inmates 18 receiving treatment. 19 (C) Health care personnel and pharmacy 20 personnel shall ensure that the facility for- 21 mulary contains all Food and Drug Administra- 22 tion-approved medications necessary to provide 23 comprehensive treatment for inmates living with 24 HIV, and that the facility maintains adequate 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 782 •HR 6637 IH supplies of such medications to meet inmates’ 1 medical needs. Health care personnel and phar- 2 macy personnel shall also develop and imple- 3 ment automatic renewal systems for these medi- 4 cations to prevent interruptions in care. 5 (D) Correctional staff, health care per- 6 sonnel, and pharmacy personnel shall develop 7 and implement distribution procedures to en- 8 sure timely and confidential access to medica- 9 tions. 10 (7) PROTECTION OF CONFIDENTIALITY.— 11 (A) Health care personnel shall develop 12 and implement procedures to ensure the con- 13 fidentiality of inmate tests, diagnoses, and 14 treatment. Health care personnel and correc- 15 tional staff shall receive regular training on the 16 implementation of these procedures. Penalties 17 for violations of inmate confidentiality by health 18 care personnel or correctional staff shall be 19 specified and strictly enforced. 20 (B) HIV testing, counseling, and treat- 21 ment shall be provided in a confidential setting 22 where other routine health services are provided 23 and in a manner that allows the inmate to re- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 783 •HR 6637 IH quest and obtain these services as routine med- 1 ical services. 2 (8) TESTING, COUNSELING, AND REFERRAL 3 PRIOR TO REENTRY.— 4 (A) Health care personnel shall provide 5 routine HIV testing to all inmates not earlier 6 than 3 months prior to their release and re- 7 entry into the community. Inmates who are al- 8 ready known to be infected need not be tested 9 again. This requirement may be waived if an in- 10 mate’s release occurs without sufficient notice 11 to the Bureau to allow health care personnel to 12 perform a routine HIV test and notify the in- 13 mate of the results. 14 (B) All HIV tests under this paragraph 15 shall comply with the opt-out provision. 16 (C) To all inmates who test positive for 17 HIV and all inmates who already are known to 18 have HIV, health care personnel shall provide— 19 (i) confidential prerelease counseling 20 on managing their medical condition in the 21 community, accessing appropriate treat- 22 ment and services in the community, and 23 preventing the transmission of their condi- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 784 •HR 6637 IH tion to family members and other persons 1 in the community; 2 (ii) referrals to appropriate health 3 care providers and social service agencies 4 in the community that meet the inmate’s 5 individual needs, including voluntary part- 6 ner notification services and prevention 7 counseling services for people living with 8 HIV; and 9 (iii) a 30-day supply of any medically 10 necessary medications the inmate is cur- 11 rently receiving. 12 (9) OPT-OUT PROVISION.—Inmates shall have 13 the right to refuse routine HIV testing. Inmates 14 shall be informed both orally and in writing of this 15 right. Oral and written disclosure of this right may 16 be included with other general health information 17 and counseling provided to inmates by health care 18 personnel. If an inmate refuses a routine test for 19 HIV, health care personnel shall make a note of the 20 inmate’s refusal in the inmate’s confidential medical 21 records. However, the inmate’s refusal shall not be 22 considered a violation of prison rules or result in dis- 23 ciplinary action. Any reference in this section to the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 785 •HR 6637 IH ‘‘opt-out provision’’ shall be deemed a reference to 1 the requirement of this paragraph. 2 (10) EXCLUSION OF TESTS PERFORMED UNDER 3 SECTION 4014(b) FROM THE DEFINITION OF ROU- 4 TINE HIV TESTING.—HIV testing of an inmate 5 under section 4014(b) of title 18, United States 6 Code, is not routine HIV testing for the purposes of 7 the opt-out provision. Health care personnel shall 8 document the reason for testing under section 9 4014(b) of title 18, United States Code, in the in- 10 mate’s confidential medical records. 11 (11) TIMELY NOTIFICATION OF TEST RE- 12 SULTS.—Health care personnel shall provide timely 13 notification to inmates of the results of HIV tests. 14 (g) CHANGES IN EXISTING LAW.— 15 (1) SCREENING IN GENERAL.—Section 4014(a) 16 of title 18, United States Code, is amended— 17 (A) by striking ‘‘for a period of 6 months 18 or more’’; 19 (B) by striking ‘‘, as appropriate,’’; and 20 (C) by striking ‘‘if such individual is deter- 21 mined to be at risk for infection with such virus 22 in accordance with the guidelines issued by the 23 Bureau of Prisons relating to infectious disease 24 management’’ and inserting ‘‘unless the indi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 786 •HR 6637 IH vidual declines. The Attorney General shall also 1 cause such individual to be so tested before re- 2 lease unless the individual declines.’’. 3 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 4 CIVIL AND CRIMINAL PROCEEDINGS.—Section 5 4014(d) of title 18, United States Code, is amended 6 by inserting ‘‘or under the Stop HIV in Prison Act’’ 7 after ‘‘under this section’’. 8 (3) SCREENING AS PART OF ROUTINE SCREEN- 9 ING.—Section 4014(e) of title 18, United States 10 Code, is amended by adding at the end the fol- 11 lowing: ‘‘Such rules shall also provide that the initial 12 test under this section be performed as part of the 13 routine health screening conducted at intake.’’. 14 (h) REPORTING REQUIREMENTS.— 15 (1) REPORT ON HEPATITIS, LIVER, AND OTHER 16 DISEASES.—Not later than 1 year after the date of 17 enactment of this Act, the Director shall provide a 18 report to the Congress on the policies and proce- 19 dures of the Bureau of Prisons to provide testing, 20 treatment, and prevention education programs for 21 hepatitis, liver failure, and other liver-related dis- 22 eases transmitted through sexual activity, intra- 23 venous drug use, or other means. The Director shall 24 consult with appropriate officials of the Department 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 787 •HR 6637 IH of Health and Human Services, the Office of Na- 1 tional Drug Control Policy, the Office of National 2 AIDS Policy, and the Centers for Disease Control 3 and Prevention regarding the development of this re- 4 port. 5 (2) ANNUAL REPORTS.— 6 (A) GENERALLY.—Not later than 2 years 7 after the date of enactment of this Act, and 8 then annually thereafter, the Director shall re- 9 port to Congress on the incidence among in- 10 mates of diseases transmitted through sexual 11 activity and intravenous drug use. 12 (B) MATTERS PERTAINING TO VARIOUS 13 DISEASES.—Each report under paragraph (1) 14 shall discuss— 15 (i) the incidence among inmates of 16 HIV, hepatitis, and other diseases trans- 17 mitted through sexual activity and intra- 18 venous drug use; and 19 (ii) updates on the testing, treatment, 20 and prevention education programs for 21 these diseases conducted by the Bureau of 22 Prisons. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 788 •HR 6637 IH (C) MATTERS PERTAINING TO HIV 1 ONLY.—Each report under paragraph (1) shall 2 also include— 3 (i) the number of inmates who tested 4 positive for HIV upon intake; 5 (ii) the number of inmates who tested 6 positive prior to reentry; 7 (iii) the number of inmates who were 8 not tested prior to reentry because they 9 were released without sufficient notice; 10 (iv) the number of inmates who opted- 11 out of taking the test; 12 (v) the number of inmates who were 13 tested under section 4014(b) of title 18, 14 United States Code; and 15 (vi) the number of inmates under 16 treatment for HIV. 17 (D) CONSULTATION.—The Director shall 18 consult with appropriate officials of the Depart- 19 ment of Health and Human Services, the Office 20 of National Drug Control Policy, and the Cen- 21 ters for Disease Control and Prevention regard- 22 ing the development of each report under para- 23 graph (1). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 789 •HR 6637 IH SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICA- 1 TORS FOR MONITORING HIV CARE. 2 The Secretary of Health and Human Services, in col- 3 laboration with the Assistant Secretary for Health, the Di- 4 rector of the Office of Infectious Disease and HIV/AIDS 5 Policy, the Director of the Centers for Disease Control and 6 Prevention, the Assistant Secretary for Mental Health and 7 Substance Use, the Director of the Department of Hous- 8 ing and Urban Development, the Director of the Office 9 of AIDS Research, the Administrator of the Health Re- 10 sources and Services Administration, and the Adminis- 11 trator of the Centers for Medicare & Medicaid Services, 12 shall expand and coordinate efforts to align metrics across 13 agencies and modify Federal data systems, to— 14 (1) adopt the National Academy of Medicine’s 15 clinical HIV care indicators as the core metrics for 16 monitoring the quality of HIV care, mental health, 17 substance abuse, and supportive services; 18 (2) better enable assessment of the impact of 19 the National HIV/AIDS Strategy and the Patient 20 Protection and Affordable Care Act (Public Law 21 111–148) on improving HIV care and access to sup- 22 portive services for individuals with HIV; 23 (3) expand the demographic data elements to be 24 captured by Federal data systems relevant to HIV 25 care to permit calculation of the indicators for sub- 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 790 •HR 6637 IH groups of the population of people with diagnosed 1 HIV infection, including— 2 (A) age; 3 (B) race; 4 (C) ethnicity; 5 (D) sex (assigned at birth); 6 (E) gender identity; 7 (F) sexual orientation; 8 (G) current geographic marker of resi- 9 dence; 10 (H) income or poverty level; and 11 (I) primary means of reimbursement for 12 medical services (including a State Medicaid 13 program, the Medicare program, the Ryan 14 White HIV Program, private insurance, health 15 maintenance organizations, and no coverage); 16 and 17 (4) streamline data collection and systematically 18 review all existing reporting requirements for feder- 19 ally funded HIV programs to ensure that only essen- 20 tial data are collected. 21 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 791 •HR 6637 IH SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 1 ENDING THE HIV EPIDEMIC: A PLAN FOR 2 AMERICA. 3 Title II of the Public Health Service Act (42 U.S.C. 4 202 et seq.) is amended by inserting after section 241 the 5 following: 6 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 7 OF NATIONAL HIV/AIDS STRATEGY. 8 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 9 tionary appropriations made available to the Department 10 of Health and Human Services for any fiscal year for pro- 11 grams and activities that, as determined by the Secretary, 12 pertain to HIV, the Secretary may transfer up to 1 per- 13 cent of such appropriations to the Office of the Assistant 14 Secretary for Health for implementation of the Ending the 15 HIV Epidemic: A Plan for America. 16 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 17 30 days before making any transfer under this section, 18 the Secretary shall give notice of the transfer to the Con- 19 gress. 20 ‘‘(c) DEFINITIONS.—In this section, the term ‘End- 21 ing the HIV Epidemic: A Plan for America’ means the 22 initiative that seeks to reduce the number of new HIV in- 23 fections in the United States by 75 percent by 2025, and 24 then by at least 90 percent by 2030, for an estimated 25 250,000 total HIV infections averted.’’. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 792 •HR 6637 IH Subtitle F—Diabetes 1 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 2 Subpart 3 of part C of title IV of the Public Health 3 Service Act (42 U.S.C. 285c et seq.) is amended by adding 4 at the end the following new section: 5 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 6 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 7 pand, intensify, and support ongoing research and other 8 activities with respect to prediabetes and diabetes, particu- 9 larly type 2, in minority populations. 10 ‘‘(b) RESEARCH.— 11 ‘‘(1) DESCRIPTION.—Research under subsection 12 (a) shall include investigation into— 13 ‘‘(A) the causes of diabetes, including so- 14 cioeconomic, geographic, clinical, environmental, 15 genetic, and other factors that may contribute 16 to increased rates of diabetes in minority popu- 17 lations; and 18 ‘‘(B) the causes of increased incidence of 19 diabetes complications in minority populations, 20 and possible interventions to decrease such inci- 21 dence. 22 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 23 In conducting and supporting research described in 24 subsection (a), the Director of NIH shall seek to in- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 793 •HR 6637 IH clude minority participants as study subjects in clin- 1 ical trials. 2 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 3 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 4 Interagency Coordinating Committee shall— 5 ‘‘(A) prepare and submit to the Congress, 6 not later than 6 months after the date of enact- 7 ment of this section, a report on Federal re- 8 search and public health activities with respect 9 to prediabetes and diabetes in minority popu- 10 lations; and 11 ‘‘(B) develop and submit to Congress, not 12 later than 1 year after the date of enactment of 13 this section, an effective and comprehensive 14 Federal plan (including all appropriate Federal 15 health programs) to address prediabetes and di- 16 abetes in minority populations. 17 ‘‘(2) CONTENTS.—The report under paragraph 18 (1)(A) shall at minimum address each of the fol- 19 lowing: 20 ‘‘(A) Research on diabetes and prediabetes 21 in minority populations, including such research 22 on— 23 ‘‘(i) genetic, behavioral, and environ- 24 mental factors; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 794 •HR 6637 IH ‘‘(ii) prevention and complications 1 among individuals within these populations 2 who have already developed diabetes. 3 ‘‘(B) Surveillance and data collection on 4 diabetes and prediabetes in minority popu- 5 lations, including with respect to— 6 ‘‘(i) efforts to better determine the 7 prevalence of diabetes among Asian-Amer- 8 ican and Pacific Islander subgroups; and 9 ‘‘(ii) efforts to coordinate data collec- 10 tion on the American Indian population. 11 ‘‘(C) Community-based interventions to ad- 12 dress diabetes and prediabetes targeting minor- 13 ity populations, including— 14 ‘‘(i) the evidence base for such inter- 15 ventions; 16 ‘‘(ii) the cultural appropriateness of 17 such interventions; and 18 ‘‘(iii) efforts to educate the public on 19 the causes and consequences of diabetes. 20 ‘‘(D) Education and training programs for 21 health professionals (including community 22 health workers) on the prevention and manage- 23 ment of diabetes and its related complications 24 that is supported by the Health Resources and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 795 •HR 6637 IH Services Administration, including such pro- 1 grams supported by— 2 ‘‘(i) the National Health Service 3 Corps; or 4 ‘‘(ii) the community health centers 5 program under section 330. 6 ‘‘(d) EDUCATION.—The Director of NIH shall— 7 ‘‘(1) through the National Institute on Minority 8 Health and Health Disparities and the National Di- 9 abetes Education Program— 10 ‘‘(A) make grants to programs funded 11 under section 464z–4 for the purpose of estab- 12 lishing a mentoring program for health care 13 professionals to be more involved in weight 14 counseling, obesity research, and nutrition; and 15 ‘‘(B) provide for the participation of mi- 16 nority health professionals in diabetes-focused 17 research programs; and 18 ‘‘(2) make grants for programs to establish a 19 pipeline from high school to professional school that 20 will increase minority representation in diabetes-fo- 21 cused health fields by expanding Minority Access to 22 Research Careers program internships and men- 23 toring opportunities for recruitment. 24 ‘‘(e) DEFINITIONS.—For purposes of this section: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 796 •HR 6637 IH ‘‘(1) DIABETES MELLITUS INTERAGENCY CO- 1 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 2 Interagency Coordinating Committee’ means the Di- 3 abetes Mellitus Interagency Coordinating Committee 4 established under section 429. 5 ‘‘(2) MINORITY POPULATION.—The term ‘mi- 6 nority population’ means a racial and ethnic minor- 7 ity group, as defined in section 1707.’’. 8 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 9 Part B of title III of the Public Health Service Act 10 (42 U.S.C. 243 et seq.), as amended by section 721, is 11 further amended by inserting after section 317W the fol- 12 lowing section: 13 ‘‘SEC. 317X. DIABETES IN MINORITY POPULATIONS. 14 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, shall conduct and support 18 research and public health activities with respect to 19 diabetes in minority populations. 20 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 21 paragraph (1) regarding diabetes in minority popu- 22 lations shall include the following: 23 ‘‘(A) Further enhancing the National 24 Health and Nutrition Examination Survey by 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 797 •HR 6637 IH oversampling Asian Americans, Native Hawai- 1 ians, and Pacific Islanders in appropriate geo- 2 graphic areas to better determine the preva- 3 lence of diabetes in such populations as well as 4 to improve the data collection of diabetes pene- 5 tration disaggregated into major ethnic groups 6 within such populations. The Secretary shall en- 7 sure that any such oversampling does not re- 8 duce the oversampling of other minority popu- 9 lations including African-American and Latino 10 populations. 11 ‘‘(B) Through the Division of Diabetes 12 Translation— 13 ‘‘(i) providing for prevention research 14 to better understand how to influence 15 health care systems changes to improve 16 quality of care being delivered to such pop- 17 ulations; 18 ‘‘(ii) carrying out model demonstra- 19 tion projects to design, implement, and 20 evaluate effective diabetes prevention and 21 control interventions for minority popu- 22 lations, including culturally appropriate 23 community-based interventions; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 798 •HR 6637 IH ‘‘(iii) developing and implementing a 1 strategic plan to reduce diabetes in minor- 2 ity populations through applied research to 3 reduce disparities and culturally and lin- 4 guistically appropriate community-based 5 interventions; 6 ‘‘(iv) supporting, through the national 7 diabetes prevention program under section 8 399V–3, diabetes prevention program sites 9 in underserved regions highly impacted by 10 diabetes; and 11 ‘‘(v) implementing, through the na- 12 tional diabetes prevention program under 13 section 399V–3, a demonstration program 14 developing new metrics measuring health 15 outcomes related to diabetes that can be 16 stratified by specific minority populations. 17 ‘‘(b) EDUCATION.—The Secretary, acting through 18 the Director of the Centers for Disease Control and Pre- 19 vention, shall direct the Division of Diabetes Translation 20 to conduct and support both programs to educate the pub- 21 lic on diabetes in minority populations and programs to 22 educate minority populations about the causes and effects 23 of diabetes. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 799 •HR 6637 IH ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 1 ACTIVITIES, AND ACCESS.—The Secretary, acting through 2 the Director of the Centers for Disease Control and Pre- 3 vention and the National Diabetes Education Program, 4 shall conduct and support programs to educate specific 5 minority populations through culturally appropriate and 6 linguistically appropriate information campaigns about 7 prevention of, and managing, diabetes. 8 ‘‘(d) DEFINITION.—For purposes of this section, the 9 term ‘minority population’ means a racial and ethnic mi- 10 nority group, as defined in section 1707.’’. 11 SEC. 773. 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 by section 733, is 14 further amended by adding at the end the following new 15 section: 16 ‘‘SEC. 399V–9. PROGRAMS TO EDUCATE HEALTH PRO- 17 VIDERS ON THE CAUSES AND EFFECTS OF DI- 18 ABETES IN MINORITY POPULATIONS. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Director of the Health Resources and Services Admin- 21 istration, shall conduct and support programs described 22 in subsection (b) to educate health professionals on the 23 causes and effects of diabetes in minority populations. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 800 •HR 6637 IH ‘‘(b) PROGRAMS.—Programs described in this sub- 1 section, with respect to education on diabetes in minority 2 populations, shall include the following: 3 ‘‘(1) Giving priority, under the primary care 4 training and enhancement program under section 5 747— 6 ‘‘(A) to awarding grants to focus on or ad- 7 dress diabetes; and 8 ‘‘(B) to adding minority populations to the 9 list of vulnerable populations that should be 10 served by such grants. 11 ‘‘(2) Providing additional funds for the Health 12 Careers Opportunity Program, the Centers for Ex- 13 cellence, and the Minority Faculty Fellowship Pro- 14 gram to partner with the Office of Minority Health 15 under section 1707 and the National Institutes of 16 Health to strengthen programs for career opportuni- 17 ties focused on diabetes treatment and care within 18 underserved regions highly impacted by diabetes. 19 ‘‘(3) Developing a diabetes focus within, and 20 providing additional funds for, the National Health 21 Service Corps scholarship program— 22 ‘‘(A) to place individuals in areas that are 23 disproportionately affected by diabetes and to 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 801 •HR 6637 IH provide diabetes treatment and care in such 1 areas; and 2 ‘‘(B) to provide such individuals continuing 3 medical education specific to diabetes care.’’. 4 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 5 Part P of title III of the Public Health Service Act 6 (42 U.S.C. 280g et seq.), as amended by section 773, is 7 further amended by adding at the end the following sec- 8 tion: 9 ‘‘SEC. 399V–10. RESEARCH, EDUCATION, AND OTHER ACTIVI- 10 TIES REGARDING DIABETES IN AMERICAN IN- 11 DIAN POPULATIONS. 12 ‘‘In addition to activities under sections 399V–6 and 13 434B, the Secretary, acting through the Indian Health 14 Service and in collaboration with other appropriate Fed- 15 eral agencies, shall— 16 ‘‘(1) conduct and support research and other 17 activities with respect to diabetes; and 18 ‘‘(2) coordinate the collection of data on clini- 19 cally and culturally appropriate diabetes treatment, 20 care, prevention, and services by health care profes- 21 sionals to the American Indian population.’’. 22 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 802 •HR 6637 IH SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 1 The Secretary of Health and Human Services shall 2 seek to enter into an arrangement with the National Acad- 3 emy of Medicine under which the National Academy will— 4 (1) not later than 1 year after the date of en- 5 actment of this Act, submit to Congress an updated 6 version of the 2002 report entitled ‘‘Unequal Treat- 7 ment: Confronting Racial and Ethnic Disparities in 8 Health Care’’; and 9 (2) in such updated version, address how racial 10 and ethnic health disparities have changed since the 11 publication of the original report. 12 Subtitle G—Lung Disease 13 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU- 14 CATION AND PREVENTION PROGRAM. 15 (a) FINDINGS.—Congress finds as follows: 16 (1) The prevalence of asthma has increased 17 since 1980 and affects more than 26,000,000 people 18 in the United States. 19 (2) Significant disparities in asthma morbidity 20 and mortality exist for both adults and children par- 21 ticularly for low-income and minority populations, 22 particularly African Americans and Puerto Ricans. 23 (3) African-American children are twice as like- 24 ly to have asthma as White children. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 803 •HR 6637 IH (4) In 2016, almost 4,500,000 non-Hispanic 1 African Americans reported having asthma. African 2 Americans with asthma are 3 times as likely to visit 3 the emergency department and twice as likely to get 4 hospitalized as White patients with asthma. 5 (5) Puerto Ricans are 3.4 times as likely to die 6 from asthma compared with all other Hispanic or 7 Latino groups. Overall Hispanic Americans are 30 8 percent more likely to be hospitalized for asthma 9 than non-Hispanic Whites. 10 (6) The majority of adults with asthma are 11 women. 12 (b) IN GENERAL.—Not later than 2 years after the 13 date of the enactment of this Act, the Secretary of Health 14 and Human Services shall convene a working group com- 15 prised of patient groups, nonprofit organizations, medical 16 societies, and other relevant governmental and nongovern- 17 mental entities, including those that participate in the Na- 18 tional Asthma Education and Prevention Program, to de- 19 velop a report to Congress that— 20 (1) catalogs, with respect to asthma prevention, 21 management, and surveillance— 22 (A) the activities of the Federal Govern- 23 ment, including identifying all Federal pro- 24 grams that carry out asthma-related activities, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 804 •HR 6637 IH as well as assessment of the progress of the 1 Federal Government and States, with respect to 2 achieving the goals of Healthy People 2020; 3 and 4 (B) the activities of other entities that par- 5 ticipate in the program, including nonprofit or- 6 ganizations, patient advocacy groups, and med- 7 ical societies; and 8 (2) makes recommendations for the future di- 9 rection of asthma activities, in consultation with re- 10 searchers from the National Institutes of Health and 11 other member bodies of the National Asthma Edu- 12 cation and Prevention Program who are qualified to 13 review and analyze data and evaluate interventions, 14 including— 15 (A) a description of how the Federal Gov- 16 ernment may better coordinate and improve its 17 response to asthma including identifying any 18 barriers that may exist; 19 (B) a description of how the Federal Gov- 20 ernment may continue, expand, and improve its 21 private-public partnerships with respect to asth- 22 ma including identifying any barriers that may 23 exist; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 805 •HR 6637 IH (C) identification of steps that may be 1 taken to reduce the— 2 (i) morbidity, mortality, and overall 3 prevalence of asthma; 4 (ii) financial burden of asthma on so- 5 ciety; 6 (iii) burden of asthma on dispropor- 7 tionately affected areas, particularly those 8 in medically underserved populations (as 9 defined in section 330(b)(3) of the Public 10 Health Service Act (42 U.S.C. 11 254b(b)(3))); and 12 (iv) burden of asthma as a chronic 13 disease; 14 (D) identification of programs and policies 15 that have achieved the steps described in sub- 16 paragraph (C), and steps that may be taken to 17 expand such programs and policies to benefit 18 larger populations; and 19 (E) recommendations for future research 20 and interventions. 21 (c) REPORT TO CONGRESS.—At the end of the 5-year 22 period following the submission of the report under this 23 section, the National Asthma Education and Prevention 24 Program shall evaluate the analyses and recommendations 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 806 •HR 6637 IH under such report and determine whether a new report 1 to the Congress is necessary, and make appropriate rec- 2 ommendations to the Congress. 3 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 4 FOR DISEASE CONTROL AND PREVENTION. 5 Section 317I of the Public Health Service Act (42 6 U.S.C. 247b–10) is amended to read as follows: 7 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 8 FOR DISEASE CONTROL AND PREVENTION. 9 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 10 EDUCATION TO THE PUBLIC.—The Secretary, acting 11 through the Director of the Centers for Disease Control 12 and Prevention, shall collaborate with State and local 13 health departments to conduct activities, including the 14 provision of information and education to the public re- 15 garding asthma including— 16 ‘‘(1) deterring the harmful consequences of un- 17 controlled asthma; and 18 ‘‘(2) disseminating health education and infor- 19 mation regarding prevention of asthma episodes and 20 strategies for managing asthma. 21 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 22 The Secretary, acting through the Director of the Centers 23 for Disease Control and Prevention, shall collaborate with 24 State and local health departments to develop State plans 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 807 •HR 6637 IH incorporating public health responses to reduce the burden 1 of asthma, particularly regarding disproportionately af- 2 fected populations. 3 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 4 through the Director of the Centers for Disease Control 5 and Prevention, shall, in cooperation with State and local 6 public health officials— 7 ‘‘(1) conduct asthma surveillance activities to 8 collect data on the prevalence and severity of asth- 9 ma, the effectiveness of public health asthma inter- 10 ventions, and the quality of asthma management, in- 11 cluding— 12 ‘‘(A) collection of household data on the 13 local burden of asthma; 14 ‘‘(B) surveillance of health care facilities; 15 and 16 ‘‘(C) collection of data not containing indi- 17 vidually identifiable information from electronic 18 health records or other electronic communica- 19 tions; 20 ‘‘(2) compile and annually publish data regard- 21 ing the prevalence and incidence of childhood asth- 22 ma, the child mortality rate, and the number of hos- 23 pital admissions and emergency department visits by 24 children associated with asthma nationally and in 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 808 •HR 6637 IH each State and at the county level by age, sex, race, 1 and ethnicity, as well as lifetime and current preva- 2 lence; and 3 ‘‘(3) compile and annually publish data regard- 4 ing the prevalence and incidence of adult asthma, 5 the adult mortality rate, and the number of hospital 6 admissions and emergency department visits by 7 adults associated with asthma nationally and in each 8 State and at the county level by age, sex, race, eth- 9 nicity, industry, and occupation, as well as lifetime 10 and current prevalence. 11 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 12 Director of the Centers for Disease Control and Preven- 13 tion, in conjunction with State and local health depart- 14 ments, shall coordinate data collection activities under 15 subsection (c)(2) so as to maximize comparability of re- 16 sults. 17 ‘‘(e) COLLABORATION.—The Centers for Disease 18 Control and Prevention are encouraged to collaborate with 19 national, State, and local nonprofit organizations to pro- 20 vide information and education about asthma, and to 21 strengthen such collaborations when possible. 22 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 23 other authorization of appropriations that is available to 24 the Centers for Disease Control and Prevention for the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 809 •HR 6637 IH purpose of carrying out this section, there are authorized 1 to be appropriated to such Centers such sums as may be 2 necessary for each of fiscal years 2021 through 2025 for 3 the purpose of carrying out this section.’’. 4 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM- 5 PAIGN. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services shall— 8 (1) enhance the annual campaign by the De- 9 partment of Health and Human Services to increase 10 the number of people vaccinated each year for influ- 11 enza and pneumonia; and 12 (2) include in such campaign the use of written 13 educational materials, public service announcements, 14 physician education, and any other means which the 15 Secretary deems effective. 16 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 17 out the annual campaign described in subsection (a), the 18 Secretary of Health and Human Services shall ensure 19 that— 20 (1) educational materials and public service an- 21 nouncements are readily and widely available in 22 communities experiencing disparities in the incidence 23 and mortality rates of influenza and pneumonia; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 810 •HR 6637 IH (2) the campaign uses targeted, culturally ap- 1 propriate messages and messengers to reach under- 2 served communities. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2021 through 2025. 7 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 8 ACTION PLAN. 9 (a) FINDINGS.—Congress finds as follows: 10 (1) Chronic obstructive pulmonary disease (re- 11 ferred to in this subsection as ‘‘COPD’’) refers to 12 chronic bronchitis and emphysema, incurable dis- 13 eases that make it difficult to exhale all the air from 14 one’s lungs, and that can cause persistent coughing, 15 shortness of breath, and sputum. 16 (2) COPD exacerbations—episodes of acute dif- 17 ficulty breathing and moderate to severe fatigue— 18 are dangerous, and their treatment often requires 19 hospitalization. 20 (3) While smoking is the primary risk factor for 21 COPD, other risk factors include air pollution, occu- 22 pational exposures, heredity, a history of childhood 23 respiratory infections, and socioeconomic status. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 811 •HR 6637 IH (4) It is estimated that over 13,500,000 adults 1 in the United States have COPD. 2 (5) COPD is the third-leading cause of death in 3 the United States, claiming over 134,000 lives in 4 2010. 5 (6) Since 2000, deaths for women with COPD 6 have exceeded deaths in men. 7 (7) Although African Americans have a lower 8 prevalence of COPD in the United States, research- 9 ers have shown that African Americans may be 10 underdiagnosed. Furthermore, research has shown 11 that African Americans develop COPD with less cu- 12 mulative smoke exposure and at a younger age. 13 (b) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention shall conduct, support, 15 and expand public health strategies, prevention, diagnosis, 16 surveillance, and public and professional awareness activi- 17 ties regarding chronic obstructive pulmonary disease. 18 (c) NATIONAL ACTION PLAN.— 19 (1) DEVELOPMENT.—Not later than 2 years 20 after the date of the enactment of this Act, the Di- 21 rector of the National Heart, Lung, and Blood Insti- 22 tute, in consultation with the Director of the Centers 23 for Disease Control and Prevention, shall develop a 24 national action plan to address chronic obstructive 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 812 •HR 6637 IH pulmonary disease in the United States with partici- 1 pation from patients, caregivers, health profes- 2 sionals, patient advocacy organizations, researchers, 3 providers, public health professionals, and other 4 stakeholders. 5 (2) CONTENTS.—At a minimum, such plan 6 shall include recommendations for— 7 (A) public health interventions for the pur- 8 pose of implementation of the national plan; 9 (B) biomedical, health services, and public 10 health research on chronic obstructive pul- 11 monary disease; and 12 (C) inclusion of chronic obstructive pul- 13 monary disease in the health data collections of 14 all Federal agencies. 15 (3) CONSIDERATION.—In developing such plan, 16 the Director of the National Heart, Lung, and Blood 17 Institute shall consider the recommendations and 18 findings of the National Academy of Medicine in the 19 report entitled ‘‘A Nationwide Framework for Sur- 20 veillance of Cardiovascular and Chronic Lung Dis- 21 eases’’ (July 22, 2011). 22 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 23 The Director of the National Heart, Lung, and Blood In- 24 stitute shall carry out the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 813 •HR 6637 IH (1) Conduct public education and awareness ac- 1 tivities with patient and professional organizations 2 to stimulate earlier diagnosis and improve patient 3 outcomes from treatment of chronic obstructive pul- 4 monary disease. To the extent known and relevant, 5 such public education and awareness activities shall 6 reflect differences in chronic obstructive pulmonary 7 disease by cause (tobacco, environmental, occupa- 8 tional, biological, and genetic) and include a focus 9 on outreach to undiagnosed and, as appropriate, mi- 10 nority populations. 11 (2) Supplement and expand upon the activities 12 of the National Heart, Lung, and Blood Institute by 13 making grants to nonprofit organizations, State and 14 local jurisdictions, and Indian tribes for the purpose 15 of reducing the burden of chronic obstructive pul- 16 monary disease, especially in disproportionately im- 17 pacted communities, through public health interven- 18 tions and related activities. 19 (3) Coordinate with the Centers for Disease 20 Control and Prevention, the Indian Health Service, 21 the Health Resources and Services Administration, 22 and the Department of Veterans Affairs to develop 23 pilot programs to demonstrate best practices for the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 814 •HR 6637 IH diagnosis and management of chronic obstructive 1 pulmonary disease. 2 (4) Develop improved techniques and identify 3 best practices, in coordination with the Secretary of 4 Veterans Affairs, for assisting chronic obstructive 5 pulmonary disease patients to successfully stop 6 smoking, including identification of subpopulations 7 with different needs. Initiatives under this para- 8 graph may include research to determine whether 9 successful smoking cessation strategies are different 10 for chronic obstructive pulmonary disease patients 11 compared to such strategies for patients with other 12 chronic diseases. 13 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 14 PROGRAMS.—The Director of the Centers for Disease 15 Control and Prevention shall— 16 (1) support research into the environmental and 17 occupational causes and biological mechanisms that 18 contribute to chronic obstructive pulmonary disease; 19 and 20 (2) develop and disseminate public health inter- 21 ventions that will lessen the impact of environmental 22 and occupational causes of chronic obstructive pul- 23 monary disease. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 815 •HR 6637 IH (f) DATA COLLECTION.—Not later than 180 days 1 after the enactment of this Act, the Director of the Na- 2 tional Heart, Lung, and Blood Institute and the Director 3 of the Centers for Disease Control and Prevention, acting 4 jointly, shall assess the depth and quality of information 5 on chronic obstructive pulmonary disease that is collected 6 in surveys and population studies conducted by the Cen- 7 ters for Disease Control and Prevention, including wheth- 8 er there are additional opportunities for information to be 9 collected in the National Health and Nutrition Examina- 10 tion Survey, the National Health Interview Survey, and 11 the Behavioral Risk Factors Surveillance System surveys. 12 The Director of the National Heart, Lung, and Blood In- 13 stitute shall include the results of such assessment in the 14 national action plan under subsection (c). 15 (g) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2021 through 2025. 19 Subtitle H—Tuberculosis 20 SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 21 (a) SHORT TITLE.—This subtitle may be cited as the 22 ‘‘End Tuberculosis Act’’. 23 (b) FINDINGS.—Congress makes the following find- 24 ings: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 816 •HR 6637 IH (1) In the United States, 9,025 people were di- 1 agnosed with tuberculosis (referred to in this section 2 as ‘‘TB’’) in 2018. 3 (2) Disparities in TB exist and significantly im- 4 pact minority communities in the United States. The 5 Centers for Disease Control and Prevention (re- 6 ferred to in this section as ‘‘CDC’’) finds that 70 7 percent of people diagnosed with TB in 2018 self- 8 identified as racial and ethnic minorities. 9 (3) African Americans comprised 20 percent of 10 people diagnosed with TB during 2018. The popu- 11 lation-adjusted rate of TB among African Americans 12 is 1.7 times higher than the national total, and 8.0 13 times higher than among Whites. 14 (4) Asian Americans, Native Hawaiians, and 15 other Pacific Islanders comprised 37 percent of peo- 16 ple diagnosed with TB during 2018. The population- 17 adjusted rate of TB among Asian Americans is 6.2 18 times higher than the national total, and 31 times 19 higher than among Whites. The population-adjusted 20 rate of TB among Native Hawaiians and other Pa- 21 cific Islanders is 4.8 times higher than the national 22 total, and 23.2 times higher than among Whites. 23 (5) Hispanics and Latinos comprised 26 per- 24 cent of people diagnosed with TB during 2018. The 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 817 •HR 6637 IH population-adjusted rate of TB among Hispanics 1 and Latinos is 1.6 times higher than the national 2 total, and 8.0 times higher than among Whites. 3 (6) TB is both preventable and curable, but the 4 current rate of decline of TB in the United States 5 remains too slow to achieve TB elimination in this 6 century. 7 (7) TB is transmitted through the air when a 8 person who has TB disease in their lungs coughs or 9 sneezes. People who are in close proximity to the 10 person with TB can breathe in the TB bacteria, and 11 the bacteria will initially settle in their lungs. With- 12 out proper and timely diagnosis and access to treat- 13 ment, the TB bacteria may grow and spread to 14 other parts of their body. 15 (8) As many as 13,000,000 people in the 16 United States may have latent TB Infection (re- 17 ferred to in this section as ‘‘LTBI’’). People with 18 LTBI have TB bacteria in their bodies, but their 19 immune system is containing the bacteria, and they 20 are not sick, nor do they have any current risk of 21 spreading TB to others. LTBI can activate into in- 22 fectious, life-threatening TB if not treated. Modeling 23 has shown that eliminating TB is not possible with- 24 out addressing LTBI. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 818 •HR 6637 IH (9) Comorbidities associated with TB include 1 cancer, diabetes mellitus, and HIV. People with 2 these medical conditions and compromised immune 3 systems are more likely to develop active TB disease 4 and to have worse outcomes from TB. 5 (10) Forms of active TB that do not show drug 6 resistance are classified as drug-susceptible TB (re- 7 ferred to in this section as ‘‘DS–TB’’). Drug-resist- 8 ant TB (referred to in this section as ‘‘DR–TB’’) is 9 a rising threat to the public health of the United 10 States. DR–TB that exhibits resistance to two or 11 more first-line drugs is referred to as multi-drug re- 12 sistant TB (referred to in this section as ‘‘MDR– 13 TB’’). MDR–TB that also is resistant to at least 14 one injectable second-line medication and at least 15 one fluoroquinolone is classified as extensively drug- 16 resistant TB (referred to in this section as ‘‘XDR– 17 TB’’). 18 (11) Approximately 97 people in the United 19 States were diagnosed with MDR–TB in 2018. One 20 person was diagnosed with XDR–TB in the same 21 year. 22 (12) In the United States, $480 million was 23 spent in 2018 to treat TB; direct treatment costs 24 average $19,000 to treat a patient with DS–TB, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 819 •HR 6637 IH $175,000 to treat a patient with MDR–TB, and 1 $544,000 to treat a patient with XDR–TB. When 2 factoring in productivity losses during treatment, 3 DS–TB averages $46,000, MDR–TB averages 4 $294,000 and XDR–TB averages $694,000. Treat- 5 ment is often difficult, with daily complex multi-pill 6 regimens and injections, with side-effects ranging 7 from hearing and vision loss to mental health issues. 8 (13) Recognizing the public health, economic 9 and societal costs to the threat of MDR–TB, the 10 National Action Plan to Combat MDR–TB was de- 11 veloped by the White House to provide the United 12 States with a comprehensive three-pronged strategy 13 to address MDR–TB by strengthening domestic ca- 14 pacity to combat MDR–TB; improve international 15 capacity and cooperation to combat MDR–TB; accel- 16 erate basic and applied research and development 17 for new therapies, diagnostics and prevention strate- 18 gies to combat MDR–TB. 19 (14) Additional Federal support is necessary to 20 expand TB control efforts in case finding and treat- 21 ment to address LTBI in a national prevention ini- 22 tiative. Key policy and research breakthroughs in- 23 crease the success of a TB prevention initiative: the 24 U.S. Preventative Services Task Force recommenda- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 820 •HR 6637 IH tion’s ‘‘B’’ rating, screening for LTBI among high- 1 risk adults as a covered service increases the likeli- 2 hood that impacted racial and ethnic minority 3 groups can get tested for TB; a new, shorter course 4 treatment regimen reduces the length of treatment 5 for LTBI from every day for 6 to 9 months to one 6 dose per week for 12 weeks, increasing likelihood of 7 treatment completion; and the use of blood-based di- 8 agnostic tests, Interferon-gamma release assays or 9 IGRAs, increases ability to detect LTBI among pa- 10 tients in affected communities. 11 (15) The right to health, and the right to 12 science as a necessary human right to help achieve 13 the right to health, is enshrined in Articles 25 and 14 27 of the Universal Declaration of Human Rights. 15 These fundamental human rights cannot be achieved 16 when anyone lacks access to TB prevention or treat- 17 ment, and when the benefits of scientific innovation 18 are not extended to people with all forms of TB. 19 SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM- 20 BATING AND ELIMINATING TUBERCULOSIS. 21 Section 317E(h) of the Public Health Act (42 U.S.C. 22 247b–6(h)) is amended by adding at the end the following: 23 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN 24 COMBATING AND ELIMINATING TUBERCULOSIS.—In 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 821 •HR 6637 IH addition to amounts otherwise authorized to be ap- 1 propriated to carry out this section, there are au- 2 thorized to be appropriated such sums as may be 3 necessary to carry out section 317 for each of fiscal 4 years 2020 through 2021.’’. 5 SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 6 FOR TUBERCULOSIS. 7 (a) IN GENERAL.—The Secretary of Health and 8 Human Services shall expand and intensify support for 9 current and prospective research activities of the National 10 Institutes of Health, the Biomedical Advanced Research 11 and Development Authority, and the Centers for Disease 12 Control and Prevention Division of Tuberculosis Elimi- 13 nation to develop new therapeutics, diagnostics, vaccines, 14 and other prevention modalities in addressing all forms 15 of tuberculosis (referred to in this section as ‘‘TB’’). 16 (b) INCLUDED RESEARCH ACTIVITIES.—Research 17 activities under subsection (a) shall include— 18 (1) research and development, and pathways to 19 approval, for novel, safe drugs and drug regimens 20 for the treatment of TB, including in adolescent and 21 pediatric populations and in pregnant and lactating 22 women; 23 (2) research to develop rapid diagnostic tests 24 for all forms of TB, including diagnostics that can 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 822 •HR 6637 IH be used for pediatric populations and people living 1 with HIV, diagnostics that can detect extra pul- 2 monary TB and drug resistance, and diagnostics 3 that can be used at the point of care; 4 (3) research to advance basic knowledge of the 5 pathogenesis of TB and its major comorbidities, in- 6 cluding HIV and diabetes mellitus; 7 (4) research to improve knowledge and under- 8 standings of the role of latency in TB and the fac- 9 tors that increase the risk of latent TB infection 10 progressing to active, symptomatic TB disease; 11 (5) awarding grants and contracts to specifi- 12 cally develop new and needed vaccines to address 13 TB; 14 (6) awarding grants and contracts to support 15 the training and development of clinical researchers 16 whose research improves the landscape of tools to 17 combat TB; and 18 (7) awarding grants and contracts to support 19 capacity-building and develop clinical trial site infra- 20 structure in the United States and in TB endemic 21 countries to support the aforementioned research ac- 22 tivities. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 823 •HR 6637 IH Subtitle I—Osteoarthritis and 1 Musculoskeletal Diseases 2 SEC. 785. FINDINGS. 3 Congress finds as follows: 4 (1) Eighty percent of African-American women 5 and nearly 74 percent of Hispanic men are either 6 overweight or obese, speeding the onset and progres- 7 sion of arthritis. 8 (2) Arthritis affects 46,000,000 people in the 9 United States, and that number will rise to 10 67,000,000 by the year 2030. 11 (3) Twenty-seven million people in the United 12 States suffer from osteoarthritis, the most common 13 form of arthritis, making it the leading cause of dis- 14 ability in the United States. Osteoarthritis is some- 15 times referred to as degenerative joint disease. 16 (4) Obesity accelerates the onset of arthritis: 70 17 percent of obese adults with mild osteoarthritis of 18 the knee at age 60 will develop advanced end-stage 19 disease by age 80. In contrast, just 43 percent of 20 non-obese adults will have end-stage disease over the 21 same time period. 22 (5) Arthritis affects 1 in 5 people in the United 23 States and is the single greatest cause of chronic 24 pain and disability in the United States. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 824 •HR 6637 IH (6) Women, African Americans, and Hispanics 1 have more severe arthritis and functional limitations. 2 These same individuals are more likely to be obese, 3 diabetic, and have higher incidence of heart dis- 4 ease—medical conditions that can be improved with 5 physical activity. Instead of moving, however, these 6 groups have an inactivity rate of 40 to 50 percent, 7 which continues to increase. 8 (7) Arthritis costs $128,000,000,000 a year, in- 9 cluding $81,000,000,000 in direct costs (medical) 10 and $47,000,000,000 in indirect costs (lost earn- 11 ings). Each year, $309,000,000,000 in direct and in- 12 direct costs is lost due to disparities in osteoarthritis 13 and musculoskeletal diseases. 14 (8) Obesity and other chronic health conditions 15 exacerbate the debilitating impact of arthritis, lead- 16 ing to inactivity, loss of independence, and a per- 17 petual cycle of comorbid chronic conditions. 18 (9) Sixty-one percent of arthritis sufferers are 19 women, and women represent 64 percent of an esti- 20 mated 43,000,000 annual visits to physicians’ offices 21 and outpatient clinics where arthritis was the pri- 22 mary diagnosis. Women also represented 60 percent 23 of approximately 1,000,000 hospitalizations that oc- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 825 •HR 6637 IH curred in 2003 for which arthritis was the primary 1 diagnosis. 2 (10) Women ages 65 and older have up to 21⁄2 3 times more disabilities than men of the same age. 4 Higher rates of obesity and arthritis among this 5 group explained up to 48 percent of the gender gap 6 in disability, above all other common chronic health 7 conditions. 8 (11) The primary indication for total knee 9 arthroplasty (referred to in this section as ‘‘TKA’’), 10 also known as knee replacement, is relief of signifi- 11 cant, disabling pain caused by severe arthritis. 12 (12) Knee replacement is surgery for people 13 with severe knee damage. Knee replacement can re- 14 lieve pain and allow you to be more active. When 15 you have a total knee replacement, the surgeon re- 16 moves damaged cartilage and bone from the surface 17 of your knee joint and replaces them with a man- 18 made surface of metal and plastic. In a partial knee 19 replacement, the surgeon only replaces one part of 20 your knee joint. 21 (13) Total hip replacement, also called total hip 22 arthroplasty (referred to in this section as ‘‘THA’’), 23 is used if your hip pain interferes with daily activi- 24 ties and more conservative treatments have not 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 826 •HR 6637 IH helped. Arthritis damage is the most common reason 1 to need hip replacement. 2 (14) The odds of a family practice physician 3 recommending TKA to a male patient with moderate 4 arthritis are twice that of a female patient, while the 5 odds of an orthopaedic surgeon recommending TKA 6 to a male patient with moderate arthritis are 22 7 times that of a female patient. 8 (15) African Americans with doctor-diagnosed 9 arthritis have a higher prevalence of severe pain at- 10 tributable to arthritis, compared with Whites (34.0 11 percent versus 22.6 percent). African Americans, 12 compared to Whites, report a higher proportion of 13 work limitations (39.5 percent versus 28.0 percent) 14 and a higher prevalence of arthritis-attributable 15 work limitation (6.6 percent versus 4.6 percent). 16 (16) Hispanics are 50 percent more likely than 17 non-Hispanic Whites to report needing assistance 18 with at least one instrumental activity of daily living 19 and to have difficulty walking. 20 (17) African Americans and Hispanics were 1.3 21 times more likely to have activity limitation, 1.6 22 times more likely to have work limitations, and 1.9 23 times more likely to have severe joint pain than 24 Whites. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 827 •HR 6637 IH (18) In 2003, the National Academy of Medi- 1 cine reported that the rates of TKA and THA 2 among African-American and Hispanic patients are 3 significantly lower than for Whites—even for those 4 with equitable health care coverage such as through 5 Medicare or the Department of Veterans Affairs. 6 (19) According to the Centers for Disease Con- 7 trol and Prevention, in 2000, African-American 8 Medicare enrollees were 37 percent less likely than 9 White Medicare enrollees to undergo total knee re- 10 placements. In 2006, the disparity increased to 39 11 percent. 12 (20) Even after adjusting for insurance and 13 health access, Hispanics and African Americans are 14 almost 50 percent less likely to undergo total knee 15 replacement than Whites. 16 SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULO- 17 SKELETAL HEALTH-RELATED ACTIVITIES OF 18 THE CENTERS FOR DISEASE CONTROL AND 19 PREVENTION. 20 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 21 Secretary of Health and Human Services, acting through 22 the Director of the Centers for Disease Control and Pre- 23 vention, shall direct the National Center for Chronic Dis- 24 ease Prevention and Health Promotion to conduct and ex- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 828 •HR 6637 IH pand the Health Community Program and Arthritis Pro- 1 gram to educate the public on— 2 (1) the causes of, preventive health actions for, 3 and effects of arthritis and other musculoskeletal 4 conditions in minority patient populations; and 5 (2) the effects of such conditions on other 6 comorbidities including obesity, hypertension, and 7 cardiovascular disease. 8 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 9 SKELETAL CONDITIONS.—Education and awareness pro- 10 grams of the Centers for Disease Control and Prevention 11 on arthritis and other musculoskeletal conditions in minor- 12 ity communities shall— 13 (1) be culturally and linguistically appropriate 14 to minority patients, targeting musculoskeletal 15 health promotion and prevention programs of each 16 major ethnic group, including— 17 (A) Native Americans and Alaska Natives; 18 (B) Asian Americans; 19 (C) African Americans and Blacks; 20 (D) Hispanic and Latino Americans; and 21 (E) Native Hawaiians and Pacific Island- 22 ers; and 23 (2) include public awareness campaigns directed 24 toward these patient populations that emphasize the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 829 •HR 6637 IH importance of musculoskeletal health, physical activ- 1 ity, diet and healthy lifestyle, and weight reduction 2 for overweight and obese patients. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as are necessary for fiscal year 2021 and each 6 subsequent fiscal year. 7 SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 8 AND MUSCULOSKELETAL DISEASE HEALTH 9 EDUCATION WITHIN HEALTH PROFESSIONS 10 SCHOOLS. 11 (a) PROGRAM AUTHORIZED.—The Secretary of 12 Health and Human Services (in this section referred to 13 as the ‘‘Secretary’’), in coordination with the Secretary of 14 Education, shall award grants, on a competitive basis, to 15 academic health science centers, health professions 16 schools, and other institutions of higher education to en- 17 able such institutions to provide people with comprehen- 18 sive education on arthritis and musculoskeletal health, 19 particularly— 20 (1) obesity-related musculoskeletal diseases; 21 (2) arthritis and osteoarthritis; 22 (3) arthritis and musculoskeletal health dispari- 23 ties; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 830 •HR 6637 IH (4) the relationship between arthritis and mus- 1 culoskeletal diseases and metabolic activity, psycho- 2 logical health, and comorbidities such as diabetes, 3 cardiovascular disease, and hypertension. 4 (b) DURATION.—Grants awarded under this section 5 shall be for a period of 5 years. 6 (c) APPLICATIONS.—An academic health science cen- 7 ter, health professions school, or other institution of high- 8 er education seeking a grant under this section shall sub- 9 mit an application to the Secretary at such time, in such 10 manner, and containing such information as the Secretary 11 may require. 12 (d) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to an institution of 14 higher education that— 15 (1) has an enrollment of needy students, as de- 16 fined in section 318(b) of the Higher Education Act 17 of 1965 (20 U.S.C. 1059e(b)); 18 (2) is a Hispanic-serving institution, as defined 19 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 20 (3) is a Tribal College or University, as defined 21 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 22 (4) is an Alaska Native-serving institution, as 23 defined in section 317(b) of such Act (20 U.S.C. 24 1059d(b)); 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 831 •HR 6637 IH (5) is a Native Hawaiian-serving institution, as 1 defined in section 317(b) of such Act (20 U.S.C. 2 1059d(b)); 3 (6) is a Predominately Black Institution, as de- 4 fined in section 318(b) of such Act (20 U.S.C. 5 1059e(b)); 6 (7) is a Native American-serving, non-Tribal in- 7 stitution, as defined in section 319(b) of such Act 8 (20 U.S.C. 1059f(b)); 9 (8) is an Asian American and Native American 10 Pacific Islander-serving institution, as defined in 11 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 12 (9) is a minority institution, as defined in sec- 13 tion 365 of such Act (20 U.S.C. 1067k), with an en- 14 rollment of needy students, as defined in section 312 15 of such Act (20 U.S.C. 1058). 16 (e) USES OF FUNDS.—An institution of higher edu- 17 cation receiving a grant under this section may use grant 18 funds to integrate issues relating to comprehensive arthri- 19 tis and musculoskeletal health into the academic or sup- 20 port sectors of the institution in order to reach a large 21 number of students, by carrying out 1 or more of the fol- 22 lowing activities: 23 (1) Developing educational content for issues 24 relating to comprehensive arthritis and musculo- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 832 •HR 6637 IH skeletal health education that will be incorporated 1 into first-year orientation or core courses. 2 (2) Creating innovative technology-based ap- 3 proaches to deliver arthritis and musculoskeletal 4 health education to students, faculty, and staff. 5 (3) Developing and employing peer-outreach 6 and education programs to generate discussion, edu- 7 cate, and raise awareness among students about 8 issues relating to arthritis and musculoskeletal 9 health disorders, and their relationship to diabetes, 10 hypertension, cardiovascular disease, psychological 11 health, and other comorbid conditions. 12 (f) REPORT TO CONGRESS.— 13 (1) IN GENERAL.—Not later than 1 year after 14 the date of the enactment of this Act, and annually 15 thereafter for a period of 5 years, the Secretary shall 16 prepare and submit to the appropriate committees of 17 Congress a report on the activities to provide health 18 professions students with comprehensive arthritis 19 and musculoskeletal health education funded under 20 this section. 21 (2) REPORT ELEMENTS.—The report described 22 in paragraph (1) shall include information about— 23 (A) the number of entities that are receiv- 24 ing grant funds; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 833 •HR 6637 IH (B) the specific activities supported by 1 grant funds; 2 (C) the number of students served by 3 grant programs; and 4 (D) the status of program evaluations. 5 Subtitle J—Sleep and Circadian 6 Rhythm Disorders 7 SEC. 791. SHORT TITLE; FINDINGS. 8 (a) SHORT TITLE.—This subtitle may be cited as the 9 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 10 ties Act’’. 11 (b) FINDINGS.—Congress finds the following: 12 (1) Decrements in sleep health such as sleep 13 apnea, insufficient sleep time, and insomnia, affect 14 50,000,000 to 70,000,000 adults in the United 15 States. Twelve to eighteen million United States 16 adults have sleep apnea, a chronic disorder charac- 17 terized by one or more pauses in breathing which 18 can last from a few seconds to minutes. They may 19 occur 30 times or more an hour, disrupting sleep 20 and resulting in excessive daytime sleepiness and 21 loss in productivity. 22 (2) Seventy percent of high school students are 23 not getting enough sleep on school nights, while 33 24 percent of people in the United States get fewer 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 834 •HR 6637 IH than 7 hours of sleep per night, and roughly 6,000 1 fatal motor vehicle crashes are caused by drowsy 2 drivers. 3 (3) Insufficient sleep and insomnia are more 4 prevalent in women. Women who are pregnant and 5 have sleep apnea are at an increased risk of cardio- 6 vascular complications during pregnancy. The im- 7 pact of disparities in sleep health is associated with 8 a growing number of health problems, including the 9 following: 10 (A) Hypertension. 11 (B) Cancer. 12 (C) Stroke. 13 (D) Cardiac arrhythmia. 14 (E) Chronic heart failure and heart dis- 15 ease. 16 (F) Diabetes. 17 (G) Cognitive functioning and behavior. 18 (H) Depression and bipolar disorder. 19 (I) Substance abuse. 20 (4) A sleep disparity exists in that poor sleep 21 quality is strongly associated with poverty and race. 22 Factors such as employment, education, and health 23 status, amongst others, significantly mediated this 24 effect only in poor subjects, suggesting a differential 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 835 •HR 6637 IH vulnerability to these factors in poor relative to 1 nonpoor individuals in the context of sleep quality. 2 (5) African Americans sleep worse than Cauca- 3 sian Americans. African Americans take longer to 4 fall asleep, report poorer sleep quality, have more 5 light and less deep sleep, and nap more often and 6 longer. 7 (6) African Americans and individuals in lower 8 socioeconomic status groups may be at an increased 9 risk for sleep disturbances and associated health 10 consequences. 11 (7) Among young African Americans, the likeli- 12 hood of having sleep disordered breathing and exhib- 13 iting risk factors for poor sleep is twice that in 14 young Caucasians. Frequent snoring is more com- 15 mon among African-American and Hispanic women 16 and Hispanic men compared to non-Hispanic Cauca- 17 sians, independent of other factors including obesity. 18 (8) African Americans with sleep-disordered 19 breathing develop symptoms at a younger age than 20 Caucasians but appear less likely to be diagnosed 21 and treated in a timely manner. This delay may at 22 least in part be due to reduced access to care. 23 (9) Sleep loss contributes to increased risk for 24 chronic conditions such as obesity, diabetes, and hy- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 836 •HR 6637 IH pertension, all of which have increased prevalence in 1 underserved, underrepresented minorities. Racial 2 and ethnic disparities related to obesity may also 3 contribute to disparities in health outcomes related 4 to sleep-disordered breathing. 5 (10) Non-Caucasian adults report an insomnia 6 rate of 12.9 percent compared to only 6.6 percent 7 for Caucasians. 8 (11) African-American women have a higher in- 9 cidence of insomnia than African-American men, 10 perhaps related in part to higher risk for chronic 11 persisting symptoms. 12 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 13 SEARCH ACTIVITIES OF THE NATIONAL IN- 14 STITUTES OF HEALTH. 15 (a) IN GENERAL.—The Director of the National In- 16 stitutes of Health, acting through the Director of the Na- 17 tional Heart, Lung, and Blood Institute, shall— 18 (1) continue to expand research activities ad- 19 dressing sleep health disparities; and 20 (2) continue implementation of the NIH Sleep 21 Disorders Research Plan across all institutes and 22 centers of the National Institutes of Health to im- 23 prove treatment and prevention of sleep health dis- 24 parities. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 837 •HR 6637 IH (b) REQUIRED RESEARCH ACTIVITIES.—In con- 1 ducting or supporting research relating to sleep and circa- 2 dian rhythm, the Director of the National Heart, Lung, 3 and Blood Institute shall— 4 (1) advance epidemiology and clinical research 5 to achieve a more complete understanding of dispari- 6 ties in domains of sleep health and across population 7 subgroups for which cardiovascular and metabolic 8 health disparities exist, including— 9 (A) prevalence and severity of sleep apnea; 10 (B) habitual sleep duration; 11 (C) sleep timing and regularity; and 12 (D) insomnia; 13 (2) develop study designs and analytical ap- 14 proaches to explain and predict multilevel and life- 15 course determinants of sleep health and to elucidate 16 the sleep-related causes of cardiovascular and meta- 17 bolic health disparities across the age spectrum, in- 18 cluding such determinants and causes that are— 19 (A) environmental; 20 (B) biological or genetic; 21 (C) psychosocial; 22 (D) societal; 23 (E) political; or 24 (F) economic; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 838 •HR 6637 IH (3) determine the contribution of sleep impair- 1 ments such as sleep apnea, insufficient sleep dura- 2 tion, irregular sleep schedules, and insomnia to un- 3 explained disparities in cardiovascular and metabolic 4 risk and disease outcomes; 5 (4) develop study designs, data sampling and 6 collection tools, and analytical approaches to opti- 7 mize understanding of mediating and moderating 8 factors, and feedback mechanisms coupling sleep to 9 cardiovascular and metabolic health disparities; 10 (5) advance research to understand cultural 11 and linguistic barriers (on the person, provider, or 12 system level) to access to care, medical diagnosis, 13 and treatment of sleep disorders in diverse popu- 14 lation groups; 15 (6) develop and test multilevel interventions (in- 16 cluding sleep health education in diverse commu- 17 nities) to reduce disparities in sleep health that will 18 impact ability to improve disparities in cardio- 19 vascular and metabolic risk or disease; 20 (7) create opportunities to integrate sleep and 21 health disparity science by strategically utilizing re- 22 sources (existing or anticipated cohorts), exchanging 23 scientific data and ideas (cross-over into scientific 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 839 •HR 6637 IH meetings), and develop multidisciplinary investi- 1 gator-initiated grant applications; and 2 (8) enhance the diversity and foster career de- 3 velopment of young investigators involved in sleep 4 and health disparities science. 5 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 6 out this section, there are authorized to be appropriated 7 such sums as may be necessary for fiscal year 2021 and 8 each subsequent fiscal year. 9 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 10 PARITIES-RELATED ACTIVITIES OF THE CEN- 11 TERS FOR DISEASE CONTROL AND PREVEN- 12 TION. 13 (a) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention shall conduct, support, 15 and expand public health strategies and prevention, diag- 16 nosis, surveillance, and public and professional awareness 17 activities regarding sleep and circadian rhythm disorders. 18 (b) FINDINGS.—Congress finds as follows: 19 (1) Sleep disorders and sleep deficiency unre- 20 lated to a primary sleep disorder are underdiagnosed 21 and are increasingly detrimental to health status. 22 (2) The consequences to society include addi- 23 tional diseases, motor vehicle accidents, decreased 24 longevity, elevated direct medical costs, and indirect 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 840 •HR 6637 IH costs related to work absenteeism and property dam- 1 age. 2 (c) REQUIRED SURVEILLANCE AND EDUCATION 3 AWARENESS ACTIVITIES.—In conducting or supporting 4 research relating to sleep and circadian rhythm disorders 5 surveillance and education awareness activities, the Direc- 6 tor of the Centers for Disease Control and Prevention 7 shall— 8 (1) ensure that such activities are culturally 9 and linguistically appropriate to minority patients, 10 targeting sleep and circadian rhythm health pro- 11 motion and prevention programs of each major eth- 12 nic group, including— 13 (A) Native Americans and Alaska Natives; 14 (B) Asian Americans; 15 (C) African Americans and Blacks; 16 (D) Hispanic and Latino Americans; and 17 (E) Native Hawaiians and Pacific Island- 18 ers; 19 (2) collect and compile national and State sur- 20 veillance data on sleep disorders health disparities; 21 (3) continue to develop and implement new 22 sleep questions in public health surveillance systems 23 to increase public awareness of sleep health and 24 sleep disorders and their impact on health; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 841 •HR 6637 IH (4) publish monthly reports highlighting geo- 1 graphic, racial, and ethnic disparities in sleep health, 2 as well as relationships between insufficient sleep 3 and chronic disease, health risk behaviors, and other 4 outcomes as determined necessary by the Director; 5 and 6 (5) include public awareness campaigns that in- 7 form patient populations from major ethnic groups 8 about the prevalence of sleep and circadian rhythm 9 disorders and emphasize the importance of sleep 10 health. 11 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 12 out this section, there are authorized to be appropriated 13 such sums as may be necessary for fiscal year 2021 and 14 each subsequent fiscal year. 15 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR- 16 CADIAN HEALTH EDUCATION WITHIN 17 HEALTH PROFESSIONS SCHOOLS. 18 (a) PROGRAM AUTHORIZED.—The Secretary of 19 Health and Human Services (referred to in this section 20 as the ‘‘Secretary’’), in coordination with the Secretary of 21 Education, shall award grants, on a competitive basis, to 22 academic health science centers, health professions 23 schools, and other institutions of higher education to en- 24 able such institutions to provide people with comprehen- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00841 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 842 •HR 6637 IH sive education on sleep and circadian health, particu- 1 larly— 2 (1) poor sleep health; 3 (2) sleep disorders; 4 (3) sleep health disparities; and 5 (4) the relationship between sleep and circadian 6 health on metabolic activity, neurological activity, 7 comorbidities, and other diseases. 8 (b) DURATION.—Grants awarded under this section 9 shall be for a period of 5 years. 10 (c) APPLICATIONS.—Any academic health science 11 center, health professions school, or other institutions of 12 higher education seeking a grant under this section shall 13 submit an application to the Secretary at such time, in 14 such manner, and containing such information as the Sec- 15 retary may require. 16 (d) PRIORITY.—In awarding grants under this sec- 17 tion, the Secretary shall give priority to an institution 18 that— 19 (1) has an enrollment of needy students, as de- 20 fined in section 318(b) of the Higher Education Act 21 of 1965 (20 U.S.C. 1059e(b)); 22 (2) is a Hispanic-serving institution, as defined 23 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 843 •HR 6637 IH (3) is a Tribal College or University, as defined 1 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 2 (4) is an Alaska Native-serving institution, as 3 defined in section 317(b) of such Act (20 U.S.C. 4 1059d(b)); 5 (5) is a Native Hawaiian-serving institution, as 6 defined in section 317(b) of such Act (20 U.S.C. 7 1059d(b)); 8 (6) is a Predominately Black Institution, as de- 9 fined in section 318(b) of such Act (20 U.S.C. 10 1059e(b)); 11 (7) is a Native American-serving, nontribal in- 12 stitution, as defined in section 319(b) of such Act 13 (20 U.S.C. 1059f(b)); 14 (8) is an Asian American and Native American 15 Pacific Islander-serving institution, as defined in 16 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 17 (9) is a minority institution, as defined in sec- 18 tion 365 of such Act (20 U.S.C. 1067k), with an en- 19 rollment of needy students, as defined in section 312 20 of such Act (20 U.S.C. 1058). 21 (e) USES OF FUNDS.—An institution of higher edu- 22 cation receiving a grant under this section may use grant 23 funds to integrate issues relating to comprehensive sleep 24 and circadian health into the academic or support sectors 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 844 •HR 6637 IH of the institution in order to reach a large number of stu- 1 dents, by carrying out 1 or more of the following activities: 2 (1) Developing educational content for issues 3 relating to comprehensive sleep and circadian health 4 education that will be incorporated into first-year 5 orientation or core courses. 6 (2) Creating innovative technology-based ap- 7 proaches to deliver sleep health education to stu- 8 dents, faculty, and staff. 9 (3) Developing and employing peer-outreach 10 and education programs to generate discussion, edu- 11 cate, and raise awareness among students about 12 issues relating to poor quality sleep, sleep and circa- 13 dian disorders, and the role sleep health plays in 14 other diseases and comorbidities. 15 (f) REPORT TO CONGRESS.— 16 (1) IN GENERAL.—Not later than 1 year after 17 the date of the enactment of this Act, and annually 18 thereafter for a period of 5 years, the Secretary shall 19 prepare and submit to the appropriate committees of 20 Congress a report on the activities to provide health 21 professions students with comprehensive sleep and 22 circadian health education funded under this section. 23 (2) REPORT ELEMENTS.—The report described 24 in paragraph (1) shall include information about— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00844 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 845 •HR 6637 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 Congress and the Presi- 14 dent a report on the impact of sleep and circadian health 15 disorders for racial and ethnic minority communities and 16 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00845 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 846 •HR 6637 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—Kidney Disease Re- 8 search, Surveillance, Preven- 9 tion, and Treatment 10 SEC. 797. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, 11 PREVENTION, AND TREATMENT. 12 (a) SHORT TITLE.—This section may be cited as the 13 ‘‘Kidney Disease Research, Surveillance, Prevention and 14 Treatment Improvement Act of 2020’’. 15 (b) FINDINGS.—Congress makes the following find- 16 ings: 17 (1) Kidney diseases impact 37 million Ameri- 18 cans. 19 (2) African Americans comprise just 13 percent 20 of the United States population, but 33 percent of 21 the United States dialysis patient population. Com- 22 pared to Caucasians, kidney failure prevalence is 23 about 3.7 times greater in African Americans, 1.4 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00846 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 847 •HR 6637 IH times greater in Native Americans, and 1.5 times 1 greater in Asian Americans. 2 (3) Peritoneal dialysis and home hemodialysis 3 use is 40–50 percent lower among African Ameri- 4 cans and Hispanics. 5 (4) Every racial/ethnic minority group in the 6 United States is significantly less likely to be treated 7 with home dialysis than Whites, and demographic 8 and clinical characteristics are insufficient to explain 9 this differential use. 10 (5) African Americans on dialysis, irrespective 11 of dialysis modality, and Hispanics undergoing PD 12 or in-center HD, are significantly less likely than 13 their White counterparts to receive a kidney trans- 14 plant. 15 (6) African Americans, Hispanics, and Asian 16 Americans are less likely to receive living donor kid- 17 ney transplants than Whites. Efforts to reduce dis- 18 parities in live donor kidney transplantation for Afri- 19 can-American, Hispanic, and Asian patients with 20 kidney failure have been unsuccessful. 21 (7) Medicare and Medicaid patients are less 22 likely to receive a preemptive transplant from a de- 23 ceased donor compared to private insurance patients 24 (5 percent and 11 percent versus 24 percent), and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00847 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 848 •HR 6637 IH Black and Hispanic patients are less likely to receive 1 a preemptive transplant from a deceased donor com- 2 pared with White patients even after changes to the 3 kidney allocation system (5 percent of Black patients 4 and 5 percent of Hispanic patients compared with 5 18 percent of White patients). 6 (8) Low-income populations are significantly 7 more likely to progress to kidney failure. 8 (9) Low socioeconomic status is associated with 9 increased incidence of chronic kidney disease, pro- 10 gression to kidney failure, inadequate dialysis treat- 11 ment, and reduced access to kidney transplantation. 12 (10) The three goals of the recent Executive 13 Order on Advancing American Kidney Health recog- 14 nizes the need for more transplants, better preven- 15 tion and education and improved access to treatment 16 modalities. 17 SEC. 798. KIDNEY DISEASE RESEARCH IN MINORITY POPU- 18 LATIONS. 19 (a) IN GENERAL.—The Director of the National In- 20 stitutes of Health shall expand, intensify, and support on- 21 going research and other activities with respect to kidney 22 disease in minority populations. 23 (b) RESEARCH.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00848 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 849 •HR 6637 IH (1) DESCRIPTION.—Research under subsection 1 (a) shall include investigation into— 2 (A) the causes of kidney disease, including 3 socioeconomic, geographic, clinical, environ- 4 mental, genetic, and other factors that may 5 contribute to increased rates of kidney disease 6 in minority populations; and 7 (B) the causes of increased incidence of 8 kidney disease complications in minority popu- 9 lations, and possible interventions to decrease 10 such incidence. 11 (2) INCLUSION OF MINORITY PARTICIPANTS.— 12 In conducting and supporting research described in 13 subsection (a), the Director of the National Insti- 14 tutes of Health shall seek to include minority par- 15 ticipants as study subjects in clinical trials. 16 (c) REPORT; COMPREHENSIVE PLAN.— 17 (1) IN GENERAL.—The Secretary of Health and 18 Human Services shall— 19 (A) prepare and submit to the Congress, 20 not later than 6 months after the date of enact- 21 ment of this section, a report on Federal re- 22 search and public health activities with respect 23 to kidney disease in minority populations; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00849 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 850 •HR 6637 IH (B) develop and submit to Congress, not 1 later than 1 year after the date of enactment of 2 this section, an effective and comprehensive 3 Federal plan (including all appropriate Federal 4 health programs) to address kidney disease in 5 minority populations. 6 (2) CONTENTS.—The report under paragraph 7 (1)(A) shall at minimum address each of the fol- 8 lowing: 9 (A) Research on kidney disease in minority 10 populations, including such research on— 11 (i) genetic, behavioral, and environ- 12 mental factors; and 13 (ii) prevention and complications 14 among individuals within these populations 15 who have already developed kidney disease. 16 (B) Surveillance and data collection on 17 kidney disease in minority populations, includ- 18 ing with respect to— 19 (i) efforts to better determine the 20 prevalence of kidney disease among Asian- 21 American and Pacific Islander subgroups; 22 and 23 (ii) efforts to coordinate data collec- 24 tion on the American Indian population. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00850 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 851 •HR 6637 IH (C) Community-based interventions to ad- 1 dress kidney disease targeting minority popu- 2 lations, including— 3 (i) the evidence base for such inter- 4 ventions; 5 (ii) the cultural appropriateness of 6 such interventions; and 7 (iii) efforts to educate the public on 8 the causes and consequences of kidney dis- 9 ease. 10 (D) Education and training programs for 11 health professionals (including community 12 health workers) on the prevention and manage- 13 ment of kidney disease and its related complica- 14 tions that are supported by the Health Re- 15 sources and Services Administration, including 16 such programs supported by the Bureau of 17 Health Workforce, the Bureau of Primary 18 Health Care, and the Healthcare Systems Bu- 19 reau. 20 SEC. 799. KIDNEY DISEASE ACTION PLAN. 21 (a) IN GENERAL.—The Director of the Centers for 22 Disease Control and Prevention shall conduct, support, 23 and expand public health strategies, prevention, diagnosis, 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00851 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 852 •HR 6637 IH surveillance, and public and professional awareness activi- 1 ties regarding kidney disease. 2 (b) NATIONAL ACTION PLAN.— 3 (1) DEVELOPMENT.—Not later than 2 years 4 after the date of the enactment of this Act, the Di- 5 rector of the National Institute of Diabetes and Di- 6 gestive and Kidney Disease, in consultation with the 7 Director of the Centers for Disease Control and Pre- 8 vention, shall develop a national action plan to ad- 9 dress kidney disease in the United States with par- 10 ticipation from patients, caregivers, health profes- 11 sionals, patient advocacy organizations, researchers, 12 providers, public health professionals, and other 13 stakeholders. 14 (2) CONTENTS.—At a minimum, such plan 15 shall include recommendations for— 16 (A) public health interventions for the pur- 17 pose of implementation of the national plan; 18 (B) biomedical, health services, and public 19 health research on kidney disease; and 20 (C) inclusion of kidney disease in the 21 health data collections of all Federal agencies. 22 (c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 23 Director of the National Institute of Diabetes and Diges- 24 tive and Kidney Disease shall carry out the following: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00852 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 853 •HR 6637 IH (1) Conduct public education and awareness ac- 1 tivities with patient and professional organizations 2 to stimulate earlier diagnosis and improve patient 3 outcomes from treatment of kidney disease. To the 4 extent known and relevant, such public education 5 and awareness activities shall reflect differences in 6 kidney disease by cause (such as hypertension, dia- 7 betes, and polycystic kidney disease) and include a 8 focus on outreach to undiagnosed and, as appro- 9 priate, minority populations. 10 (2) Supplement and expand upon the activities 11 of the National Institute of Diabetes and Digestive 12 and Kidney Disease by making grants to nonprofit 13 organizations, State and local jurisdictions, and In- 14 dian tribes for the purpose of reducing the burden 15 of kidney disease, especially in disproportionately im- 16 pacted communities, through public health interven- 17 tions and related activities. 18 (3) Coordinate with the Centers for Disease 19 Control and Prevention, the Indian Health Service, 20 the Health Resources and Services Administration, 21 and the Department of Veterans Affairs to develop 22 pilot programs to demonstrate best practices for the 23 diagnosis and management of kidney disease. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00853 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 854 •HR 6637 IH (4) Develop improved techniques and identify 1 best practices, in coordination with the Secretary of 2 Veterans Affairs, for assisting kidney disease pa- 3 tients. 4 (d) DATA COLLECTION.—Not later than 180 days 5 after the date of enactment of this Act, the Director of 6 the National Institute of Diabetes and Digestive and Kid- 7 ney Disease and the Director of the Centers for Disease 8 Control and Prevention, acting jointly, shall assess the 9 depth and quality of information on kidney disease that 10 is collected in surveys and population studies conducted 11 by the Centers for Disease Control and Prevention, includ- 12 ing whether there are additional opportunities for informa- 13 tion to be collected in the National Health and Nutrition 14 Examination Survey, the National Health Interview Sur- 15 vey, and the Behavioral Risk Factors Surveillance System 16 surveys. The Director of the National Institute of Diabetes 17 and Digestive and Kidney Disease shall include the results 18 of such assessment in the national action plan under sub- 19 section (b). 20 (e) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 23 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis- 24 cal year 2024, and $1,000,000 for fiscal year 2025. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00854 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 855 •HR 6637 IH SEC. 799A. HOME DIALYSIS AND INCREASING END-STAGE 1 RENAL DISEASE TREATMENT MODALITIES IN 2 MINORITY COMMUNITIES ACTION PLAN. 3 (a) NATIONAL ACTION PLAN.— 4 (1) DEVELOPMENT.—Not later than 2 years 5 after the date of the enactment of this Act, the Di- 6 rector of the National Institute of Diabetes and Di- 7 gestive and Kidney Disease, in consultation with the 8 Director of the Centers for Disease Control and Pre- 9 vention, shall develop a national action plan to in- 10 crease the number of home dialyzers and choice in 11 dialysis treatment modality in the United States 12 with participation from patients, caregivers, health 13 professionals, patient advocacy organizations, re- 14 searchers, providers, public health professionals, and 15 other stakeholders in the minority community. 16 (2) CONTENTS.—At a minimum, such plan 17 shall include recommendations for— 18 (A) public health officials for the purpose 19 of implementation of the national plan; 20 (B) biomedical, health services, and public 21 health research on home dialysis and modalities 22 in minority communities; and 23 (C) inclusion of dialysis location and mo- 24 dality in the health data collections of all Fed- 25 eral agencies. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00855 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 856 •HR 6637 IH (b) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 3 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis- 4 cal year 2024, and $1,000,000 for fiscal year 2025. 5 SEC. 799B. INCREASING KIDNEY TRANSPLANTS IN MINOR- 6 ITY COMMUNITIES. 7 (a) IN GENERAL.—The Director of the National In- 8 stitutes of Health shall expand, intensify, and support on- 9 going research and other activities with respect to kidney 10 transplants in minority populations. 11 (b) RESEARCH.—Research under subsection (a) shall 12 include investigation into— 13 (1) the causes of lower rates of kidney trans- 14 plants in minority communities, including socio- 15 economic, geographic, clinical, environmental, ge- 16 netic, and other factors that may contribute to lower 17 rates of kidney transplants in minority populations; 18 and 19 (2) possible interventions to increase kidney 20 transplants. 21 (c) REPORT; COMPREHENSIVE PLAN.— 22 (1) IN GENERAL.—The Secretary of Health and 23 Human Services shall— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00856 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 857 •HR 6637 IH (A) prepare and submit to the Congress, 1 not later than 6 months after the date of enact- 2 ment of this section, a report on Federal re- 3 search and public health activities with respect 4 to kidney transplants as a treatment for end- 5 stage renal disease in minority populations; and 6 (B) develop and submit to the Congress, 7 not later than 1 year after the date of enact- 8 ment of this section, an effective and com- 9 prehensive Federal plan (including all appro- 10 priate Federal health programs) to increase the 11 number of kidney transplants in minority popu- 12 lations. 13 (2) CONTENTS.—The report under paragraph 14 (1)(A) shall at a minimum address each of the fol- 15 lowing: 16 (A) Research on kidney transplants in mi- 17 nority populations, including such research on 18 financial, insurance coverage, genetic, behav- 19 ioral, and environmental factors. 20 (B) Surveillance and data collection on 21 kidney transplants in minority populations, in- 22 cluding with respect to— 23 (i) efforts to increase kidney trans- 24 plants disease among Asian-American and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00857 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 858 •HR 6637 IH Pacific Islander subgroups with end-stage 1 renal disease; and 2 (ii) efforts to increase kidney trans- 3 plants in the American Indian population. 4 (C) Community-based efforts to increase 5 kidney transplants targeting minority popu- 6 lations, including— 7 (i) the evidence base for such in- 8 creases; 9 (ii) the cultural appropriateness of 10 such increases; and 11 (iii) efforts to educate the public on 12 the kidney transplants. 13 (D) Education and training programs for 14 health professionals (including community 15 health workers) on the kidney transplants that 16 are supported by the Health Resources and 17 Services Administration, including such pro- 18 grams supported by the Bureau of Health 19 Workforce, the Bureau of Primary Health Care, 20 and the Healthcare Systems Bureau. 21 SEC. 799C. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 22 PROGRAMS. 23 The Director of the Centers for Disease Control and 24 Prevention shall— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00858 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 859 •HR 6637 IH (1) support research into the environmental and 1 occupational causes and biological mechanisms that 2 contribute to kidney disease; and 3 (2) develop and disseminate public health inter- 4 ventions that will lessen the impact of environmental 5 and occupational causes of kidney disease. 6 SEC. 799D. UNDERSTANDING THE TREATMENT PATTERNS 7 ASSOCIATED WITH PROVIDING CARE AND 8 TREATMENT OF KIDNEY FAILURE IN MINOR- 9 ITY POPULATIONS. 10 (a) STUDY.—The Secretary of Health and Human 11 Services (in this section referred to as the ‘‘Secretary’’) 12 shall conduct a study on treatment patterns associated 13 with providing care, under the Medicare program under 14 title XVIII of the Social Security Act (42 U.S.C. 1395 15 et seq.), the Medicaid program under title XIX of such 16 Act (42 U.S.C. 1396 et seq.), and through private health 17 insurance, to minority populations that are disproportion- 18 ately affected by kidney failure. 19 (b) REPORT.—Not later than 1 year after the date 20 of the enactment of this Act, the Secretary shall submit 21 to Congress a report on the study conducted under sub- 22 section (a), together with such recommendations as the 23 Secretary determines to be appropriate. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00859 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 860 •HR 6637 IH SEC. 799E. IMPROVING ACCESS IN UNDERSERVED AREAS. 1 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec- 2 tion 331(a)(3)(D) of the Public Health Service Act (42 3 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘renal di- 4 alysis,’’ after ‘‘dentistry,’’. 5 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR- 6 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 7 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert- 8 ing ‘‘, which may include nephrology health professionals’’ 9 before the period at the end. 10 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE- 11 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 12 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 13 by inserting ‘‘, which may include nephrology health pro- 14 fessionals’’ before the period at the end. 15 TITLE VIII—HEALTH 16 INFORMATION TECHNOLOGY 17 SEC. 800. DEFINITIONS. 18 In this title: 19 (1) CERTIFIED ELECTRONIC HEALTH RECORD 20 TECHNOLOGY.—The term ‘‘certified EHR tech- 21 nology’’ has the meaning given such term in section 22 3000 of the Public Health Service Act (42 U.S.C. 23 300jj). 24 (2) EHR.—The term ‘‘EHR’’ means an elec- 25 tronic health record. 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00860 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 861 •HR 6637 IH (3) INTEROPERABILITY.—The term ‘‘interoper- 1 ability’’ has the meaning given such term in section 2 3000 of the Public Health Service Act (42 U.S.C. 3 300jj). Evaluation and measurement of interoper- 4 ability shall consider exchange of electronic health 5 information, usability of exchanged electronic health 6 information, effective application and use of the ex- 7 changed electronic health information, and impact 8 on outcomes of interoperability. 9 (4) ACCESS.—The term ‘‘access’’ has the mean- 10 ing given such term within the definition of ‘‘inter- 11 operability’’ in section 3000 of the Public Health 12 Service Act (42 U.S.C. 300jj) and within HIPAA’s 13 Privacy Rule (45 C.F.R. 164.524). 14 (5) CERTIFIED ELECTRONIC HEALTH RECORD 15 TECHNOLOGY; EHR.—The term ‘‘certified electronic 16 health record technology’’ and the term ‘‘EHR’’ both 17 include the health information infrastructure for 18 interoperability, access, exchange, and use of elec- 19 tronic health information required by sections 4003 20 and 4006 of the 21st Century Cures Act, and are 21 not limited solely to doctors’ electronic health 22 records. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00861 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 862 •HR 6637 IH Subtitle A—Reducing Health 1 Disparities Through Health IT 2 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 3 PROMOTION OF HEALTH IT. 4 The Secretary of Health and Human Services, acting 5 through the Administrator of the Health Resources and 6 Services Administration, shall expand and intensify the 7 programs and activities of the Administration (directly or 8 through grants or contracts) to provide technical assist- 9 ance and resources to health centers (as defined in section 10 330(a) of the Public Health Service Act (42 U.S.C. 11 254b(a))) to adopt and meaningfully use certified EHR 12 technology for the management of chronic diseases and 13 health conditions and reduction of health disparities. 14 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 15 CIAL AND ETHNIC MINORITY COMMUNITIES; 16 OUTREACH AND ADOPTION OF HEALTH IT IN 17 SUCH COMMUNITIES. 18 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 19 MATION TECHNOLOGY.—Not later than 18 months after 20 the date of enactment of this Act, the National Coordi- 21 nator for Health Information Technology (referred to in 22 this section as the ‘‘National Coordinator’’) shall— 23 (1) conduct an evaluation of the level of inter- 24 operability, access, use, and accessibility of electronic 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00862 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 863 •HR 6637 IH health records in racial and ethnic minority commu- 1 nities, focusing on whether patients in such commu- 2 nities have providers who use electronic health 3 records, and the degree to which patients in such 4 communities can access, exchange, and use without 5 special effort their health information in those elec- 6 tronic health records, and indicating whether such 7 providers— 8 (A) are participating in the Medicare pro- 9 gram under title XVIII of the Social Security 10 Act (42 U.S.C. 1395 et seq.) or a State plan 11 under title XIX of such Act (42 U.S.C. 1396 et 12 seq.) (or a waiver of such plan); 13 (B) have received incentive payments or in- 14 centive payment adjustments under Medicare 15 and Medicaid Electronic Health Records Incen- 16 tive Programs (as defined in subsection (c)(2)); 17 (C) are MIPS eligible professionals, as de- 18 fined in paragraph (1)(C) of section 1848(q) of 19 the Social Security Act (42 U.S.C. 1395w– 20 4(q)), for purposes of the Merit-Based Incentive 21 Payment System under such section; or 22 (D) have been recruited by any of the 23 Health Information Technology Regional Ex- 24 tension Centers established under section 3012 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00863 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 864 •HR 6637 IH of the Public Health Service Act (42 U.S.C. 1 300jj–32); 2 (2) publish the results of such evaluation in- 3 cluding the race and ethnicity of such providers and 4 the populations served by such providers; and 5 (3) not later than 12 months after the enact- 6 ment of this Act, shall promulgate a certification cri- 7 terion and module of certified EHR technology that 8 stratifies quality measures by disparity characteris- 9 tics, including race, ethnicity, language, gender, gen- 10 der identity, sexual orientation, socio-economic sta- 11 tus, and disability status, as those characteristics 12 are defined in certified EHR technology; and reports 13 to Centers for Medicare & Medicaid Services the 14 quality measures stratified by race and at least two 15 other disparity characteristics. 16 The term ‘‘quality measures’’ refers to the quality meas- 17 ures specified in MIPS. 18 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 19 As soon as practicable after the date of enactment of this 20 Act, the Director of the National Center for Health Statis- 21 tics shall provide to Congress a more detailed analysis of 22 the data presented in National Center for Health Statis- 23 tics data brief entitled ‘‘Adoption of Certified Electronic 24 Health Record Systems and Electronic Information Shar- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00864 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 865 •HR 6637 IH ing in Physician Offices: United States, 2013 and 2014’’ 1 (NCHS Data Brief No. 236). 2 (c) CENTERS FOR MEDICARE & MEDICAID SERV- 3 ICES.— 4 (1) IN GENERAL.—As part of the process of 5 collecting information, with respect to a provider, at 6 registration and attestation for purposes of Medicare 7 and Medicaid Electronic Health Records Incentive 8 Programs (as defined in paragraph (2)) or the 9 Merit-Based Incentive Payment System under sec- 10 tion 1848(q) of the Social Security Act (42 U.S.C. 11 1395w–4(q)), the Secretary of Health and Human 12 Services shall collect the race and ethnicity of such 13 provider. 14 (2) MEDICARE AND MEDICAID ELECTRONIC 15 HEALTH RECORDS INCENTIVE PROGRAMS DE- 16 FINED.—For purposes of paragraph (1), the term 17 ‘‘Medicare and Medicaid Electronic Health Records 18 Incentive Programs’’ means the incentive programs 19 under section 1814(l)(3), subsections (a)(7) and (o) 20 of section 1848, subsections (l) and (m) of section 21 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 22 1886, and subsections (a)(3)(F) and (t) of section 23 1903 of the Social Security Act (42 U.S.C. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00865 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 866 •HR 6637 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’’; 14 (3) by striking ‘‘The National Coordinator’’ and 15 inserting the following: 16 ‘‘(i) IN GENERAL.—The National Co- 17 ordinator’’; and 18 (4) by adding at the end the following: 19 ‘‘(ii) CRITERIA.—In any publication 20 under clause (i), the National Coordinator 21 shall include best practices for encouraging 22 partnerships between the Federal Govern- 23 ment, States, and private entities to ex- 24 pand outreach for and the adoption of cer- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00866 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 867 •HR 6637 IH tified EHR technology in communities with 1 a high proportion of individuals from racial 2 and ethnic minority groups (as so defined), 3 while also maintaining the accessibility re- 4 quirements of section 508 of the Rehabili- 5 tation Act of 1973 to encourage patient in- 6 volvement in patient health care. The Na- 7 tional Coordinator shall— 8 ‘‘(I) not later than 6 months 9 after the submission of the report re- 10 quired under section 822 of the 11 Health Equity and Accountability Act 12 of 2020, establish criteria for evalu- 13 ating the impact of health information 14 technology on communities with a 15 high proportion of individuals from 16 racial and ethnic minority groups (as 17 so defined) taking into account the 18 findings in such report; and 19 ‘‘(II) not later than 1 year after 20 the submission of such report, conduct 21 and publish the results of an evalua- 22 tion of such impact.’’. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00867 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 868 •HR 6637 IH SEC. 803. NONDISCRIMINATION AND HEALTH EQUITY IN 1 HEALTH INFORMATION TECHNOLOGY. 2 Covered entities shall ensure that electronic and in- 3 formation technology in their health programs or activities 4 does not exclude individuals from participation in, deny 5 them the benefits of, or subject them to discrimination 6 under any health program or activity on the basis of race, 7 color, national origin, sex, age, or disability. The term 8 ‘‘covered entity’’ means— 9 (1) an entity that operates a health program or 10 activity, any part of which receives Federal financial 11 assistance; 12 (2) an entity established under title I of the Pa- 13 tient Protection and Affordable Care Act that ad- 14 ministers a health program or activity; and 15 (3) the U.S. Department of Health and Human 16 Services. 17 SEC. 804. LANGUAGE ACCESS IN HEALTH INFORMATION 18 TECHNOLOGY. 19 The National Coordinator shall— 20 (1) not later than 18 months following enact- 21 ment of this Act, require the Office of the National 22 Coordinator to provide access to certified EHR tech- 23 nology to provide patients access to their personal 24 health information in a computable format, includ- 25 ing using patient portals or third-party applications 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00868 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 869 •HR 6637 IH (as described in the 21st Century Cures Act), in the 1 ten (10) most common non-English languages; 2 (2) hold a public hearing to identify best prac- 3 tices for such a requirement listed in paragraph (1); 4 and 5 (3) not later than 6 months after the public 6 hearing, promulgate a regulation and subsequent 7 proposed rulemaking. 8 Subtitle B—Modifications To 9 Achieve Parity in Existing Pro- 10 grams 11 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 12 HEALTH IT INFRASTRUCTURE IN RACIAL 13 AND ETHNIC MINORITY COMMUNITIES. 14 Section 3011 of the Public Health Service Act (42 15 U.S.C. 300jj–31) is amended— 16 (1) in subsection (a), in the matter preceding 17 paragraph (1), by inserting ‘‘, including with respect 18 to communities with a high proportion of individuals 19 from racial and ethnic minority groups (as defined 20 in section 1707(g))’’ before the colon; and 21 (2) by adding at the end the following new sub- 22 section: 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00869 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 870 •HR 6637 IH ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 1 National Coordinator shall report annually to Congress on 2 activities and expenditures under this section.’’. 3 SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE- 4 VELOPMENT OF LOAN PROGRAMS TO FACILI- 5 TATE ADOPTION OF CERTIFIED EHR TECH- 6 NOLOGY BY PROVIDERS SERVING RACIAL 7 AND ETHNIC MINORITY GROUPS. 8 Section 3014(e) of the Public Health Service Act (42 9 U.S.C. 300jj–34(e)) is amended, in the matter preceding 10 paragraph (1), by inserting ‘‘, including with respect to 11 communities with a high proportion of individuals from 12 racial and ethnic minority groups (as defined in section 13 1707(g))’’ after ‘‘health care provider to’’. 14 SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 15 Section 3018 of the Public Health Service Act (42 16 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 17 2009 through 2013’’ and inserting ‘‘fiscal years 2021 18 through 2026’’. 19 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00870 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 871 •HR 6637 IH Subtitle C—Additional Research 1 and Studies 2 SEC. 821. DATA COLLECTION AND ASSESSMENTS CON- 3 DUCTED IN COORDINATION WITH MINORITY- 4 SERVING INSTITUTIONS. 5 Section 3001(c)(6) of the Public Health Service Act 6 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 7 end the following new subparagraph: 8 ‘‘(F) DATA COLLECTION AND ASSESS- 9 MENTS CONDUCTED IN COORDINATION WITH 10 MINORITY-SERVING INSTITUTIONS.— 11 ‘‘(i) IN GENERAL.—In carrying out 12 subparagraph (C) with respect to commu- 13 nities with a high proportion of individuals 14 from racial and ethnic minority groups (as 15 defined in section 1707(g)), the National 16 Coordinator shall, to the greatest extent 17 possible, coordinate with an entity de- 18 scribed in clause (ii). 19 ‘‘(ii) MINORITY-SERVING INSTITU- 20 TIONS.—For purposes of clause (i), an en- 21 tity described in this clause is a historically 22 Black college or university, a Hispanic- 23 serving institution, a Tribal College or 24 University, or an Asian American, Native 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00871 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 872 •HR 6637 IH American, or Pacific Islander-serving insti- 1 tution with an accredited public health, 2 health policy, or health services research 3 program.’’. 4 SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 5 IN MEDICALLY UNDERSERVED COMMU- 6 NITIES. 7 (a) IN GENERAL.—Not later than 2 years after the 8 date of enactment of this Act, the Secretary of Health and 9 Human Services shall— 10 (1) enter into an agreement with the National 11 Academies of Sciences, Engineering, and Medicine to 12 conduct a study on the development, implementa- 13 tion, and effectiveness of health information tech- 14 nology within medically underserved areas (as de- 15 scribed in subsection (c)); and 16 (2) submit a report to Congress describing the 17 results of such study, including any recommenda- 18 tions for legislative or administrative action. 19 (b) STUDY.—The study described in subsection 20 (a)(1) shall— 21 (1) identify barriers to successful implementa- 22 tion of health information technology in medically 23 underserved areas; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00872 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 873 •HR 6637 IH (2) survey a cross-section of individuals in 1 medically underserved areas and report their opin- 2 ions about the various topics of study; 3 (3) examine the degree of interoperability 4 among health information technology and users of 5 health information technology in medically under- 6 served areas, including patients, providers, and com- 7 munity services; 8 (4) examine the impact of health information 9 technology on providing quality care and reducing 10 the cost of care to individuals in such areas, includ- 11 ing the impact of such technology on improved 12 health outcomes for individuals, including which 13 technology worked for which population and how it 14 improved health outcomes for that population; 15 (5) examine the impact of health information 16 technology on improving health care-related deci- 17 sions by both patients and providers in such areas; 18 (6) identify specific best practices for using 19 health information technology to foster the con- 20 sistent provision of physical accessibility and reason- 21 able policy accommodations in health care to individ- 22 uals with disabilities in such areas; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00873 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 874 •HR 6637 IH (7) assess the feasibility and costs associated 1 with the use of health information technology in 2 such areas; 3 (8) evaluate whether the adoption and use of 4 qualified electronic health records (as defined in sec- 5 tion 3000 of the Public Health Service Act (42 6 U.S.C. 300jj)) is effective in reducing health dispari- 7 ties, including analysis of clinical quality measures 8 reported by providers who are participating in the 9 Medicare program under title XVIII of the Social 10 Security Act (42 U.S.C. 1395 et seq.) or a State 11 plan under title XIX of such Act (42 U.S.C. 1396 12 et seq.) (or a waiver of such plan), pursuant to pro- 13 grams to encourage the adoption and use of certified 14 EHR technology; 15 (9) identify providers in medically underserved 16 areas that are not electing to adopt and use elec- 17 tronic health records and determine what barriers 18 are preventing those providers from adopting and 19 using such records; and 20 (10) examine urban and rural community 21 health systems and determine the impact that health 22 information technology may have on the capacity of 23 primary health providers in those systems. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00874 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 875 •HR 6637 IH (c) MEDICALLY UNDERSERVED AREA.—The term 1 ‘‘medically underserved area’’ means— 2 (1) a population that has been designated as a 3 medically underserved population under section 4 330(b)(3) of the Public Health Service Act (42 5 U.S.C. 254b(b)(3)); 6 (2) an area that has been designated as a 7 health professional shortage area under section 332 8 of the Public Health Service Act (42 U.S.C. 254e); 9 (3) an area or population that has been des- 10 ignated as a medically underserved community under 11 section 799B of the Public Health Service Act (42 12 U.S.C. 295p); or 13 (4) another area or population that— 14 (A) experiences significant barriers to ac- 15 cessing quality health services; and 16 (B) has a high prevalence of diseases or 17 conditions described in title VII, with such dis- 18 eases or conditions having a disproportionate 19 impact on racial and ethnic minority groups (as 20 defined in section 1707(g) of the Public Health 21 Service Act (42 U.S.C. 300u–6(g))) or a sub- 22 group of people with disabilities who have spe- 23 cific functional impairments. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00875 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 876 •HR 6637 IH SEC. 823. ASSESSMENT OF USE AND MISUSE OF DE-IDENTI- 1 FIED HEALTH DATA. 2 (a) IN GENERAL.—Not later than 18 months after 3 the date of enactment of this Act, the Secretary of Health 4 and Human Services shall— 5 (1) enter into an agreement with the Office of 6 the National Coordinator to conduct a study on the 7 impact of digital health technology on medically un- 8 derserved areas (as described in section 822(c) of 9 the Health Equity and Accountability Act of 2020) 10 in consultation with relevant stakeholders; and 11 (2) submit a report to Congress describing the 12 results of such study, including any recommenda- 13 tions for legislative or administrative action. 14 (b) STUDY.—The study described in subsection 15 (a)(1) shall— 16 (1) examine the overall prevalence, and histor- 17 ical and existing practices and their respective preva- 18 lence, of use and misuse of de-identified protected 19 health information, as it is defined in section 20 160.103, title 45, Code of Federal Regulations, to 21 discriminate against or benefit medically under- 22 served areas; 23 (2) identify best practices and tools to leverage 24 the benefits and prevent misuse of de-identified pro- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00876 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 877 •HR 6637 IH tected health information to discriminate against 1 medically underserved areas; 2 (3) examine the overall prevalence, and histor- 3 ical and existing practices and their respective preva- 4 lence, of use and misuse of de-identified personal 5 health information other than protected health infor- 6 mation, as it is defined in section 160.103, title 45, 7 Code of Federal Regulations, to discriminate against 8 or benefit medically underserved areas; and 9 (4) identify best practices and tools to leverage 10 the benefits and prevent misuse of de-identified per- 11 sonal health information other than protected health 12 information to discriminate against medically under- 13 served areas. 14 Subtitle D—Closing Gaps in 15 Funding To Adopt Certified EHRs 16 SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY- 17 MENTS TO REHABILITATION FACILITIES, 18 LONG-TERM CARE FACILITIES, AND HOME 19 HEALTH AGENCIES. 20 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So- 21 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend- 22 ed— 23 (1) in clause (i), by striking ‘‘, or’’ and insert- 24 ing a semicolon; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00877 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 878 •HR 6637 IH (2) in clause (ii), by striking the period at the 1 end and inserting a semicolon; and 2 (3) by inserting after clause (ii) the following 3 new clauses: 4 ‘‘(iii) a rehabilitation facility (as defined in sec- 5 tion 1886(j)(1)) that furnishes acute or subacute re- 6 habilitation services; 7 ‘‘(iv) a long-term care hospital (as defined in 8 section 1886(d)(1)(B)(iv)); or 9 ‘‘(v) a home health agency (as defined in sec- 10 tion 1861(o)).’’. 11 (b) EFFECTIVE DATE.—The amendment made by 12 subsection (a) shall apply with respect to amounts ex- 13 pended under section 1903(a)(3)(F) of the Social Security 14 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 15 ginning on or after the date of the enactment of this Act. 16 SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 17 FOR MEDICAID ELECTRONIC HEALTH 18 RECORD INCENTIVE PAYMENTS. 19 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 20 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 21 amended to read as follows: 22 ‘‘(v) physician assistant.’’. 23 (b) EFFECTIVE DATE.—The amendment made by 24 subsection (a) shall apply with respect to amounts ex- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00878 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 879 •HR 6637 IH pended under section 1903(a)(3)(F) of the Social Security 1 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 2 ginning on or after the date of the enactment of this Act. 3 TITLE IX—ACCOUNTABILITY 4 AND EVALUATION 5 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 6 ASSISTED HEALTH CARE SERVICES AND RE- 7 SEARCH PROGRAMS ON THE BASIS OF SEX 8 (INCLUDING SEX ORIENTATION, GENDER 9 IDENTITY, AND PREGNANCY, INCLUDING 10 TERMINATION OF PREGNANCY), RACE, 11 COLOR, NATIONAL ORIGIN, MARITAL STATUS, 12 FAMILIAL STATUS, SEXUAL ORIENTATION, 13 GENDER IDENTITY, OR DISABILITY STATUS. 14 (a) IN GENERAL.—No person in the United States 15 shall, on the basis of sex (including sex orientation, gender 16 identity, and pregnancy, including termination of preg- 17 nancy), race, color, national origin, marital status, familial 18 status, sexual orientation, gender identity, or disability 19 status, be excluded from participation in, be denied the 20 benefits of, or be subjected to discrimination under any 21 health program or activity, including any health research 22 program or activity, receiving Federal financial assistance, 23 including credits, subsidies, or contracts of insurance or 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00879 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 880 •HR 6637 IH any health program or activity that is administered by an 1 executive agency. 2 (b) DEFINITION.—In this section, the term ‘‘familial 3 status’’ means, with respect to one or more individuals— 4 (1) being domiciled with any individual related 5 by blood or affinity whose close association with the 6 individual is the equivalent of a family relationship; 7 (2) being in the process of securing legal cus- 8 tody of any individual; or 9 (3) being pregnant. 10 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 11 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 12 A payment to a provider of services, physician, or 13 other supplier under part B, C, or D of title XVIII of 14 the Social Security Act shall be deemed a grant, and not 15 a contract of insurance or guaranty, for the purposes of 16 title VI of the Civil Rights Act of 1964. 17 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 18 THE DEPARTMENT OF HEALTH AND HUMAN 19 SERVICES. 20 Title XXXIV of the Public Health Service Act, as 21 amended by titles I, II, and III of this Act, is further 22 amended by inserting after subtitle C the following: 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00880 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 881 •HR 6637 IH ‘‘Subtitle D—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 that receive Federal financial as- 10 sistance are in compliance with title VI of the Civil Rights 11 Act, including through the following activities: 12 ‘‘(1) The development and implementation of 13 an action plan to address racial and ethnic health 14 care disparities, which shall address concerns relat- 15 ing to the Office for Civil Rights as released by the 16 United States Commission on Civil Rights in the re- 17 port entitled ‘Health Care Challenge: Acknowledging 18 Disparity, Confronting Discrimination, and Ensur- 19 ing Equity’ (September 1999) in conjunction with 20 the reports by the National Academy of Sciences 21 (formerly known as the Institute of Medicine) enti- 22 tled ‘Unequal Treatment: Confronting Racial and 23 Ethnic Disparities in Health Care’, ‘Crossing the 24 Quality Chasm: A New Health System for the 21st 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00881 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 882 •HR 6637 IH Century’, ‘In the Nation’s Compelling Interest: En- 1 suring Diversity in the Health Care Workforce’, 2 ‘The National Partnership for Action to End Health 3 Disparities’, and ‘The Health of Lesbian, Gay, Bi- 4 sexual, and Transgender People’, and other related 5 reports by the National Academy of Sciences. This 6 plan shall be publicly disclosed for review and com- 7 ment and the final plan shall address any comments 8 or concerns that are received by the Office. 9 ‘‘(2) Investigative and enforcement actions 10 against intentional discrimination and policies and 11 practices that have a disparate impact on minorities. 12 ‘‘(3) The review of racial, ethnic, gender iden- 13 tity, sexual orientation, sex, disability status, socio- 14 economic status, and primary language health data 15 collected by Federal health agencies to assess health 16 care disparities related to intentional discrimination 17 and policies and practices that have a disparate im- 18 pact on minorities. Such review shall include an as- 19 sessment of health disparities in communities with a 20 combination of these classes. 21 ‘‘(4) Outreach and education activities relating 22 to compliance with title VI of the Civil Rights Act. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00882 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 883 •HR 6637 IH ‘‘(5) The provision of technical assistance for 1 health entities to facilitate compliance with title VI 2 of the Civil Rights Act. 3 ‘‘(6) Coordination and oversight of activities of 4 the civil rights compliance offices established under 5 section 3442. 6 ‘‘(7) Ensuring— 7 ‘‘(A) at a minimum, compliance with the 8 most recent version of the Office of Manage- 9 ment and Budget statistical policy directive en- 10 titled ‘Standards for Maintaining, Collecting, 11 and Presenting Federal Data on Race and Eth- 12 nicity’; and 13 ‘‘(B) consideration of available data and 14 language standards such as— 15 ‘‘(i) the standards for collecting and 16 reporting data under section 3101; and 17 ‘‘(ii) the National Standards on Cul- 18 turally and Linguistically Appropriate 19 Services of the Office of Minority Health. 20 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 21 sure the effectiveness of the Office of Health Disparities 22 by ensuring that the Office is provided with— 23 ‘‘(1) adequate funding to enable the Office to 24 carry out its duties under this section; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00883 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 884 •HR 6637 IH ‘‘(2) staff with expertise in— 1 ‘‘(A) epidemiology; 2 ‘‘(B) statistics; 3 ‘‘(C) health quality assurance; 4 ‘‘(D) minority health and health dispari- 5 ties; 6 ‘‘(E) cultural and linguistic competency; 7 ‘‘(F) civil rights; and 8 ‘‘(G) social, behavioral, and economic de- 9 terminants of health. 10 ‘‘(d) REPORT.—Not later than December 31, 2021, 11 and annually thereafter, the Secretary, in collaboration 12 with the Director of the Office for Civil Rights and the 13 Deputy Assistant Secretary for Minority Health, shall 14 submit a report to the Committee on Health, Education, 15 Labor, and Pensions of the Senate and the Committee on 16 Energy and Commerce of the House of Representatives 17 that includes— 18 ‘‘(1) the number of cases filed, broken down by 19 category; 20 ‘‘(2) the number of cases investigated and 21 closed by the office; 22 ‘‘(3) the outcomes of cases investigated; 23 ‘‘(4) the staffing levels of the office including 24 staff credentials; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00884 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 885 •HR 6637 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 2021 through 2026. 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 programs, services, and activities in a manner 20 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 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00885 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 886 •HR 6637 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 the applicable agency, including the estab- 11 lishment of disparity reduction standards to encom- 12 pass disparities in health and health care related to 13 race, national origin, language, ethnicity, sex, age, 14 disability, sexual orientation, and gender identity. 15 ‘‘(2) The development and implementation of 16 program-specific guidelines that interpret and apply 17 Department of Health and Human Services guid- 18 ance under title VI of the Civil Rights Act of 1964 19 and section 1557 of the Patient Protection and Af- 20 fordable Care Act to each Federal health program 21 administered by the agency. 22 ‘‘(3) The development of a disparity-reduction 23 impact analysis methodology that shall be applied to 24 every rule issued by the agency and published as 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00886 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 887 •HR 6637 IH part of the formal rulemaking process under sections 1 555, 556, and 557 of title 5, United States Code. 2 ‘‘(4) Oversight of data collection, analysis, and 3 publication requirements for all recipients of Federal 4 financial assistance under each Federal health pro- 5 gram administered by the agency; compliance with, 6 at a minimum, the most recent version of the Office 7 of Management and Budget statistical policy direc- 8 tive entitled ‘Standards for Maintaining, Collecting, 9 and Presenting Federal Data on Race and Eth- 10 nicity’; and consideration of available data and lan- 11 guage standards 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. 17 ‘‘(5) The conduct of publicly available studies 18 regarding discrimination within Federal health pro- 19 grams administered by the agency as well as dis- 20 parity reduction initiatives by recipients of Federal 21 financial assistance under Federal health programs. 22 ‘‘(6) Annual reports to the Committee on 23 Health, Education, Labor, and Pensions and the 24 Committee on Finance of the Senate and the Com- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00887 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 888 •HR 6637 IH mittee on Energy and Commerce and the Committee 1 on Ways and Means of the House of Representatives 2 on the progress in reducing disparities in health and 3 health care through the Federal programs adminis- 4 tered by the agency. 5 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 6 IN THE DEPARTMENT OF JUSTICE.— 7 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 8 SERVICES.—The Office for Civil Rights of the De- 9 partment of Health and Human Services shall pro- 10 vide standard-setting and compliance review inves- 11 tigation support services to the Civil Rights Compli- 12 ance Office for each agency described in subsection 13 (a), subject to paragraph (2). 14 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 15 for Civil Rights of the Department of Justice may, 16 as appropriate, institute formal proceedings when a 17 civil rights compliance office established under sub- 18 section (a) determines that a recipient of Federal fi- 19 nancial assistance is not in compliance with the dis- 20 parity reduction standards of the applicable agency. 21 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 22 health programs’ mean programs— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00888 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 889 •HR 6637 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 minority groups 22 based on race or color, promote coordination of such 23 activities of— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00889 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 890 •HR 6637 IH ‘‘(A) the Office for Civil Rights within the 1 Office of Justice Programs of the Department 2 of Justice; 3 ‘‘(B) the Office of Justice Programs within 4 the Department of Justice; 5 ‘‘(C) the Office for Civil Rights within the 6 Department of Health and Human Services; 7 and 8 ‘‘(D) the Office of Minority Health within 9 the Department of Health and Human Services 10 (headed by the Deputy Assistant Secretary for 11 Minority Health).’’. 12 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 13 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 14 1975c) is amended by striking the first sentence and in- 15 serting the following: ‘‘For the purpose of carrying out 16 this Act, there are authorized to be appropriated 17 $30,000,000 for fiscal year 2021, and such sums as may 18 be necessary for each of the fiscal years 2022 through 19 2026.’’. 20 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 21 ING OF ACTIVITIES TO ELIMINATE RACIAL 22 AND ETHNIC HEALTH DISPARITIES. 23 (a) FINDINGS.—Congress makes the following find- 24 ings: 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00890 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 891 •HR 6637 IH (1) The health status of the population of the 1 United States is declining and the United States 2 currently ranks below most industrialized nations in 3 health status measured by longevity, sickness, and 4 mortality. 5 (2) Racial and ethnic minority populations tend 6 to have the poorest health status and face substan- 7 tial cultural, social, and economic barriers to obtain- 8 ing quality health care. 9 (3) Lesbian, gay, bisexual, transgender, queer, 10 and questioning populations experience significant 11 personal and structural barriers to obtaining high- 12 quality health care. 13 (4) Efforts to improve minority health have 14 been limited by inadequate resources (funding, staff- 15 ing, and stewardship) and lack of accountability. 16 (b) SENSE OF CONGRESS.—It is the sense of Con- 17 gress that— 18 (1) health disparities negatively impact out- 19 comes for health and human security of the Nation; 20 (2) reducing racial, ethnic, sexual, and gender 21 disparities in prevention and treatment are unique 22 civil and human rights challenges and, as such, Fed- 23 eral agencies and health care entities and systems 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00891 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 892 •HR 6637 IH receiving Federal funds should be accountable for 1 their role in causing disparities and inequity; 2 (3) funding for the National Institute on Mi- 3 nority Health and Health Disparities, the Office of 4 Civil Rights in the Department of Health and 5 Human Services, the National Institute of Nursing 6 Research, and the Office of Minority Health should 7 be doubled by fiscal year 2022; 8 (4) adequate funding by fiscal year 2022, and 9 subsequent funding increases, should be provided for 10 health and human service professions training pro- 11 grams, the Racial and Ethnic Approaches to Com- 12 munity Health Initiative at the Centers for Disease 13 Control and Prevention, the Minority HIV/AIDS 14 Initiative, and the Excellence Centers to Eliminate 15 Ethnic/Racial Disparities Program at the Agency for 16 Healthcare Research and Quality; 17 (5) funding should be fully restored to the Ra- 18 cial and Ethnic Approaches to Community Health 19 Initiative at the Centers for Disease Control and 20 Prevention, which has been a successful program at 21 the community health level, and efforts should con- 22 tinue to place a strong emphasis on building commu- 23 nity capacity to secure financial resources and tech- 24 nical assistance to eliminate health disparities; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00892 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 893 •HR 6637 IH (6) adequate funding for fiscal year 2022 and 1 increased funding for future years should be pro- 2 vided for the Racial and Ethnic Approaches to Com- 3 munity Health Initiative’s United States Risk Fac- 4 tor Survey to ensure adequate data collection to 5 track health disparities, and there should be appro- 6 priate avenues provided to disseminate findings to 7 the general public; 8 (7) current and newly created health disparity 9 elimination incentives, programs, agencies, and de- 10 partments under this Act (and the amendments 11 made by this Act) should receive adequate staffing 12 and funding by fiscal year 2022; and 13 (8) stewardship and accountability should be 14 provided to the Congress and the President for 15 measurable and sustainable progress toward health 16 disparity elimination. 17 SEC. 906. GAO AND NIH REPORTS. 18 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 19 NIC DIVERSITY.— 20 (1) IN GENERAL.—The Comptroller General of 21 the United States shall conduct a study on the racial 22 and ethnic diversity among the following groups: 23 (A) All applicants for grants, contracts, 24 and cooperative agreements awarded by the Na- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00893 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 894 •HR 6637 IH tional Institutes of Health during the period be- 1 ginning on January 1, 2009, and ending De- 2 cember 31, 2019. 3 (B) All recipients of such grants, con- 4 tracts, and cooperative agreements during such 5 period. 6 (C) All members of the peer review panels 7 of such applicants and recipients, respectively. 8 (2) REPORT.—Not later than 6 months after 9 the date of the enactment of this Act, the Comp- 10 troller General shall complete the study under para- 11 graph (1) and submit to Congress a report con- 12 taining the results of such study. 13 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 14 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 15 DISPARITIES.—Not later than 6 months after the date of 16 the enactment of this Act, and biennially thereafter, the 17 Director of the National Institutes of Health, in collabora- 18 tion with the Director of the National Institute on Minor- 19 ity Health and Health Disparities, shall submit to Con- 20 gress a report that details and evaluates— 21 (1) the steps taken during the applicable report 22 period by the Director of the National Institutes of 23 Health to enforce the expanded planning, coordina- 24 tion, review, and evaluation authority provided the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00894 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 895 •HR 6637 IH National Institute on Minority Health and Health 1 Disparities under section 464z–3(h) of the Public 2 Health Service Act (42 U.S.C. 285(h)) over all mi- 3 nority health and health disparity research that is 4 conducted or supported by the Institutes and Cen- 5 ters at the National Institutes of Health; and 6 (2) the outcomes of such steps. 7 (c) GAO REPORT RELATED TO RECIPIENTS OF 8 PPACA FUNDING.—Not later than one year after the 9 date of the enactment of this Act and biennially thereafter 10 until 2024, the Comptroller General of the United States 11 shall submit to Congress a report that identifies— 12 (1) the racial and ethnic diversity of commu- 13 nity-based organizations that applied for Federal en- 14 rollment funding provided pursuant to the Patient 15 Protection and Affordable Care Act (Public Law 16 111–148) (including the amendments made by such 17 Act); 18 (2) the percentage of such organizations that 19 were awarded such funding; and 20 (3) the impact of such community-based organi- 21 zations’ enrollment efforts on the insurance status of 22 their communities. 23 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 24 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00895 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 896 •HR 6637 IH PARITIES.—The Director of the National Institute on Mi- 1 nority Health and Health Disparities shall prepare an an- 2 nual report on the activities carried out or to be carried 3 out by such institute, and shall submit each such report 4 to the Committee on Health, Education, Labor, and Pen- 5 sions of the Senate, the Committee on Energy and Com- 6 merce of the House of Representatives, the Secretary of 7 Health and Human Services, and the Director of the Na- 8 tional Institutes of Health. With respect to the fiscal year 9 involved, the report shall— 10 (1) describe and evaluate the progress made in 11 health disparities research conducted or supported 12 by institutes and centers of the National Institutes 13 of Health; 14 (2) summarize and analyze expenditures made 15 for activities with respect to health disparities re- 16 search conducted or supported by the National Insti- 17 tutes of Health; 18 (3) include a separate statement applying the 19 requirements of paragraphs (1) and (2) specifically 20 to minority health disparities research; and 21 (4) contain such recommendations as the Direc- 22 tor of the Institute considers appropriate. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00896 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 897 •HR 6637 IH TITLE X—ADDRESSING SOCIAL 1 DETERMINANTS AND IM- 2 PROVING ENVIRONMENTAL 3 JUSTICE 4 Subtitle A—In General 5 SEC. 1001. DEFINITIONS. 6 In this title: 7 (1) DETERMINANTS OF HEALTH.—The term 8 ‘‘determinants of health’’— 9 (A) means the range of personal, social, 10 economic, and environmental factors that influ- 11 ence health status; and 12 (B) includes social determinants of health 13 (which are sometimes referred to as ‘‘social and 14 economic determinants of health’’, ‘‘socio- 15 economic determinants of health’’, ‘‘environ- 16 mental determinants of health’’, ‘‘social drivers 17 of inequality’’, and ‘‘personal determinants of 18 health’’). 19 (2) ENVIRONMENTAL DETERMINANTS OF 20 HEALTH.—The term ‘‘environmental determinants 21 of health’’ means the broad physical (including man- 22 made and natural environments), psychological, so- 23 cial, spiritual, cultural and aesthetic environment. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00897 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 898 •HR 6637 IH (3) BUILT ENVIRONMENT.—The term ‘‘built 1 environment’’ means the components of the environ- 2 ment, and the location of these components in a geo- 3 graphically defined space, that are created or modi- 4 fied by individuals to form the physical and social 5 characteristics of a community or enhance quality of 6 human life, including— 7 (A) homes, schools, and places of work and 8 worship; 9 (B) parks, recreation areas, and green- 10 ways; 11 (C) transportation systems; 12 (D) business, industry, and agriculture; 13 and 14 (E) land-use plans, projects, and policies 15 that impact the physical or social characteris- 16 tics of a community, including access to services 17 and amenities. 18 (4) PERSONAL DETERMINANTS OF HEALTH.— 19 The term ‘‘personal determinants of health’’ means 20 an individual’s behavior, biology, and genetics. 21 (5) SOCIAL DETERMINANTS OF HEALTH.—The 22 term ‘‘social determinants of health’’ means a subset 23 of determinants of the health of individuals and en- 24 vironments (such as communities, neighborhoods, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00898 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 899 •HR 6637 IH and societies) that describe an individual’s or group 1 of people’s social identity, describe the social and 2 economic resources to which such individual or 3 group has access, and describe the conditions in 4 which an individual or group of people works, lives, 5 and plays. 6 (6) ECONOMIC DETERMINANTS OF HEALTH.— 7 The term ‘‘economic determinants of health’’ refers 8 to income and social status. Higher income and so- 9 cioeconomic status (SES) are linked to decreased 10 rates of morbidity and mortality. The higher your 11 SES, the healthier you are the longer you’ll live. 12 Low SES leads to an increased risk of illness and 13 death. 14 SEC. 1002. FINDINGS. 15 Congress finds as follows: 16 (1) Social determinants of health are the larg- 17 est predictors of health outcomes. 18 (2) Social determinants of health, including 19 health-related behaviors, social and economic factors, 20 and physical environment factors account for 80 per- 21 cent of health outcomes, whereas clinical care ac- 22 counts for 20 percent of improved health outcomes. 23 Yet, in 2017, public health spending only rep- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00899 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 900 •HR 6637 IH resented 2.5 percent of all health spending in the 1 United States. 2 (3) There are more opportunities to improve 3 health for everyone when we understand that health 4 starts, first, not in a medical setting, but in our 5 families, in our schools and workplaces, in our 6 neighborhoods, in the air we breathe, and in the 7 water we drink. 8 (4)(A) Healthy People 2020 identifies health 9 and health care quality as a function of not only ac- 10 cess to health care, but also the social determinants 11 of health, categorized into the following: neighbor- 12 hoods and the built environment; social and commu- 13 nity context; education; and economic stability. 14 (B) The following examples illustrate the nexus 15 between the unequal distribution of the social deter- 16 minants of health and health disparities: 17 (i) The built environment influences resi- 18 dents’ level of physical activity. Neighborhoods 19 with high levels of poverty are significantly less 20 likely to have places where children can be 21 physically active, such as parks, green spaces, 22 and bike paths and lanes. Neighborhoods and 23 communities can provide opportunities for phys- 24 ical activity and support active lifestyles 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00900 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 901 •HR 6637 IH through accessible and safe parks and open 1 spaces and through land use policy, zoning, and 2 healthy community design. 3 (ii) Emotional and physical health and 4 well-being are directly impacted by perceived 5 levels of safety, such as unlit streets at night. 6 Community members have expressed that safety 7 is not only a barrier to accessing programs and 8 services that increase quality of life but they 9 are also not able to access physical activity in 10 their community through the built environment. 11 (iii) In many workplace environments. 12 (iv) Historical and institutional racism in 13 the United States has shaped the way in which 14 social and economic resources and exposure to 15 health promoting environments are distributed. 16 Income, education, occupation, neighborhood 17 conditions, schools, workplaces, the use of 18 health and social services, and experiences with 19 the criminal justice system are all highly pat- 20 terned by race, with people of color experiencing 21 more that is health harming. Finding ways to 22 uncouple the link between race and access to re- 23 sources and healthy environments is a principal 24 means of reducing health disparities. Addition- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00901 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 902 •HR 6637 IH ally, the anticipation of racism itself causes 1 higher psychological and cardiovascular stress 2 levels that are linked to poor health outcomes. 3 Remedying discriminatory practices at the indi- 4 vidual and systemic levels will likely reduce 5 health disparities caused by this unequal dis- 6 tribution of stress. 7 (v) Poor health among Native Americans 8 has largely been driven by post-colonial oppres- 9 sion and historical trauma. The expropriation of 10 native lands and territories to the American 11 state had severe consequences on Native Amer- 12 ican health. This resulted in the deprivation of 13 traditional food sources—and nutrients—for 14 Native Americans and also the destruction of 15 traditional economies and community organiza- 16 tion. Today, Native Americans have twice the 17 rate of diabetes of non-Hispanic Whites. Rec- 18 ognition of the origins of the diabetes as having 19 a social and community context, rather than 20 just individual responsibility and genetic pre- 21 disposition, will shape better policy to provide 22 food security. 23 (vi) In the context of prisons, overcrowding 24 has led to the deterioration of the physical and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00902 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 903 •HR 6637 IH mental health of individuals after they leave 1 prison. In particular, the mass incarceration of 2 African-American males as a result of unequal 3 contact with and treatment in the criminal jus- 4 tice system has contributed to an overburdening 5 of certain infectious diseases within the African- 6 American community. As a social institution, 7 incarceration amplifies existing adverse health 8 conditions by concentrating diseases and harm- 9 ful health behaviors such as tobacco use, drug 10 use, and violence. 11 (vii) Educational attainment is the strong- 12 est predictor of adult mortality. It is a basic 13 component of socioeconomic status that shapes 14 earning potential to access resources that pro- 15 mote health. People with more education are 16 less likely to report that they are in poor health, 17 and are also less likely to have diabetes and 18 other chronic diseases. 19 (viii) Individuals with lower levels of edu- 20 cational attainment are much more likely to re- 21 port to be current smokers. In 2017, smoking 22 prevalence was 36.8 percent among adults with 23 a GED diploma, 23.1 percent with less than a 24 high school diploma, and 18.7 percent with a 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00903 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 904 •HR 6637 IH high school diploma, while dropping signifi- 1 cantly to 7.1 percent among adults with an un- 2 dergraduate college degree and 4.1 percent with 3 a postgraduate college degree. 4 (ix) Income inequality differences account 5 for a large part of health disparities. For exam- 6 ple, children living in poverty experience poorer 7 housing conditions, increased exposure to in- 8 door allergens and toxins (such as pesticides, 9 lead, mercury, radon, air pollution, and carcino- 10 gens), increased food insecurity, and more psy- 11 chological stress. These experiences culminate 12 in worse adult health as compared with children 13 with higher socioeconomic status. Specifically, 14 children living in lower socioeconomic neighbor- 15 hoods have higher rates of asthma due to high- 16 er rates of psychological stress resulting from 17 higher rates of violence. Food insecurity is asso- 18 ciated with obesity and racial and ethnic mi- 19 norities have higher rates of food insecurity. 20 (x) Lesbian, gay, bisexual, transgender, 21 queer, questioning and intersex (LGBTQIA) in- 22 dividuals face health disparities linked to soci- 23 etal stigma, discrimination, and denial of their 24 civil and human rights. Discrimination against 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00904 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 905 •HR 6637 IH LGBTQIA individuals has been associated with 1 high rates of psychiatric disorders, substance 2 abuse, and suicide. Experiences of violence and 3 victimization are frequent for LGBTQIA indi- 4 viduals, and have long-lasting effects on the in- 5 dividual and the community. Personal, family, 6 and social acceptance of sexual orientation and 7 gender identity affects the mental health and 8 personal safety of LGBTQIA individuals. 9 (xi) Individuals in older and cheaper hous- 10 ing are at higher risks to be exposed to lead, 11 particularly in housing built prior to 1960. The 12 threat of lead poisoning disproportionally af- 13 fects vulnerable populations, with children living 14 in poverty (5.6 percent) and Black children 15 (5.6) experiencing the highest rates. According 16 to the Department of Housing and Urban De- 17 velopment, about 3,600,000 homes nationwide 18 that house young children have lead hazards 19 such as contaminated drinking water, peeling 20 paint, contaminated dust, or toxic soil. The 21 combined cost of medical treatment and special 22 education for lead poisoned children averages 23 about $5,600 per child per year, and lead-poi- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00905 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 906 •HR 6637 IH soning costs the United States an estimated 1 $50,000,000,000 annually. 2 (xii) Individuals with disabilities, as a 3 group, experience health disparities in routine 4 public health arenas such as health behaviors, 5 clinical preventive services, and chronic condi- 6 tions. Compared with individuals without dis- 7 abilities, individuals with disabilities are— 8 (I) less likely to receive recommended 9 preventive health care services, such as 10 routine teeth cleanings and cancer 11 screenings; 12 (II) at a high risk for poor health out- 13 comes such as obesity, hypertension, falls- 14 related injuries, and mood disorders such 15 as depression; and 16 (III) more likely to engage in 17 unhealthy behaviors that put their health 18 at risk, such as cigarette smoking and in- 19 adequate physical activity (from Healthy 20 People 2020). 21 (5) Laws and regulations that improve opportu- 22 nities to live in safe neighborhoods, with more social 23 cohesion, attain higher education, sustain stable em- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00906 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 907 •HR 6637 IH ployment, and bridge class differences help foster 1 the health and safety of individuals. 2 (6) The global public health community has 3 reached consensus through the Rio Political Declara- 4 tion of Social Determinants of Health adopted by 5 the World Health Organization in October 2011 that 6 ‘‘[c]ollaboration in coordinated and intersectoral pol- 7 icy actions has proven to be effective. Health in All 8 Policies, an initiative of the American Public Health 9 Association, together with intersectoral cooperation 10 and action, is one promising approach to enhance 11 accountability in other sectors of health, as well as 12 the promotion of health equity and more inclusive 13 and productive societies.’’. 14 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 15 (a) FINDINGS.—Congress makes the following find- 16 ings: 17 (1) Health Impact Assessment is a tool to help 18 planners, health officials, decisionmakers, and the 19 public make more informed decisions about the po- 20 tential health effects of proposed plans, policies, pro- 21 grams, and projects in order to maximize health 22 benefits and minimize harms. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00907 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 908 •HR 6637 IH (2) Health Impact Assessments fosters commu- 1 nity leadership, ownership and participation in deci- 2 sion-making processes. 3 (3) Health Impact Assessments can build com- 4 munity support and reduce opposition to a project or 5 policy, thereby facilitating economic growth by aid- 6 ing the development of consensus regarding new de- 7 velopment proposals. 8 (4) Health Impact Assessments facilitate col- 9 laboration across sectors. 10 (b) PURPOSES.—It is the purpose of this section to— 11 (1) provide more information about the poten- 12 tial human health effects of policy decisions and the 13 distribution of those effects; 14 (2) improve how health is considered in plan- 15 ning and decision-making processes; and 16 (3) build stronger, healthier communities 17 through the use of Health Impact Assessment. 18 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 19 III of the Public Health Service Act (42 U.S.C. 280g et 20 seq.), as amended by section 796A, is further amended 21 by adding at the end the following: 22 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 23 ‘‘(a) DEFINITIONS.—In this section: 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00908 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 909 •HR 6637 IH ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 1 trator’ means the Administrator of the Environ- 2 mental Protection Agency. 3 ‘‘(2) DIRECTOR.—The term ‘Director’ means 4 the Director of the Centers for Disease Control and 5 Prevention. 6 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 7 ‘health impact assessment’ means a systematic proc- 8 ess that uses an array of data sources and analytic 9 methods and considers input from stakeholders to 10 determine the potential effects of a proposed policy, 11 plan, program, or project on the health of a popu- 12 lation and the distribution of those effects within the 13 population. Such term includes identifying and rec- 14 ommending appropriate actions on monitoring and 15 maximizing potential benefits and minimizing the 16 potential harms. 17 ‘‘(4) HEALTH DISPARITY.—The term ‘health 18 disparity’ means a particular type of health dif- 19 ference that is closely linked with social, economic, 20 or environmental disadvantage and that adversely 21 affects groups of people who have systematically ex- 22 perienced greater obstacles to health based on their 23 racial or ethnic group; religion; socioeconomic status; 24 gender; age; mental health; cognitive, sensory, or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00909 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 910 •HR 6637 IH physical disability; sexual orientation or gender iden- 1 tity; geographic location; citizenship status; or other 2 characteristics historically linked to discrimination 3 or exclusion. 4 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 5 through the Director and in collaboration with the Admin- 6 istrator, shall— 7 ‘‘(1) in consultation with the Director of the 8 National Center for Chronic Disease Prevention and 9 Health Promotion and relevant offices within the 10 Department of Housing and Urban Development, 11 the Department of Transportation, and the Depart- 12 ment of Agriculture, establish a program at the Na- 13 tional Center for Environmental Health at the Cen- 14 ters for Disease Control and Prevention focused on 15 advancing the field of health impact assessment that 16 includes— 17 ‘‘(A) collecting and disseminating best 18 practices; 19 ‘‘(B) administering capacity building 20 grants to States to support grantees in initi- 21 ating health impact assessments, in accordance 22 with subsection (d); 23 ‘‘(C) providing technical assistance; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00910 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 911 •HR 6637 IH ‘‘(D) developing training tools and pro- 1 viding training on conducting health impact as- 2 sessment and the implementation of built envi- 3 ronment and health indicators; 4 ‘‘(E) making information available, as ap- 5 propriate, regarding the existence of other com- 6 munity healthy living tools, checklists, and indi- 7 ces that help connect public health to other sec- 8 tors, and tools to help examine the effect of the 9 indoor built environment and building codes on 10 population health; 11 ‘‘(F) conducting research and evaluations 12 of health impact assessments; and 13 ‘‘(G) awarding competitive extramural re- 14 search grants; 15 ‘‘(2) develop guidance and guidelines to conduct 16 health impact assessments in accordance with sub- 17 section (c); and 18 ‘‘(3) establish a grant program to allow States 19 to fund eligible entities to conduct health impact as- 20 sessments. 21 ‘‘(c) GUIDANCE.— 22 ‘‘(1) IN GENERAL.—Not later than 1 year after 23 the date of enactment of the Health Equity and Ac- 24 countability Act of 2020, the Secretary, acting 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00911 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 912 •HR 6637 IH through the Director, shall issue final guidance for 1 conducting the health impact assessments. In devel- 2 oping such guidance the Secretary shall— 3 ‘‘(A) consult with the Director of the Na- 4 tional Center for Environmental Health and the 5 Director of the National Center for Chronic 6 Disease Prevention and Health Promotion, and 7 relevant offices within the Department of Hous- 8 ing and Urban Development, the Department of 9 Transportation, and the Department of Agri- 10 culture; and 11 ‘‘(B) consider available international health 12 impact assessment guidance, North American 13 health impact assessment practice standards, 14 and recommendations from the National Acad- 15 emy of Science. 16 ‘‘(2) CONTENT.—The guidance under this sub- 17 section shall include— 18 ‘‘(A) background on national and inter- 19 national efforts to bridge urban planning, cli- 20 mate forecasting, and public health institutions 21 and disciplines, including a review of health im- 22 pact assessment best practices internationally; 23 ‘‘(B) evidence-based direct and indirect 24 pathways that link land-use planning, transpor- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00912 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 913 •HR 6637 IH tation, and housing policy and objectives to 1 human health outcomes; 2 ‘‘(C) data resources and quantitative and 3 qualitative forecasting methods to evaluate both 4 the status of health determinants and health ef- 5 fects, including identification of existing pro- 6 grams that can disseminate these resources; 7 ‘‘(D) best practices for inclusive public in- 8 volvement in conducting health impact assess- 9 ments; and 10 ‘‘(E) technical assistance for other agen- 11 cies seeking to develop their own guidelines and 12 procedures for health impact assessment. 13 ‘‘(d) GRANT PROGRAM.— 14 ‘‘(1) IN GENERAL.—The Secretary, acting 15 through the Director and in collaboration with the 16 Administrator, shall— 17 ‘‘(A) award grants to States to fund eligi- 18 ble entities for capacity building or to prepare 19 health impact assessments; and 20 ‘‘(B) ensure that States receiving a grant 21 under this subsection further support training 22 and technical assistance for grantees under the 23 program by funding and overseeing appropriate 24 local, State, Tribal, Federal, institution of high- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00913 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 914 •HR 6637 IH er education, or nonprofit health impact assess- 1 ment experts to provide such technical assist- 2 ance. 3 ‘‘(2) APPLICATIONS.— 4 ‘‘(A) IN GENERAL.—To be eligible to re- 5 ceive a grant under this section, an eligible enti- 6 ty shall— 7 ‘‘(i) be a State, Indian tribe, or tribal 8 organization that includes individuals or 9 populations the health of which are, or will 10 be, affected by an activity or a proposed 11 activity; and 12 ‘‘(ii) submit to the Secretary an appli- 13 cation in accordance with this subsection, 14 at such time, in such manner, and con- 15 taining such additional information as the 16 Secretary may require. 17 ‘‘(B) INCLUSION.—An application under 18 this subsection shall include a list of proposed 19 activities that require or would benefit from 20 conducting a health impact assessment within 21 six months of awarding funds. The list should 22 be accompanied by supporting documentation, 23 including letters of support, from potential con- 24 ductors of health impact assessments for the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00914 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 915 •HR 6637 IH listed proposed activities. Each application 1 should also include an assessment by the eligi- 2 ble entity of the health of the population of its 3 jurisdiction and describe potential adverse or 4 positive effects on health that the proposed ac- 5 tivities may create. 6 ‘‘(C) PREFERENCE.—Preference in award- 7 ing funds under this section may be given to el- 8 igible entities that demonstrate the potential to 9 significantly improve population health or lower 10 health care costs as a result of potential health 11 impact assessment work. 12 ‘‘(3) USE OF FUNDS.— 13 ‘‘(A) IN GENERAL.—An entity receiving a 14 grant under this section shall use such grant 15 funds to conduct health impact assessment ca- 16 pacity building or to fund subgrantees in con- 17 ducting a health impact assessment for a pro- 18 posed activity in accordance with this sub- 19 section. 20 ‘‘(B) PURPOSES.—The purposes of a 21 health impact assessment under this subsection 22 are— 23 ‘‘(i) to facilitate the involvement of 24 tribal, State, and local public health offi- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00915 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 916 •HR 6637 IH cials in community planning, transpor- 1 tation, housing, and land use decisions and 2 other decisions affecting the built environ- 3 ment to identify any potential health con- 4 cern or health benefit relating to an activ- 5 ity or proposed activity; 6 ‘‘(ii) to provide for an investigation of 7 any health-related issue of concern raised 8 in a planning process, an environmental 9 impact assessment process, or policy ap- 10 praisal relating to a proposed activity; 11 ‘‘(iii) to describe and compare alter- 12 natives (including no-action alternatives) to 13 a proposed activity to provide clarification 14 with respect to the potential health out- 15 comes associated with the proposed activity 16 and, where appropriate, to the related ben- 17 efit-cost or cost-effectiveness of the pro- 18 posed activity and alternatives; 19 ‘‘(iv) to contribute, when applicable, 20 to the findings of a planning process, pol- 21 icy appraisal, or an environmental impact 22 statement with respect to the terms and 23 conditions of implementing a proposed ac- 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00916 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 917 •HR 6637 IH tivity or related mitigation recommenda- 1 tions, as necessary; 2 ‘‘(v) to ensure that the dispropor- 3 tionate distribution of negative impacts 4 among vulnerable populations is minimized 5 as much as possible; 6 ‘‘(vi) to engage affected community 7 members and ensure adequate opportunity 8 for public comment on all stages of the 9 health impact assessment; 10 ‘‘(vii) where appropriate, to consult 11 with local and county health departments 12 and appropriate organizations, including 13 planning, transportation, and housing or- 14 ganizations and providing them with infor- 15 mation and tools regarding how to conduct 16 and integrate health impact assessment 17 into their work; and 18 ‘‘(viii) to inspect homes, water sys- 19 tems, and other elements that pose risks to 20 lead exposure, with an emphasis on areas 21 that pose a higher risk to children. 22 ‘‘(4) ASSESSMENTS.—Health impact assess- 23 ments carried out using grant funds under this sec- 24 tion shall— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00917 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 918 •HR 6637 IH ‘‘(A) take appropriate health factors into 1 consideration as early as practicable during the 2 planning, review, or decision-making processes; 3 ‘‘(B) assess the effect on the health of in- 4 dividuals and populations of proposed policies, 5 projects, or plans that result in modifications to 6 the built environment; and 7 ‘‘(C) assess the distribution of health ef- 8 fects across various factors, such as race, in- 9 come, ethnicity, age, disability status, gender, 10 and geography. 11 ‘‘(5) ELIGIBLE ACTIVITIES.— 12 ‘‘(A) IN GENERAL.—Eligible entities fund- 13 ed under this subsection shall conduct an eval- 14 uation of any proposed activity to determine 15 whether it will have a significant adverse or 16 positive effect on the health of the affected pop- 17 ulation in the jurisdiction of the eligible entity, 18 based on the criteria described in subparagraph 19 (B). 20 ‘‘(B) CRITERIA.—The criteria described in 21 this subparagraph include, as applicable to the 22 proposed activity, the following: 23 ‘‘(i) Any substantial adverse effect or 24 significant health benefit on health out- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00918 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 919 •HR 6637 IH comes or factors known to influence health, 1 including the following: 2 ‘‘(I) Physical activity. 3 ‘‘(II) Injury. 4 ‘‘(III) Mental health. 5 ‘‘(IV) Accessibility to health-pro- 6 moting goods and services. 7 ‘‘(V) Respiratory health. 8 ‘‘(VI) Chronic disease. 9 ‘‘(VII) Nutrition. 10 ‘‘(VIII) Land use changes that 11 promote local, sustainable food 12 sources. 13 ‘‘(IX) Infectious disease. 14 ‘‘(X) Health disparities. 15 ‘‘(XI) Existing air quality, 16 ground or surface water quality or 17 quantity, or noise levels. 18 ‘‘(XII) Lead exposure. 19 ‘‘(XIII) Drinking water quality 20 and accessibility. 21 ‘‘(ii) Other factors that may be con- 22 sidered, including— 23 ‘‘(I) the potential for a proposed 24 activity to result in systems failure 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00919 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 920 •HR 6637 IH that leads to a public health emer- 1 gency; 2 ‘‘(II) the probability that the pro- 3 posed activity will result in a signifi- 4 cant increase in tourism, economic de- 5 velopment, or employment in the ju- 6 risdiction of the eligible entity; 7 ‘‘(III) any other significant po- 8 tential hazard or enhancement to 9 human health, as determined by the 10 eligible entity; or 11 ‘‘(IV) whether the evaluation of a 12 proposed activity would duplicate an- 13 other analysis or study being under- 14 taken in conjunction with the pro- 15 posed activity. 16 ‘‘(C) FACTORS FOR CONSIDERATION.—In 17 evaluating a proposed activity under subpara- 18 graph (A), an eligible entity may take into con- 19 sideration any reasonable, direct, indirect, or 20 cumulative effect that can be clearly related to 21 potential health effects and that is related to 22 the proposed activity, including the effect of 23 any action that is— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00920 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 921 •HR 6637 IH ‘‘(i) included in the long-range plan 1 relating to the proposed activity; 2 ‘‘(ii) likely to be carried out in coordi- 3 nation with the proposed activity; 4 ‘‘(iii) dependent on the occurrence of 5 the proposed activity; or 6 ‘‘(iv) likely to have a disproportionate 7 impact on high-risk or vulnerable popu- 8 lations. 9 ‘‘(6) REQUIREMENTS.—A health impact assess- 10 ment prepared with funds awarded under this sub- 11 section shall incorporate the following, after con- 12 ducting the screening phase (identifying projects or 13 policies for which a health impact assessment would 14 be valuable and feasible) through the application 15 process: 16 ‘‘(A) SCOPING.—Identifying which health 17 effects to consider and the research methods to 18 be utilized. 19 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 20 Assessing the baseline health status and factors 21 known to influence the health status in the af- 22 fected community, which may include aggre- 23 gating and synthesizing existing health assess- 24 ment evidence and data from the community. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00921 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 922 •HR 6637 IH ‘‘(C) DEVELOPING RECOMMENDATIONS.— 1 Suggesting changes to proposals to promote 2 positive or mitigate adverse health effects. 3 ‘‘(D) REPORTING.—Synthesizing the as- 4 sessment and recommendations and commu- 5 nicating the results to decisionmakers. 6 ‘‘(E) MONITORING AND EVALUATING.— 7 Tracking the decision and implementation effect 8 on health determinants and health status. 9 ‘‘(7) PLAN.—An eligible entity that is awarded 10 a grant under this section shall develop and imple- 11 ment a plan, to be approved by the Director, for 12 meaningful and inclusive stakeholder involvement in 13 all phases of the health impact assessment. Stake- 14 holders may include community leaders, community- 15 based organizations, youth-serving organizations, 16 planners, public health experts, State and local pub- 17 lic health departments and officials, health care ex- 18 perts or officials, housing experts or officials, and 19 transportation experts or officials. 20 ‘‘(8) SUBMISSION OF FINDINGS.—An eligible 21 entity that is awarded a grant under this section 22 shall submit the findings of any funded health im- 23 pact assessment activities to the Secretary and make 24 these findings publicly available. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00922 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 923 •HR 6637 IH ‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en- 1 tity that is awarded a grant under this section shall 2 ensure the assessment of the distribution of health 3 impacts (related to the proposed activity) across 4 race, ethnicity, income, age, gender, disability status, 5 and geography. 6 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 7 greatest extent feasible, a health impact assessment 8 shall be conducted under this section in a manner 9 that respects the needs and timing of the decision- 10 making process it evaluates. 11 ‘‘(11) METHODOLOGY.—In preparing a health 12 impact assessment under this subsection, an eligible 13 entity or partner shall follow the guidance published 14 under subsection (c). 15 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 16 The Secretary, acting through the Director and in collabo- 17 ration with the Administrator, shall establish, maintain, 18 and make publicly available a health impact assessment 19 database, including— 20 ‘‘(1) a catalog of health impact assessments re- 21 ceived under this section; 22 ‘‘(2) an inventory of tools used by eligible enti- 23 ties to conduct health impact assessments; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00923 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 924 •HR 6637 IH ‘‘(3) guidance for eligible entities with respect 1 to the selection of appropriate tools described in 2 paragraph (2). 3 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 4 Secretary shall award competitive grants to Prevention 5 Research Centers, or nonprofit organizations or academic 6 institutions with expertise in health impact assessments 7 to— 8 ‘‘(1) assist grantees with the provision of train- 9 ing and technical assistance in the conducting of 10 health impact assessments; 11 ‘‘(2) evaluate the activities carried out with 12 grants under subsection (d); and 13 ‘‘(3) assist the Secretary in disseminating evi- 14 dence, best practices, and lessons learned from 15 grantees. 16 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 17 after the date of enactment of the Health Equity and Ac- 18 countability Act of 2020, the Secretary shall submit to 19 Congress a report concerning the evaluation of the pro- 20 grams under this section, including recommendations as 21 to how lessons learned from such programs can be incor- 22 porated into future guidance documents developed and 23 provided by the Secretary and other Federal agencies, as 24 appropriate. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00924 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 925 •HR 6637 IH ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary. 3 ‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 4 TO IMPROVE HEALTH OUTCOMES THROUGH 5 THE BUILT ENVIRONMENT. 6 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 7 in collaboration with the Administrator of the Environ- 8 mental Protection Agency (referred to in this section as 9 the ‘Administrator’), shall award grants to public agencies 10 or private nonprofit institutions to implement evidence- 11 based programming to improve human health through im- 12 provements to the built environment and subsequently 13 human health, by addressing— 14 ‘‘(1) levels of physical activity; 15 ‘‘(2) consumption of nutritional foods; 16 ‘‘(3) rates of crime; 17 ‘‘(4) air, water, and soil quality; 18 ‘‘(5) risk or rate of injury; 19 ‘‘(6) accessibility to health-promoting goods and 20 services; 21 ‘‘(7) chronic disease rates; 22 ‘‘(8) community design; 23 ‘‘(9) housing; or transportation options; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00925 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 926 •HR 6637 IH ‘‘(10) other factors, as the Secretary determines 1 appropriate. 2 ‘‘(b) APPLICATIONS.—A public agency or private 3 nonprofit institution desiring a grant under this section 4 shall submit to the Secretary an application at such time, 5 in such manner, and containing such agreements, assur- 6 ances, and information as the Secretary, in consultation 7 with the Administrator, may require. 8 ‘‘(c) RESEARCH.—The Secretary, in consultation 9 with the Administrator, shall support, through grants 10 awarded under this section, research that— 11 ‘‘(1) uses evidence-based research to improve 12 the built environment and human health; 13 ‘‘(2) examines— 14 ‘‘(A) the scope and intensity of the impact 15 that the built environment (including the var- 16 ious characteristics of the built environment) 17 has on the human health; or 18 ‘‘(B) the distribution of such impacts by— 19 ‘‘(i) location; and 20 ‘‘(ii) population subgroup; 21 ‘‘(3) is used to develop— 22 ‘‘(A) measures and indicators to address 23 health impacts and the connection of health to 24 the built environment; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00926 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 927 •HR 6637 IH ‘‘(B) efforts to link the measures to trans- 1 portation, land use, and health databases; and 2 ‘‘(C) efforts to enhance the collection of 3 built environment surveillance data; 4 ‘‘(4) distinguishes carefully between personal 5 attitudes and choices and external influences on be- 6 havior to determine how much the association be- 7 tween the built environment and the health of resi- 8 dents, versus the lifestyle preferences of the people 9 that choose to live in the neighborhood, reflects the 10 physical characteristics of the neighborhood; and 11 ‘‘(5)(A) identifies or develops effective interven- 12 tion strategies focusing on enhancements to the built 13 environment that promote increased use physical ac- 14 tivity, access to nutritious foods, or other health-pro- 15 moting activities by residents; and 16 ‘‘(B) in developing the intervention strategies 17 under subparagraph (A), ensures that the interven- 18 tion strategies will reach out to high-risk or vulner- 19 able populations, including low-income urban and 20 rural communities and aging populations, in addi- 21 tion to the general population. 22 ‘‘(d) SURVEYS.—The Secretary may allow recipients 23 of grants under this section to use such grant funds to 24 support the expansion of national surveys and data track- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00927 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 928 •HR 6637 IH ing systems to provide more detailed information about 1 the connection between the built environment and health. 2 ‘‘(e) PRIORITY.—In awarding grants under this sec- 3 tion, the Secretary and the Administrator shall give pri- 4 ority to entities with programming that incorporates— 5 ‘‘(1) interdisciplinary approaches; or 6 ‘‘(2) the expertise of the public health, physical 7 activity, urban planning, land use, and transpor- 8 tation research communities in the United States 9 and abroad. 10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated such sums as may be 12 necessary to carry out this section. The Secretary may al- 13 locate not more than 20 percent of the amount so appro- 14 priated for a fiscal year for purposes of conducting re- 15 search under subsection (c).’’. 16 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 17 ENVIRONMENTAL PROTECTION AGENCY. 18 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 19 Administrator of the Environmental Protection Agency 20 (referred to in this section as the ‘‘Administrator’’) shall, 21 as promptly as practicable, carry out each of the following 22 recommendations of the Inspector General of the Environ- 23 mental Protection Agency as described in the report enti- 24 tled ‘‘EPA needs to conduct environmental justice reviews 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00928 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 929 •HR 6637 IH of its programs, policies and activities’’ (Report No. 2006– 1 P–00034): 2 (1) The recommendation that the program and 3 regional offices of the Environmental Protection 4 Agency identify which programs, policies, and activi- 5 ties need environmental justice reviews and the Ad- 6 ministrator require those offices to establish a plan 7 to complete the necessary reviews. 8 (2) The recommendation that the Administrator 9 ensure that the reviews described in paragraph (1) 10 determine whether the programs, policies, and activi- 11 ties may have a disproportionately high and adverse 12 health or environmental impact on minority and low- 13 income populations. 14 (3) The recommendation that each program 15 and regional office of the Environmental Protection 16 Agency develop specific environmental justice review 17 guidance for conducting environmental justice re- 18 views. 19 (4) The recommendation that the Administrator 20 designate a responsible office to compile results of 21 environmental justice reviews and recommend appro- 22 priate actions. 23 (b) GAO RECOMMENDATIONS.—In promulgating reg- 24 ulations of the Environmental Protection Agency, the Ad- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00929 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 930 •HR 6637 IH ministrator shall, as promptly as practicable, carry out 1 each of the following recommendations of the Comptroller 2 General of the United States as described in the report 3 entitled ‘‘EPA Should Devote More Attention to Environ- 4 mental Justice when Developing Clean Air Rules’’ (GAO– 5 05–289): 6 (1) The recommendation that the Administrator 7 ensure that workgroups involved in developing a rule 8 devote attention to environmental justice while draft- 9 ing and finalizing the rule. 10 (2) The recommendation that the Administrator 11 enhance the ability of the workgroups described in 12 paragraph (1) to identify potential environmental 13 justice issues through steps such as— 14 (A) providing workgroup members with 15 guidance and training to help those members 16 identify potential environmental justice prob- 17 lems; and 18 (B) involving environmental justice coordi- 19 nators in the workgroups if appropriate. 20 (3) The recommendation that the Administrator 21 improve assessments of potential environmental jus- 22 tice impacts in economic reviews by identifying the 23 data and developing the modeling techniques needed 24 to assess those impacts. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00930 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 931 •HR 6637 IH (4) The recommendation that the Administrator 1 direct appropriate officers and employees of the En- 2 vironmental Protection Agency, if feasible, to re- 3 spond fully to public comments on environmental 4 justice, including by— 5 (A) improving the explanation by the Ad- 6 ministrator of the basis for any conclusions re- 7 lating to environmental justice; and 8 (B) including in an explanation under sub- 9 paragraph (A) supporting data. 10 (c) 2004 INSPECTOR GENERAL REPORT.— 11 (1) IN GENERAL.—The Administrator shall, as 12 promptly as practicable, carry out each of the fol- 13 lowing recommendations of the Inspector General of 14 the Environmental Protection Agency as described 15 in the report entitled ‘‘EPA Needs to Consistently 16 Implement the Intent of the Executive Order on En- 17 vironmental Justice’’ (Report No. 2004–P–00007): 18 (A) The recommendation that the Admin- 19 istrator clearly define the mission of the Office 20 of Environmental Justice and provide Environ- 21 mental Protection Agency staff with an under- 22 standing of the roles and responsibilities of that 23 Office. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00931 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 932 •HR 6637 IH (B) The recommendation that the Admin- 1 istrator— 2 (i) establish, through the issuance of 3 guidance or a policy statement, specific 4 timeframes for the development of defini- 5 tions, goals, and measurements regarding 6 environmental justice; and 7 (ii) provide the regions and program 8 offices a standard and consistent definition 9 for a minority and low-income community, 10 with instructions on how the Environ- 11 mental Protection Agency will implement 12 and put into operation environmental jus- 13 tice in the daily activities of the Environ- 14 mental Protection Agency. 15 (C) The recommendation that the Adminis- 16 trator ensure that the comprehensive training 17 program under development (as of the date of 18 enactment of this Act) includes standard and 19 consistent definitions of the key environmental 20 justice concepts, such as ‘‘low-income’’, ‘‘minor- 21 ity’’, and ‘‘disproportionately impacted’’, and 22 instructions for implementation of those con- 23 cepts. 24 (2) REPORTS.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00932 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 933 •HR 6637 IH (A) INITIAL REPORT.—Not later than 180 1 days after the date of enactment of this Act, 2 the Administrator shall submit to Congress an 3 initial report on the strategy of the Adminis- 4 trator for implementing the recommendations 5 described in subparagraphs (A), (B), and (C) of 6 paragraph (1). 7 (B) SUBSEQUENT REPORTS.—After sub- 8 mitting the initial report under subparagraph 9 (A), the Administrator shall submit to Congress 10 semiannual reports on the progress of the Ad- 11 ministrator in— 12 (i) implementing the recommendations 13 referred to in subparagraph (A); and 14 (ii) modifying the emergency manage- 15 ment procedures of the Administrator to 16 incorporate environmental justice in the 17 Incident Command Structure of the Envi- 18 ronmental Protection Agency, in accord- 19 ance with the December 18, 2006, letter 20 from the Deputy Administrator to the Act- 21 ing Inspector General of the Environ- 22 mental Protection Agency. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00933 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 934 •HR 6637 IH (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 1 PROTECTING PEOPLE AND THEIR FAMILIES FROM 2 RADON.— 3 (1) FINDINGS.—Congress finds that radon is a 4 naturally occurring radioactive gas that is— 5 (A) recognized as the leading cause of lung 6 cancer among nonsmokers; and 7 (B) a particular environmental threat for 8 low-income and minority individuals because of 9 the lack of information about radon levels in 10 the homes of those individuals. 11 (2) IMPLEMENTATION.—Not later than 180 12 days after the date of the enactment of this Act, the 13 Administrator shall implement the action plan enti- 14 tled ‘‘Protecting People and Families from Radon: A 15 Federal Action Plan for Saving Lives’’ (June 20, 16 2011), in consultation with the Director of the Cen- 17 ters for Disease Control and Prevention and any 18 other Federal agencies referred to in the action plan. 19 (3) SPECIFIC STEPS.—In carrying out para- 20 graph (2), the Administrator shall ensure that— 21 (A) the workgroup comprised of the Fed- 22 eral agencies participating in the development 23 of the action plan referred to in paragraph (2) 24 implements specific steps within the existing 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00934 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 935 •HR 6637 IH authority and activities of each Federal agency 1 to reduce exposure to radon; and 2 (B) not later than the date that is 1 year 3 after the date on which the Administrator be- 4 gins implementation of the action plan de- 5 scribed in paragraph (2), the workgroup de- 6 scribed in subparagraph (A) meets to assess 7 and recognize achievements of the plan. 8 (4) REPORT.—After the progress meeting of 9 the workgroup under paragraph (3)(B), the Admin- 10 istrator shall submit to Congress a report on the im- 11 plementation of the action plan described in para- 12 graph (2), including the challenges remaining and 13 the progress in reducing radon exposure, particularly 14 for low-income and minority families. 15 (e) FEDERAL ACTION PLAN FOR PREVENTING 16 CHILDHOOD LEAD POISONING.— 17 (1) FINDINGS.—Congress finds that— 18 (A) the effects of lead poisoning are irre- 19 versible and cost the United States millions an- 20 nually in medical and education costs; 21 (B) the cognitive effects suffered by chil- 22 dren exposed to lead result in a lifetime of 23 health and behavioral problems, which makes 24 prevention efforts more critical; and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00935 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 936 •HR 6637 IH (C) the risk is especially high for vulner- 1 able minority populations who are more likely 2 to live in older homes, where lead-based paint 3 is more likely to be present. 4 (2) ACTION PLAN.—Not later than 180 days 5 after the date of enactment of this Act, the Adminis- 6 trator, in consultation with the Director of the Cen- 7 ters for Disease Control and Prevention and other 8 relevant Federal agencies, shall develop an action 9 plan to reduce exposure to lead. 10 (3) SPECIFIC STEPS.—In carrying out para- 11 graph (2), the Administrator shall— 12 (A) establish a working group, comprised 13 of representatives of the Federal agencies par- 14 ticipating in the development of the action plan 15 described in paragraph (2), to make rec- 16 ommendations for the implementation of spe- 17 cific steps within the existing authority and ac- 18 tivities of each Federal agency to reduce expo- 19 sure to lead; and 20 (B) assist other Federal agencies in the de- 21 velopment of materials on the hazards of lead- 22 based paint for the purpose of educating ten- 23 ants and landlords, how to recognize potential 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00936 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 937 •HR 6637 IH sources of exposure, and how to remediate those 1 sources. 2 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 3 MENTAL HEALTH IMPROVEMENT ACTIVITIES 4 AND TO IMPROVE SOCIAL DETERMINANTS OF 5 HEALTH. 6 (a) DEFINITIONS.—In this section: 7 (1) DIRECTOR.—The term ‘‘Director’’ means 8 the Director of the Centers for Disease Control and 9 Prevention, acting in collaboration with the Adminis- 10 trator of the Environmental Protection Agency and 11 the Director of the National Institute of Environ- 12 mental Health Sciences. 13 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 14 ty’’ means a State or local community that— 15 (A) bears a disproportionate burden of ex- 16 posure to environmental health hazards; 17 (B) bears a disproportionate burden of ex- 18 posure to unhealthy living conditions, low 19 standard housing conditions, low socioeconomic 20 status, poor nutrition, less opportunity for edu- 21 cational attainment, disproportionately high un- 22 employment rates, or lower literacy levels and 23 access to information; 24 (C) has established a coalition— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00937 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 938 •HR 6637 IH (i) with not less than 1 community- 1 based organization or demonstration pro- 2 gram; and 3 (ii) with not less than 1— 4 (I) public health entity; 5 (II) health care provider organi- 6 zation; 7 (III) academic institution, includ- 8 ing any minority-serving institution 9 (including a Hispanic-serving institu- 10 tion, a historically Black college or 11 university, or a Tribal College or Uni- 12 versity); 13 (IV) child-serving institution; or 14 (V) landlord or housing provider 15 working on lead remediation; 16 (D) ensures planned activities and funding 17 streams are coordinated to improve community 18 health; and 19 (E) submits an application in accordance 20 with subsection (c). 21 (b) ESTABLISHMENT.—The Director shall establish a 22 grant program under which eligible entities shall receive 23 grants to conduct environmental health improvement ac- 24 tivities and to improve social determinants of health. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00938 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 939 •HR 6637 IH (c) APPLICATION.—To receive a grant under this sec- 1 tion, an eligible entity shall submit an application to the 2 Director at such time, in such manner, and accompanied 3 by such information as the Director may require. 4 (d) USE OF GRANT FUNDS.—An eligible entity may 5 use a grant under this section— 6 (1) to promote environmental health; 7 (2) to address environmental health disparities 8 among all populations, including children; and 9 (3) to address racial and ethnic disparities in 10 social determinants of health. 11 (e) AMOUNT OF COOPERATIVE AGREEMENT.—The 12 Director shall award grants to eligible entities at the fol- 13 lowing 3 funding levels: 14 (1) LEVEL 1 COOPERATIVE AGREEMENTS.— 15 (A) IN GENERAL.—An eligible entity 16 awarded a grant under this paragraph shall use 17 the funds to identify environmental health prob- 18 lems and solutions by— 19 (i) establishing a planning and 20 prioritizing council in accordance with sub- 21 paragraph (B); and 22 (ii) conducting an environmental 23 health assessment in accordance with sub- 24 paragraph (C). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00939 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 940 •HR 6637 IH (B) PLANNING AND PRIORITIZING COUN- 1 CIL.— 2 (i) IN GENERAL.—A prioritizing and 3 planning council established under sub- 4 paragraph (A)(i) (referred to in this para- 5 graph as a ‘‘PPC’’) shall assist the envi- 6 ronmental health assessment process and 7 environmental health promotion activities 8 of the eligible entity. 9 (ii) MEMBERSHIP.—Membership of a 10 PPC shall consist of representatives from 11 various organizations within public health, 12 planning, development, and environmental 13 services and shall include stakeholders 14 from vulnerable groups such as children, 15 the elderly, disabled, and minority ethnic 16 groups that are often not actively involved 17 in democratic or decision-making proc- 18 esses. 19 (iii) DUTIES.—A PPC shall— 20 (I) identify key stakeholders and 21 engage and coordinate potential part- 22 ners in the planning process; 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00940 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 941 •HR 6637 IH (II) establish a formal advisory 1 group to plan for the establishment of 2 services; 3 (III) conduct an in-depth review 4 of the nature and extent of the need 5 for an environmental health assess- 6 ment, including a local epidemiological 7 profile, an evaluation of the service 8 provider capacity of the community, 9 and a profile of any target popu- 10 lations; and 11 (IV) define the components of 12 care and form essential programmatic 13 linkages with related providers in the 14 community. 15 (C) ENVIRONMENTAL HEALTH ASSESS- 16 MENT.— 17 (i) IN GENERAL.—A PPC shall carry 18 out an environmental health assessment to 19 identify environmental health concerns. 20 (ii) ASSESSMENT PROCESS.—The 21 PPC shall— 22 (I) define the goals of the assess- 23 ment; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00941 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 942 •HR 6637 IH (II) generate the environmental 1 health issue list; 2 (III) analyze issues with a sys- 3 tems framework; 4 (IV) develop appropriate commu- 5 nity environmental health indicators; 6 (V) rank the environmental 7 health issues; 8 (VI) set priorities for action; 9 (VII) develop an action plan; 10 (VIII) implement the plan; and 11 (IX) evaluate progress and plan- 12 ning for the future. 13 (D) EVALUATION.—Each eligible entity 14 that receives a grant under this paragraph shall 15 evaluate, report, and disseminate program find- 16 ings and outcomes. 17 (E) TECHNICAL ASSISTANCE.—The Direc- 18 tor may provide such technical and other non- 19 financial assistance to eligible entities as the 20 Director determines to be necessary. 21 (2) LEVEL 2 COOPERATIVE AGREEMENTS.— 22 (A) ELIGIBILITY.— 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00942 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 943 •HR 6637 IH (i) IN GENERAL.—The Director shall 1 award grants under this paragraph to eli- 2 gible entities that have already— 3 (I) established broad-based col- 4 laborative partnerships; and 5 (II) completed environmental as- 6 sessments. 7 (ii) NO LEVEL 1 REQUIREMENT.—To 8 be eligible to receive a grant under this 9 paragraph, an eligible entity is not re- 10 quired to have successfully completed a 11 Level 1 Cooperative Agreement (as de- 12 scribed in paragraph (1)). 13 (B) USE OF GRANT FUNDS.—An eligible 14 entity awarded a grant under this paragraph 15 shall use the funds to further activities to carry 16 out environmental health improvement activi- 17 ties, including— 18 (i) addressing community environ- 19 mental health priorities in accordance with 20 paragraph (1)(C)(ii), including— 21 (I) geography; 22 (II) the built environment; 23 (III) air quality; 24 (IV) water quality; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00943 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 944 •HR 6637 IH (V) land use; 1 (VI) solid waste; 2 (VII) housing; 3 (VIII) violence; 4 (IX) socioeconomic status; 5 (X) ethnicity, social construct 6 and language preference; 7 (XI) educational attainment; 8 (XII) employment; 9 (XIII) food safety, accessibility, 10 and affordability; 11 (XIV) nutrition; 12 (XV) health care services; and 13 (XVI) injuries; 14 (ii) building partnerships between 15 planning, public health, and other sectors, 16 including child-serving institutions, to ad- 17 dress how the built environment impacts 18 food availability and access and physical 19 activity to promote healthy behaviors and 20 lifestyles and reduce overweight and obe- 21 sity, musculoskeletal diseases, respiratory 22 conditions, dental, oral and mental health 23 conditions, poverty, and related co- 24 morbidities; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00944 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 945 •HR 6637 IH (iii) establishing programs to ad- 1 dress— 2 (I) how environmental and social 3 conditions of work and living choices 4 influence physical activity and dietary 5 intake; or 6 (II) how the conditions described 7 in subclause (I) influence the concerns 8 and needs of people who have im- 9 paired mobility and use assistance de- 10 vices, including wheelchairs, lower 11 limb prostheses, and hip, knee, and 12 other joint replacements; and 13 (iv) convening intervention and dem- 14 onstration programs that examine the role 15 of the social environment in connection 16 with the physical and chemical environ- 17 ment in— 18 (I) determining access to nutri- 19 tional food; 20 (II) improving physical activity to 21 reduce overweight, obesity, and co- 22 morbidities and increase quality of 23 life; and 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00945 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 946 •HR 6637 IH (III) location and access to med- 1 ical facilities. 2 (3) LEVEL 3 COOPERATIVE AGREEMENTS.— 3 (A) IN GENERAL.—An eligible entity 4 awarded a grant under this paragraph shall use 5 the funds to identify and address racial and 6 ethnic disparities in social determinants of 7 health by creating demonstration programs that 8 assess the feasibility of establishing a federally 9 funded comprehensive program and describe 10 key outcomes that address racial and ethnic dis- 11 parities in social determinants of health. 12 (B) PROGRAM DESIGN.— 13 (i) EVALUATION.—No later than 1 14 year after enactment of this Act, the Di- 15 rector shall evaluate the best practices of 16 existing programs from the private, public, 17 community-based, and academically sup- 18 ported initiatives focused on reducing dis- 19 parities in the social determinants of 20 health for racial and ethnic populations. 21 (ii) DEMONSTRATION PROJECTS.— 22 Not later than two years after the date of 23 enactment of this Act, the Director shall 24 implement at least ten demonstration 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 947 •HR 6637 IH projects including at least one project for 1 each major racial and ethnic minority 2 group, each of which is unique to the cul- 3 tural and linguistic needs of each of the 4 following groups: 5 (I) Native Americans and Alaska 6 Natives. 7 (II) Asian Americans. 8 (III) African Americans/Blacks. 9 (IV) Hispanic/Latino Americans. 10 (V) Native Hawaiians and Pacific 11 Islanders. 12 (iii) REPORT TO CONGRESS.—No later 13 than 2 years after the implementation of 14 the initial demonstration projects, the Di- 15 rector shall submit to Congress a report 16 which includes— 17 (I) a description of each dem- 18 onstration project and design; 19 (II) an evaluation of the cost-ef- 20 fectiveness of each project’s preven- 21 tion and treatment efforts; 22 (III) an evaluation of the cultural 23 and linguistic appropriateness of each 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00947 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 948 •HR 6637 IH project by racial and ethnic group; 1 and 2 (IV) an evaluation of the bene- 3 ficiary’s health status improvement 4 under the demonstration project. 5 (iv) ANY OTHER INFORMATION 6 DEEMED APPROPRIATE BY THE DIREC- 7 TOR.—The Director shall require eligible 8 entities awarded a grant under this para- 9 graph to report any other information the 10 Director determines appropriate to be 11 shared by or developed by such entity, in- 12 cluding the following: 13 (I) Developing models and evalu- 14 ating methods that improve the cul- 15 tural and linguistically appropriate 16 services provided through the Centers 17 for Disease Control and Prevention to 18 target individuals impacted by health 19 disparities based on their race, eth- 20 nicity, and gender. 21 (II) Promoting the collaboration 22 between primary and specialty care 23 health care providers and patients, to 24 ensure patients impacted by health 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00948 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 949 •HR 6637 IH disparities based on race, ethnicity, 1 and gender are receiving comprehen- 2 sive and organized treatment and 3 care. 4 (III) Educating health care pro- 5 fessionals on the causes and effects of 6 disparities in the social determinants 7 of health as it relates to minority and 8 racial and ethnic communities and the 9 need for culturally and linguistically 10 appropriate care in the prevention and 11 treatment of high-impact diseases. 12 (IV) Encouraging collaboration 13 among community and patient-based 14 organizations which work to address 15 disparities in the social determinants 16 of health as it relates to high-impact 17 diseases in minority and racial and 18 ethnic populations. 19 (f) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this sec- 21 tion— 22 (1) $25,000,000 for fiscal year 2021; and 23 (2) such sums as may be necessary for fiscal 24 years 2022 through 2024. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00949 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 950 •HR 6637 IH SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 1 BETWEEN THE BUILT ENVIRONMENT AND 2 THE HEALTH OF COMMUNITY RESIDENTS. 3 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 4 section, the term ‘‘eligible institution’’ means a public or 5 private nonprofit institution that submits to the Secretary 6 of Health and Human Services (in this section referred 7 to as the ‘‘Secretary’’) and the Administrator of the Envi- 8 ronmental Protection Agency (in this section referred to 9 as the ‘‘Administrator’’) an application for a grant under 10 the grant program authorized under subsection (b)(2) at 11 such time, in such manner, and containing such agree- 12 ments, assurances, and information as the Secretary and 13 Administrator may require. 14 (b) RESEARCH GRANT PROGRAM.— 15 (1) DEFINITION OF HEALTH.—In this section, 16 the term ‘‘health’’ includes— 17 (A) levels of physical activity; 18 (B) degree of mobility due to factors such 19 as musculoskeletal diseases, arthritis, and obe- 20 sity; 21 (C) consumption of nutritional foods; 22 (D) rates of crime; 23 (E) air, water, and soil quality; 24 (F) risk of injury; 25 (G) accessibility to health care services; 26 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00950 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 951 •HR 6637 IH (H) levels of educational attainment; and 1 (I) other indicators as determined appro- 2 priate by the Secretary. 3 (2) GRANTS.—The Secretary, in collaboration 4 with the Administrator, shall provide grants to eligi- 5 ble institutions to conduct and coordinate research 6 on the built environment and its influence on indi- 7 vidual and population-based health. 8 (3) RESEARCH.—The Secretary shall support 9 research that— 10 (A) investigates and defines the causal 11 links between all aspects of the built environ- 12 ment and the health of residents; 13 (B) examines— 14 (i) the extent of the impact of the 15 built environment (including the various 16 characteristics of the built environment) on 17 the health of residents; 18 (ii) the variance in the health of resi- 19 dents by— 20 (I) location (such as inner cities, 21 inner suburbs, and outer suburbs); 22 and 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00951 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 952 •HR 6637 IH (II) population subgroup (includ- 1 ing children, the elderly, the disadvan- 2 taged); or 3 (iii) the importance of the built envi- 4 ronment to the total health of residents, 5 which is the primary variable of interest 6 from a public health perspective; 7 (C) is used to develop— 8 (i) measures to address health and the 9 connection of health to the built environ- 10 ment; and 11 (ii) efforts to link the measures to 12 travel and health databases; 13 (D) distinguishes carefully between per- 14 sonal attitudes and choices and external influ- 15 ences on observed behavior to determine how 16 much an observed association between the built 17 environment and the health of residents, versus 18 the lifestyle preferences of the people that 19 choose to live in the neighborhood, reflects the 20 physical characteristics of the neighborhood; 21 and 22 (E)(i) identifies or develops effective inter- 23 vention strategies to promote better health 24 among residents with a focus on behavioral 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00952 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 953 •HR 6637 IH interventions and enhancements of the built en- 1 vironment that promote increased use by resi- 2 dents; and 3 (ii) in developing the intervention strate- 4 gies under clause (i), ensures that the interven- 5 tion strategies will reach out to high-risk popu- 6 lations, including racial and ethnic minorities, 7 low-income urban and rural communities, and 8 children. 9 (4) PRIORITY.—In providing assistance under 10 the grant program authorized under paragraph (2), 11 the Secretary and the Administrator shall give pri- 12 ority to research that incorporates— 13 (A) minority-serving institutions as grant- 14 ees; 15 (B) interdisciplinary approaches; or 16 (C) the expertise of the public health, 17 physical activity, nutrition and health care (in- 18 cluding child health), urban planning, and 19 transportation research communities in the 20 United States and abroad. 21 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 22 TION. 23 (a) FINDINGS.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00953 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 954 •HR 6637 IH (1) GENERAL FINDINGS.—Congress finds 1 that— 2 (A) humans share an environment with a 3 wide variety of habitats and ecosystems that 4 nurture and sustain a diversity of species; 5 (B) the abundance of natural resources in 6 the environment forms the basis for the econ- 7 omy and has greatly contributed to human de- 8 velopment throughout history; 9 (C) the accelerated pace of human develop- 10 ment over the last several hundred years has 11 significantly impacted— 12 (i) the natural environment and its re- 13 sources; 14 (ii) the health and diversity of plant 15 and animal life; 16 (iii) the availability of critical habi- 17 tats; 18 (iv) the quality of the air and water; 19 and 20 (v) the global climate; 21 (D) the intervention of the Federal Gov- 22 ernment is necessary to minimize and mitigate 23 human impact on the environment— 24 (i) for the benefit of public health; 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00954 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 955 •HR 6637 IH (ii) to maintain air quality and water 1 quality; 2 (iii) to sustain the diversity of plants 3 and animals; 4 (iv) to combat global climate change; 5 and 6 (v) to protect the environment; 7 (E) laws and regulations in the United 8 States have been enacted and promulgated to 9 minimize and mitigate human impact on the en- 10 vironment for the benefit of public health, to 11 maintain air quality and water quality, to sus- 12 tain wildlife, and to protect the environment, in- 13 cluding— 14 (i) chapter 3203 of title 54, United 15 States Code (commonly known as the ‘‘An- 16 tiquities Act of 1906’’), which was initiated 17 by President Theodore Roosevelt to create 18 the National Park System; 19 (ii) the National Environmental Policy 20 Act of 1969 (42 U.S.C. 4321 et seq.); 21 (iii) the Clean Air Act (42 U.S.C. 22 7401 et seq.); 23 (iv) the Federal Water Pollution Con- 24 trol Act (33 U.S.C. 1251 et seq.); 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00955 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 956 •HR 6637 IH (v) the Comprehensive Environmental 1 Response, Compensation, and Liability Act 2 of 1980 (42 U.S.C. 9601 et seq.); 3 (vi) the Endangered Species Act of 4 1973 (16 U.S.C. 1531 et seq.); and 5 (vii) the National Forest Management 6 Act of 1976 (Public Law 94–588; 90 Stat. 7 2949) and the amendments made by that 8 Act; and 9 (F) attempts to repeal or weaken key envi- 10 ronmental safeguards pose dangers to the pub- 11 lic health, air quality, water quality, wildlife, 12 and the environment. 13 (2) FINDINGS ON CHANGES AND PROPOSED 14 CHANGES IN LAW.—Congress finds that, since 2001, 15 the following changes and proposed changes to exist- 16 ing law or regulations have negatively impacted or 17 will negatively impact the environment and public 18 health: 19 (A) CLEAN WATER.— 20 (i) FILL MATERIAL.— 21 (I) On May 9, 2002, the Envi- 22 ronmental Protection Agency and the 23 Corps of Engineers issued a final rule, 24 entitled ‘‘Final Revisions to the Clean 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00956 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 957 •HR 6637 IH Water Act Regulatory Definitions of 1 ‘Fill Material’ and ‘Discharge of Fill 2 Material’ ’’ (67 Fed. Reg. 31129), 3 that reconciled regulations imple- 4 menting section 404 of the Federal 5 Water Pollution Control Act (33 6 U.S.C. 1344) by redefining the term 7 ‘‘fill material’’ and amending the defi- 8 nition of the term ‘‘discharge of fill 9 material’’, reversing a 25-year-old reg- 10 ulation. 11 (II) The rule described in sub- 12 clause (I)— 13 (aa) fails to restrict the 14 dumping of hardrock mining 15 waste, construction debris, and 16 other industrial wastes into riv- 17 ers, streams, lakes, and wetlands; 18 and 19 (bb) allows destructive 20 mountaintop removal coal mining 21 companies to dump waste into 22 streams and lakes, polluting the 23 surrounding natural habitat and 24 poisoning plants and animals 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00957 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 958 •HR 6637 IH that depend on those water 1 sources. 2 (ii) LIVESTOCK WASTE REGULA- 3 TIONS.— 4 (I) On February 12, 2003, the 5 Environmental Protection Agency 6 published the rule entitled ‘‘National 7 Pollutant Discharge Elimination Sys- 8 tem Permit Regulation and Effluent 9 Limitation Guidelines and Standards 10 for Concentrated Animal Feeding Op- 11 erations (CAFOs)’’ (68 Fed. Reg. 12 7176), new livestock waste regulations 13 that aimed to control factory farm 14 pollution but which would severely un- 15 dermine then-existing protections 16 under the Federal Water Pollution 17 Control Act (33 U.S.C. 1251 et seq.). 18 (II) The regulation described in 19 subclause (I) allows large-scale animal 20 factories to foul waters in the United 21 States with animal waste, allows live- 22 stock owners to draft their own pollu- 23 tion-management plans and avoid 24 ground water monitoring, legalizes the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00958 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 959 •HR 6637 IH discharge of contaminated runoff 1 water rich in nitrogen, phosphorus, 2 bacteria, and metals, and ensures that 3 large factory farms are not held liable 4 for the environmental damage they 5 cause. 6 (III) In a 2005 Federal court de- 7 cision, Waterkeeper Alliance, et al. v. 8 Environmental Protection Agency, 9 399 F.3d 486 (2nd Cir. 2005), major 10 parts of the rule were upheld, others 11 vacated, and still others remanded 12 back to the Environmental Protection 13 Agency. 14 (IV) On November 20, 2008, the 15 Environmental Protection Agency 16 published a revised final rule, entitled 17 ‘‘Revised National Pollutant Dis- 18 charge Elimination System Permit 19 Regulation and Effluent Limitations 20 Guidelines for Concentrated Animal 21 Feeding Operations in Response to 22 the Waterkeeper Decision’’ (73 Fed. 23 Reg. 70418), that undermines envi- 24 ronmental protection provisions by re- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00959 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 960 •HR 6637 IH moving mandatory permitting require- 1 ments and allowing large animal 2 farms to self-certify the absence of 3 pollutant discharge activity. 4 (iii) TOTAL MAXIMUM DAILY LOAD.— 5 (I) On March 19, 2003, the En- 6 vironmental Protection Agency pub- 7 lished a new rule regarding the total 8 maximum daily load program under 9 section 303(d) of the Federal Water 10 Pollution Control Act (33 U.S.C. 11 1313(d)), entitled ‘‘Withdrawal of Re- 12 visions to the Water Quality Planning 13 and Management Regulation and Re- 14 visions to the National Pollutant Dis- 15 charge Elimination System Program 16 in Support of Revisions to the Water 17 Quality Planning and Management 18 Regulation’’ (68 Fed. Reg. 13608), 19 that regulates the maximum amount 20 of a particular pollutant that can be 21 present in a body of water and still 22 meet water quality standards. 23 (II) The new rule described in 24 subclause (I) withdrew the then-exist- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00960 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 961 •HR 6637 IH ing regulation issued on July 13, 1 2000, and entitled ‘‘Revisions to the 2 Water Quality Planning and Manage- 3 ment Regulation and Revisions to the 4 National Pollutant Discharge Elimi- 5 nation System Program in Support of 6 Revisions to the Water Quality Plan- 7 ning and Management Regulation’’ 8 (65 Fed. Reg. 43586) and halted mo- 9 mentum in cleaning up polluted wa- 10 terways throughout the United States. 11 (III) By abandoning the then-ex- 12 isting rule, the Environmental Protec- 13 tion Agency is undermining the effec- 14 tiveness of cleanup plans and is allow- 15 ing States to avoid cleaning polluted 16 waters entirely by dropping them from 17 their cleanup lists. 18 (IV) Waterways play a crucial 19 role in the lives of the people of the 20 United States and are critical to the 21 livelihood of fish and wildlife. 22 (V) The result of dropping the 23 rule described in subclause (II) is that 24 the restoration of polluted rivers, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00961 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 962 •HR 6637 IH shorelines, and lakes will be delayed, 1 harming more fish and wildlife and 2 worsening the quality of drinking 3 water. 4 (iv) WATERS OF THE UNITED 5 STATES.— 6 (I) On December 2, 2008, the 7 Environmental Protection Agency and 8 the Corps of Engineers jointly issued 9 a guidance document, entitled ‘‘Clean 10 Water Act Jurisdiction Following the 11 U.S. Supreme Court’s Decision in 12 Rapanos v. United States & Carabell 13 v. United States’’. 14 (II) The guidance described in 15 subclause (I) dictates enforcement ac- 16 tions under the Federal Water Pollu- 17 tion Control Act (33 U.S.C. 1251 et 18 seq.) and calls for a complicated 19 ‘‘case-by-case’’ analysis to determine 20 jurisdiction for waterways that do not 21 flow all year. 22 (III) Enforcement actions de- 23 scribed in subclause (II) endanger 24 small streams and wetlands that serve 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00962 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 963 •HR 6637 IH as important habitats for aquatic life, 1 which play a fundamental role in safe- 2 guarding sources of clean drinking 3 water and mitigate the risks and ef- 4 fects of floods and droughts. 5 (IV) The definition provided in 6 the guidance described in subclause 7 (I) for ‘‘waters of the United States’’ 8 is applicable to the Federal Water 9 Pollution Control Act (33 U.S.C. 10 1251 et seq.) as a whole, potentially 11 affecting programs that control indus- 12 trial pollution and sewage levels, pre- 13 vent oil spills, and set water quality 14 standards for all waters in the United 15 States protected under that Act. 16 (B) FORESTS AND LAND MANAGEMENT.— 17 (i) HEALTHY FORESTS RESTORATION 18 ACT OF 2003.— 19 (I) On December 3, 2003, the 20 President signed into law the Healthy 21 Forests Restoration Act of 2003 (16 22 U.S.C. 6501 et seq.) (referred to in 23 this clause as the ‘‘law’’). 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00963 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 964 •HR 6637 IH (II) Although the law attempts to 1 reduce the risk of catastrophic forest 2 fires, the law provides a boon to tim- 3 ber companies by accelerating the ag- 4 gressive thinning of backcountry for- 5 ests that are located far from at-risk 6 communities. 7 (III) The law allows for increased 8 logging of large, fire-resistant trees 9 that are not in close proximity to 10 homes and communities. 11 (IV) The law undermines critical 12 protections for endangered species by 13 exempting Federal land management 14 agencies from consulting with the 15 United States Fish and Wildlife Serv- 16 ice before approving any action that 17 could harm endangered plants or wild- 18 life. 19 (V) The law limits public partici- 20 pation by reducing the number of en- 21 vironmental reviews for projects car- 22 ried out under the law. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00964 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 965 •HR 6637 IH (ii) NFS LAND MANAGEMENT PLAN- 1 NING FINAL PLANNING RULE AND RECORD 2 OF DECISION.— 3 (I) On April 21, 2008, the Sec- 4 retary of Agriculture issued a final 5 rule entitled ‘‘National Forest System 6 Land Management Planning’’ (73 7 Fed. Reg. 21486 (April 21, 2008)) 8 (referred to in this clause as the ‘‘re- 9 vised rule’’). 10 (II) The revised rule is a revision 11 of a similar final rule entitled ‘‘Na- 12 tional Forest System Land Manage- 13 ment Planning’’ (70 Fed Reg. 1022 14 (January 5, 2005)), which the United 15 States District Court for the Northern 16 District of California remanded to the 17 Secretary of Agriculture in the case 18 styled Citizens for Better Forestry v. 19 United States Department of Agri- 20 culture (481 F. Supp. 2d 1059 (N.D. 21 Cal. 2007)) for violating— 22 (aa) the National Environ- 23 mental Policy Act of 1969 (42 24 U.S.C. 4321 et seq.); 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00965 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 966 •HR 6637 IH (bb) the Endangered Species 1 Act of 1973 (16 U.S.C. 1531 et 2 seq.); and 3 (cc) subchapter II of chapter 4 5, and chapter 7, of title 5, 5 United States Code (commonly 6 known as the ‘‘Administrative 7 Procedure Act’’). 8 (III) The revised rule eliminates 9 strict forest planning standards estab- 10 lished in 1982. 11 (IV) The revised rule opens mil- 12 lions of acres of public land to dam- 13 aging and invasive logging, mining, 14 and drilling operations. 15 (V) The revised rule would re- 16 verse more than 20 years of protec- 17 tions for wildlife and national forests 18 by— 19 (aa) removing the overall 20 goal of ensuring ecological sus- 21 tainability in managing the Na- 22 tional Forest System; 23 (bb) weakening the effect of 24 the National Forest Management 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00966 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 967 •HR 6637 IH Act of 1976 (Public Law 94–588; 1 90 Stat. 2949) and the amend- 2 ments made by that Act; and 3 (cc) effectively ending the 4 review of forest management 5 plans under the National Envi- 6 ronmental Policy Act of 1969 (42 7 U.S.C. 4321 et seq.). 8 (iii) INVENTORIED ROADLESS AREA 9 RULES.— 10 (I) On September 20, 2006, the 11 United States District Court for the 12 Northern District of California va- 13 cated the final rule entitled ‘‘Special 14 Areas; State Petitions for Inventoried 15 Roadless Area Management’’ (70 Fed. 16 Reg. 25654 (May 13, 2005)) (referred 17 to in this clause as the ‘‘2005 rule’’), 18 which gave each Governor of a State 19 18 months to petition the Federal 20 Government— 21 (aa) to restore the inven- 22 toried roadless area rules applica- 23 ble to the State of the Governor 24 before the effective date of the 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00967 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 968 •HR 6637 IH final rule entitled ‘‘Special Areas; 1 Roadless Area Conservation’’ (66 2 Fed. Reg. 3244 (January 12, 3 2001)) (referred to in this clause 4 as the ‘‘2001 rule’’); or 5 (bb) to submit a new man- 6 agement and development plan 7 for National Forest System 8 inventoried roadless areas within 9 the State. 10 (II) Despite the enjoinment of 11 the 2005 rule and the subsequent res- 12 toration of the 2001 rule, the Forest 13 Service has continued to allow States 14 to petition for a special rule under the 15 authority of section 553(e) of title 5, 16 United States Code, and has issued a 17 final rule entitled ‘‘Special Areas; 18 Roadless Area Conservation; Applica- 19 bility to the National Forests in 20 Idaho’’ (73 Fed. Reg. 61456 (October 21 16, 2008)). 22 (III) As a result, 58,500,000 23 acres of wild National Forest System 24 land are still vulnerable to logging, 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00968 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 969 •HR 6637 IH road building, and other developments 1 that may fragment natural habitats 2 and negatively impact fish and wild- 3 life. 4 (iv) BLM RESOURCE MANAGEMENT 5 PLANS.— 6 (I) On November 28, 2008, the 7 Bureau of Land Management an- 8 nounced the record of decision entitled 9 ‘‘Record of Decision for Oil Shale and 10 Tar Sands Resources to Address 11 Land Use Allocations in Colorado, 12 Utah, and Wyoming’’ (73 Fed. Reg. 13 72519 (November 28, 2008)), which 14 amended 12 resource management 15 plans in the States of Colorado, Utah, 16 and Wyoming, opening 2,000,000 17 acres of public land to commercial tar 18 sands and oil shale exploration and 19 development. 20 (II) On November 18, 2008, the 21 Bureau of Land Management issued 22 the final rule entitled ‘‘Oil Shale Man- 23 agement—General’’ (73 Fed. Reg. 24 69414 (November 18, 2008)), setting 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00969 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 970 •HR 6637 IH the policies and procedures for a com- 1 mercial leasing program for the man- 2 agement of federally owned oil shale 3 in the States referred to in subclause 4 (I). 5 (III) Previously barred by a con- 6 gressional moratorium on the com- 7 mercial leasing regulations for oil 8 shale until September 30, 2008, the 9 development of oil shale on public 10 land poses a serious threat to land 11 conservation, endangered and threat- 12 ened species, and critical habitat. 13 (IV) Domestic shale oil produc- 14 tion authorized by the final rules de- 15 scribed in subclauses (I) and (II)— 16 (aa) is water- and energy-in- 17 tensive; and 18 (bb) will intensify existing 19 water scarcity in the arid West- 20 ern United States and potentially 21 degrade air and water quality for 22 surrounding populations. 23 (C) SCIENTIFIC REVIEW.— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00970 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 971 •HR 6637 IH (i) On December 16, 2008, the United 1 States Fish and Wildlife Service and the 2 National Marine Fisheries Service jointly 3 issued a new rule, entitled ‘‘Interagency 4 Cooperation Under the Endangered Spe- 5 cies Act’’ (73 Fed. Reg. 76272) amending 6 regulations governing interagency coopera- 7 tion under section 7 of the Endangered 8 Species Act of 1973 (16 U.S.C. 1536). 9 (ii) The rule described in clause (i) 10 undermines the intention of the Endan- 11 gered Species Act (16 U.S.C. 1531 et seq.) 12 to protect species and the ecosystems on 13 which those species depend by allowing 14 Federal agencies to carry out, permit, or 15 fund an action without proper environ- 16 mental review and expert third-party con- 17 sultation from Federal wildlife experts. 18 (iii) Under the rule described in 19 clause (i), Federal agencies can unilaterally 20 circumvent the formal review process, 21 eliminating longstanding and scientifically 22 grounded safeguards that serve to protect 23 the biodiversity of ecosystems in the 24 United States and avert harm to thou- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00971 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 972 •HR 6637 IH sands of endangered and threatened spe- 1 cies. 2 (b) STATEMENT OF POLICY.—It is the policy of the 3 Federal Government to work in conjunction with States, 4 territories, Tribal governments, international organiza- 5 tions, and foreign governments as a steward of the envi- 6 ronment for the benefit of public health, to maintain air 7 quality and water quality, to sustain the diversity of plant 8 and animal species, to combat global climate change, and 9 to protect the environment for future generations. 10 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 11 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 12 TIONS, LAWS, OR PROPOSED LAWS.— 13 (1) STUDY.—Not later than 30 days after the 14 date of enactment of this Act, the President shall 15 enter into an arrangement under which the National 16 Academy of Sciences shall conduct a study to deter- 17 mine the impact on public health, air quality, water 18 quality, wildlife, and the environment of the fol- 19 lowing regulations, laws, and proposed laws: 20 (A) CLEAN WATER.— 21 (i) The final rule of the Environ- 22 mental Protection Agency and the Corps of 23 Engineers entitled ‘‘Final Revisions to the 24 Clean Water Act Regulatory Definitions of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00972 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 973 •HR 6637 IH ‘Fill Material’ and ‘Discharge of Fill Mate- 1 rial’ ’’ (67 Fed. Reg. 31129 (May 9, 2 2002)). 3 (ii) The final rule of the Environ- 4 mental Protection Agency entitled ‘‘Re- 5 vised National Pollutant Discharge Elimi- 6 nation System Permit Regulation and Ef- 7 fluent Limitations Guidelines for Con- 8 centrated Animal Feeding Operations in 9 Response to the Waterkeeper Decision’’ 10 (73 Fed. Reg. 70418 (November 20, 11 2008)). 12 (iii) The final rule entitled ‘‘With- 13 drawal of Revisions to the Water Quality 14 Planning and Management Regulation and 15 Revisions to the National Pollutant Dis- 16 charge Elimination System Program in 17 Support of Revisions to the Water Quality 18 Planning and Management Regulation’’ 19 (68 Fed. Reg. 13608 (March 19, 2003)). 20 (iv) The guidance document of the 21 Environmental Protection Agency and the 22 Corps of Engineers entitled ‘‘Clean Water 23 Act Jurisdiction Following the U.S. Su- 24 preme Court’s Decision in Rapanos v. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00973 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 974 •HR 6637 IH United States & Carabell v. United States’’ 1 (December 2, 2008). 2 (B) FORESTS AND LAND MANAGEMENT.— 3 (i) The Healthy Forests Restoration 4 Act of 2003 (16 U.S.C. 6501 et seq.). 5 (ii) The application of section 553(e) 6 of title 5, United States Code, such that a 7 State may petition for a special rule for 8 the National Forest System inventoried 9 roadless areas within the State. 10 (iii) The final rule entitled ‘‘National 11 Forest System Land Management Plan- 12 ning’’ (73 Fed. Reg. 21486 (April 21, 13 2008)). 14 (iv) The final rule entitled ‘‘Oil Shale 15 Management—General’’ (73 Fed. Reg. 16 69414 (November 18, 2008)). 17 (v) The record of decision entitled 18 ‘‘Record of Decision for Oil Shale and Tar 19 Sands Resources To Address Land Use Al- 20 locations in Colorado, Utah, and Wyo- 21 ming’’ (73 Fed. Reg. 72519 (November 22 28, 2008)). 23 (C) SCIENTIFIC REVIEW.—The final rule 24 of the United States Fish and Wildlife Service 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00974 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 975 •HR 6637 IH and the National Marine Fisheries Service enti- 1 tled ‘‘Interagency Cooperation Under the En- 2 dangered Species Act’’ (73 Fed. Reg. 76272 3 (December 16, 2008)). 4 (2) METHOD.—In conducting the study under 5 paragraph (1), the National Academy of Sciences 6 may use and compare existing scientific studies re- 7 garding the regulations, laws, and proposed laws de- 8 scribed in paragraph (1). 9 (3) REPORT.—Not later than 270 days after 10 the date on which the President enters into the ar- 11 rangement under paragraph (1), the National Acad- 12 emy of Sciences shall make publicly available and 13 shall submit to the Congress and to the head of each 14 department and agency of the Federal Government 15 that issued, implements, or would implement a regu- 16 lation, law, or proposed law described in paragraph 17 (1), a report that includes— 18 (A) a description of the impact of each 19 regulation, law, or proposed law described in 20 paragraph (1) on public health, air quality, 21 water quality, wildlife, and the environment, 22 compared to the impact of preexisting regula- 23 tions, or laws in effect, as applicable, includ- 24 ing— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00975 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 976 •HR 6637 IH (i) any negative impacts to air quality 1 or water quality; 2 (ii) any negative impacts to wildlife; 3 (iii) any delays in hazardous waste 4 cleanup that are projected to be hazardous 5 to public health; and 6 (iv) any other negative impact on pub- 7 lic health or the environment; and 8 (B) any recommendations that the Na- 9 tional Academy of Sciences considers appro- 10 priate to maintain, restore, or improve in whole 11 or in part protections for public health, air 12 quality, water quality, wildlife, and the environ- 13 ment for each of the regulations, laws, and pro- 14 posed laws described in paragraph (1), which 15 may include recommendations for the adoption 16 of any regulation or law in place or proposed 17 prior to January 1, 2001. 18 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 19 ING RULES, REGULATIONS, OR LAWS.—Not later than 20 180 days after the date on which the report is submitted 21 pursuant to subsection (c)(3), the head of each depart- 22 ment or agency that has issued or implemented a regula- 23 tion or law described in subsection (c)(1) shall submit to 24 Congress a plan describing the steps the department or 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00976 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 977 •HR 6637 IH agency will take, or has taken, to restore or improve pro- 1 tections for public health and the environment in whole 2 or in part that were in existence prior to the issuance of 3 the applicable regulation or law. 4 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 5 WATER HORIZON OIL RIG EXPLOSION IN THE 6 GULF COAST. 7 (a) STUDY.—The Comptroller General of the United 8 States shall conduct a study on the type and scope of 9 health care services administered through the Department 10 of Health and Human Services addressing the provision 11 of health care to racial and ethnic minorities, including 12 residents, cleanup workers, and volunteers, affected by the 13 blowout and explosion of the mobile offshore drilling unit 14 Deepwater Horizon that occurred on April 20, 2010, and 15 resulting hydrocarbon releases into the environment. 16 (b) SPECIFIC COMPONENTS.—In carrying out sub- 17 section (a), the Comptroller General shall— 18 (1) assess the type, size, and scope of programs 19 administered by the Secretary of Health and Human 20 Services that focus on the provision of health care 21 to communities on the Gulf Coast; 22 (2) identify the merits and disadvantages asso- 23 ciated with each of the programs; 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00977 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 978 •HR 6637 IH (3) perform an analysis of the costs and bene- 1 fits of the programs; and 2 (4) determine whether there is any duplication 3 of programs. 4 (c) REPORT.—Not later than 180 days after the date 5 of enactment of this Act, the Comptroller General shall 6 submit to Congress a report that includes— 7 (1) the findings of the study conducted under 8 subsection (a); and 9 (2) recommendations for improving access to 10 health care for racial and ethnic minorities. 11 SEC. 1009. ESTABLISH AN INTERAGENCY COUNSEL AND 12 GRANT PROGRAMS ON SOCIAL DETER- 13 MINANTS OF HEALTH. 14 (a) SHORT TITLE.—This section may be cited as the 15 ‘‘Social Determinants Accelerator Act of 2020’’. 16 (b) FINDINGS; PURPOSES.— 17 (1) FINDINGS.—Congress finds the following: 18 (A) There is a significant body of evidence 19 showing that economic and social conditions 20 have a powerful impact on individual and popu- 21 lation health outcomes and well-being, as well 22 as medical costs. 23 (B) State, local, and Tribal governments 24 and the service delivery partners of such gov- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00978 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 979 •HR 6637 IH ernments face significant challenges in coordi- 1 nating benefits and services delivered through 2 the Medicaid program and other social services 3 programs because of the fragmented and com- 4 plex nature of Federal and State funding and 5 administrative requirements. 6 (C) The Federal Government should 7 prioritize and proactively assist State and local 8 governments to strengthen the capacity of State 9 and local governments to improve health and 10 social outcomes for individuals, thereby improv- 11 ing cost-effectiveness and return on investment. 12 (2) PURPOSES.—The purposes of this Act are 13 as follows: 14 (A) To establish effective, coordinated Fed- 15 eral technical assistance to help State and local 16 governments to improve outcomes and cost-ef- 17 fectiveness of, and return on investment from, 18 health and social services programs. 19 (B) To build a pipeline of State and locally 20 designed, cross-sector interventions and strate- 21 gies that generate rigorous evidence about how 22 to improve health and social outcomes, and in- 23 crease the cost-effectiveness of, and return on 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00979 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 980 •HR 6637 IH investment from, Federal, State, local, and 1 Tribal health and social services programs. 2 (C) To enlist State and local governments 3 and the service providers of such governments 4 as partners in identifying Federal statutory, 5 regulatory, and administrative challenges in im- 6 proving the health and social outcomes of, cost- 7 effectiveness of, and return on investment from, 8 Federal spending on individuals enrolled in 9 Medicaid. 10 (D) To develop strategies to improve 11 health and social outcomes without denying 12 services to, or restricting the eligibility of, vul- 13 nerable populations. 14 (c) SOCIAL DETERMINANTS ACCELERATOR COUN- 15 CIL.— 16 (1) ESTABLISHMENT.—The Secretary of Health 17 and Human Services (referred to in this Act as the 18 ‘‘Secretary’’), in coordination with the Administrator 19 of the Centers for Medicare & Medicaid Services (re- 20 ferred to in this Act as the ‘‘Administrator’’), shall 21 establish an interagency council, to be known as the 22 Social Determinants Accelerator Interagency Council 23 (referred to in this Act as the ‘‘Council’’) to achieve 24 the purposes listed in subsection (b)(1). 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00980 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 981 •HR 6637 IH (2) MEMBERSHIP.— 1 (A) FEDERAL COMPOSITION.—The Council 2 shall be composed of at least one designee from 3 each of the following Federal agencies: 4 (i) The Office of Management and 5 Budget. 6 (ii) The Department of Agriculture. 7 (iii) The Department of Education. 8 (iv) The Indian Health Service. 9 (v) The Department of Housing and 10 Urban Development. 11 (vi) The Department of Labor. 12 (vii) The Department of Transpor- 13 tation. 14 (viii) Any other Federal agency the 15 Chair of the Council determines necessary. 16 (B) DESIGNATION.— 17 (i) IN GENERAL.—The head of each 18 agency specified in subparagraph (A) shall 19 designate at least one employee to serve as 20 a member of the Council. 21 (ii) RESPONSIBILITIES.—An employee 22 described in this clause shall be a senior 23 employee of the agency— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00981 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 982 •HR 6637 IH (I) whose responsibilities relate 1 to authorities, policies, and procedures 2 with respect to the health and well- 3 being of individuals receiving medical 4 assistance under a State plan (or a 5 waiver of such plan) under title XIX 6 of the Social Security Act (42 U.S.C. 7 1396 et seq.); or 8 (II) who has authority to imple- 9 ment and evaluate transformative ini- 10 tiatives that harness data or conducts 11 rigorous evaluation to improve the im- 12 pact and cost-effectiveness of federally 13 funded services and benefits. 14 (C) HHS REPRESENTATION.—In addition 15 to the designees under subparagraph (A), the 16 Council shall include designees from at least 17 three agencies within the Department of Health 18 and Human Services, including the Centers for 19 Medicare & Medicaid Services, at least one of 20 whom shall meet the criteria under this section. 21 (D) OMB ROLE.—The Director of the Of- 22 fice of Management and Budget shall facilitate 23 the timely resolution of Governmentwide and 24 multiagency issues to help the Council achieve 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00982 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 983 •HR 6637 IH consensus recommendations described under 1 this section. 2 (E) NON-FEDERAL COMPOSITION.—The 3 Comptroller General of the United States may 4 designate up to 6 Council designees— 5 (i) who have relevant subject matter 6 expertise, including expertise implementing 7 and evaluating transformative initiatives 8 that harness data and conduct evaluations 9 to improve the impact and cost-effective- 10 ness of Federal Government services; and 11 (ii) that each represent— 12 (I) State, local, and Tribal health 13 and human services agencies; 14 (II) public housing authorities or 15 State housing finance agencies; 16 (III) State and local government 17 budget offices; 18 (IV) State Medicaid agencies; or 19 (V) national consumer advocacy 20 organizations. 21 (F) CHAIR.— 22 (i) IN GENERAL.—The Secretary shall 23 select the Chair of the Council from among 24 the members of the Council. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00983 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 984 •HR 6637 IH (ii) INITIATING GUIDANCE.—The 1 Chair, on behalf of the Council, shall iden- 2 tify and invite individuals from diverse en- 3 tities to provide the Council with advice 4 and information pertaining to addressing 5 social determinants of health, including— 6 (I) individuals from State and 7 local government health and human 8 services agencies; 9 (II) individuals from State Med- 10 icaid agencies; 11 (III) individuals from State and 12 local government budget offices; 13 (IV) individuals from public 14 housing authorities or State housing 15 finance agencies; 16 (V) individuals from nonprofit or- 17 ganizations, small businesses, and 18 philanthropic organizations; 19 (VI) advocates; 20 (VII) researchers; and 21 (VIII) any other individuals the 22 Chair determines to be appropriate. 23 (3) DUTIES.—The duties of the Council are— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00984 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 985 •HR 6637 IH (A) to make recommendations to the Sec- 1 retary and the Administrator regarding the cri- 2 teria for making awards under this section; 3 (B) to identify Federal authorities and op- 4 portunities for use by States or local govern- 5 ments to improve coordination of funding and 6 administration of Federal programs, the bene- 7 ficiaries of whom include individuals, and which 8 may be unknown or underutilized and to make 9 information on such authorities and opportuni- 10 ties publicly available; 11 (C) to provide targeted technical assistance 12 to States developing a social determinants ac- 13 celerator plan under this section, including 14 identifying potential statutory or regulatory 15 pathways for implementation of the plan and 16 assisting in identifying potential sources of 17 funding to implement the plan; 18 (D) to report to Congress annually on the 19 subjects set forth in this section; 20 (E) to develop and disseminate evaluation 21 guidelines and standards that can be used to 22 reliably assess the impact of an intervention or 23 approach that may be implemented pursuant to 24 this Act on outcomes, cost-effectiveness of, and 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00985 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 986 •HR 6637 IH return on investment from Federal, State, local, 1 and Tribal governments, and to facilitate tech- 2 nical assistance, where needed, to help to im- 3 prove State and local evaluation designs and 4 implementation; 5 (F) to seek feedback from State, local, and 6 Tribal governments, including through an an- 7 nual survey by an independent third party, on 8 how to improve the technical assistance the 9 Council provides to better equip State, local, 10 and Tribal governments to coordinate health 11 and social service programs; 12 (G) to solicit applications for grants under 13 this section; and 14 (H) to coordinate with other cross-agency 15 initiatives focused on improving the health and 16 well-being of low-income and at-risk populations 17 in order to prevent unnecessary duplication be- 18 tween agency initiatives. 19 (4) SCHEDULE.—Not later than 60 days after 20 the date of the enactment of this Act, the Council 21 shall convene to develop a schedule and plan for car- 22 rying out the duties described in this section, includ- 23 ing solicitation of applications for the grants under 24 this section. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00986 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 987 •HR 6637 IH (5) REPORT TO CONGRESS.—The Council shall 1 submit an annual report to Congress, which shall in- 2 clude— 3 (A) a list of the Council members; 4 (B) activities and expenditures of the 5 Council; 6 (C) summaries of the interventions and ap- 7 proaches that will be supported by State, local, 8 and Tribal governments that received a grant 9 under this section, including— 10 (i) the best practices and evidence- 11 based approaches such governments plan 12 to employ to achieve the purposes listed in 13 this section; and 14 (ii) a description of how the practices 15 and approaches will impact the outcomes, 16 cost-effectiveness of, and return on invest- 17 ment from, Federal, State, local, and Trib- 18 al governments with respect to such pur- 19 poses; 20 (D) the feedback received from State and 21 local governments on ways to improve the tech- 22 nical assistance of the Council, including find- 23 ings from a third-party survey and actions the 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00987 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 988 •HR 6637 IH Council plans to take in response to such feed- 1 back; and 2 (E) the major statutory, regulatory, and 3 administrative challenges identified by State, 4 local, and Tribal governments that received a 5 grant under subsection (d), and the actions that 6 Federal agencies are taking to address such 7 challenges. 8 (6) FACA APPLICABILITY.—The Federal Advi- 9 sory Committee Act (5 U.S.C. App.) shall not apply 10 to the Council. 11 (7) COUNCIL PROCEDURES.—The Secretary, in 12 consultation with the Comptroller General of the 13 United States and the Director of the Office of Man- 14 agement and Budget, shall establish procedures for 15 the Council to— 16 (A) ensure that adequate resources are 17 available to effectively execute the responsibil- 18 ities of the Council; 19 (B) effectively coordinate with other rel- 20 evant advisory bodies and working groups to 21 avoid unnecessary duplication; 22 (C) create transparency to the public and 23 Congress with regard to Council membership, 24 costs, and activities, including through use of 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00988 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 989 •HR 6637 IH modern technology and social media to dissemi- 1 nate information; and 2 (D) avoid conflicts of interest that would 3 jeopardize the ability of the Council to make de- 4 cisions and provide recommendations. 5 (d) SOCIAL DETERMINANTS ACCELERATOR GRANTS 6 TO STATES OR LOCAL GOVERNMENTS.— 7 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 8 AND TRIBES.—Not later than 180 days after the 9 date of the enactment of this Act, the Administrator, 10 in consultation with the Secretary and the Council, 11 shall award on a competitive basis not more than 25 12 grants to eligible applicants described in this section, 13 for the development of social determinants accel- 14 erator plans, as described in this section. 15 (2) ELIGIBLE APPLICANT.—An eligible appli- 16 cant described in this section is a State, local, or 17 Tribal health or human services agency that— 18 (A) demonstrates the support of relevant 19 parties across relevant State, local, or Tribal ju- 20 risdictions; and 21 (B) in the case of an applicant that is a 22 local government agency, provides to the Sec- 23 retary a letter of support from the lead State 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00989 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 990 •HR 6637 IH health or human services agency for the State 1 in which the local government is located. 2 (3) AMOUNT OF GRANT.—The Administrator, 3 in coordination with the Council, shall determine the 4 total amount that the Administrator will make avail- 5 able to each grantee under this section. 6 (4) APPLICATION.—An eligible applicant seek- 7 ing a grant under this section shall include in the 8 application the following information: 9 (A) The target population (or populations) 10 that would benefit from implementation of the 11 social determinants accelerator plan proposed to 12 be developed by the applicant. 13 (B) A description of the objective or objec- 14 tives and outcome goals of such proposed plan, 15 which shall include at least one health outcome 16 and at least one other important social out- 17 come. 18 (C) The sources and scope of inefficiencies 19 that, if addressed by the plan, could result in 20 improved cost-effectiveness of or return on in- 21 vestment from Federal, State, local, and Tribal 22 governments. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00990 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 991 •HR 6637 IH (D) A description of potential interventions 1 that could be designed or enabled using such 2 proposed plan. 3 (E) The State, local, Tribal, academic, 4 nonprofit, community-based organizations, and 5 other private sector partners that would partici- 6 pate in the development of the proposed plan 7 and subsequent implementation of programs or 8 initiatives included in such proposed plan. 9 (F) Such other information as the Admin- 10 istrator, in consultation with the Secretary and 11 the Council, determines necessary to achieve the 12 purposes of this Act. 13 (5) USE OF FUNDS.—A recipient of a grant 14 under this section may use funds received through 15 the grant for the following purposes: 16 (A) To convene and coordinate with rel- 17 evant government entities and other stake- 18 holders across sectors to assist in the develop- 19 ment of a social determinant accelerator plan. 20 (B) To identify populations of individuals 21 receiving medical assistance under a State plan 22 (or a waiver of such plan) under title XIX of 23 the Social Security Act (42 U.S.C. 1396 et 24 seq.) who may benefit from the proposed ap- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00991 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 992 •HR 6637 IH proaches to improving the health and well-being 1 of such individuals through the implementation 2 of the proposed social determinants accelerator 3 plan. 4 (C) To engage qualified research experts to 5 advise on relevant research and to design a pro- 6 posed evaluation plan, in accordance with the 7 standards and guidelines issued by the Admin- 8 istrator. 9 (D) To collaborate with the Council to sup- 10 port the development of social determinants ac- 11 celerator plans. 12 (E) To prepare and submit a final social 13 determinants accelerator plan to the Council. 14 (6) CONTENTS OF PLANS.—A social deter- 15 minant accelerator plan developed under this section 16 shall include the following: 17 (A) A description of the target population 18 (or populations) that would benefit from imple- 19 mentation of the social determinants accelerator 20 plan, including an analysis describing the pro- 21 jected impact on the well-being of individuals 22 described in paragraph (5)(B). 23 (B) A description of the interventions or 24 approaches designed under the social deter- 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00992 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 993 •HR 6637 IH minants accelerator plan and the evidence for 1 selecting such interventions or approaches. 2 (C) The objectives and outcome goals of 3 such interventions or approaches, including at 4 least one health outcome and at least one other 5 important social outcome. 6 (D) A plan for accessing and linking rel- 7 evant data to enable coordinated benefits and 8 services for the jurisdictions described in this 9 section and an evaluation of the proposed inter- 10 ventions and approaches. 11 (E) A description of the State, local, Trib- 12 al, academic, nonprofit, or community-based or- 13 ganizations, or any other private sector organi- 14 zations that would participate in implementing 15 the proposed interventions or approaches, and 16 the role each would play to contribute to the 17 success of the proposed interventions or ap- 18 proaches. 19 (F) The identification of the funding 20 sources that would be used to finance the pro- 21 posed interventions or approaches. 22 (G) A description of any financial incen- 23 tives that may be provided, including outcome- 24 focused contracting approaches to encourage 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00993 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 994 •HR 6637 IH service providers and other partners to improve 1 outcomes of, cost-effectiveness of, and return on 2 investment from, Federal, State, local, or Tribal 3 government spending. 4 (H) The identification of the applicable 5 Federal, State, local, or Tribal statutory and 6 regulatory authorities, including waiver authori- 7 ties, to be leveraged to implement the proposed 8 interventions or approaches. 9 (I) A description of potential consider- 10 ations that would enhance the impact, 11 scalability, or sustainability of the proposed 12 interventions or approaches and the actions the 13 grant awardee would take to address such con- 14 siderations. 15 (J) A proposed evaluation plan, to be car- 16 ried out by an independent evaluator, to meas- 17 ure the impact of the proposed interventions or 18 approaches on the outcomes of, cost-effective- 19 ness of, and return on investment from, Fed- 20 eral, State, local, and Tribal governments. 21 (K) Precautions for ensuring that vulner- 22 able populations will not be denied access to 23 Medicaid or other essential services as a result 24 of implementing the proposed plan. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00994 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 995 •HR 6637 IH (e) FUNDING.— 1 (1) IN GENERAL.—Out of any money in the 2 Treasury not otherwise appropriated, there is appro- 3 priated to carry out this Act $25,000,000, of which 4 up to $5,000,000 may be used to carry out this Act, 5 to remain available for obligation until the date that 6 is 5 years after the date of enactment of this Act. 7 (2) RESERVATION OF FUNDS.— 8 (A) IN GENERAL.—Of the funds made 9 available under paragraph (1), the Secretary 10 shall reserve not less than 20 percent to award 11 grants to eligible applicants for the development 12 of social determinants accelerator plans under 13 this section intended to serve rural populations. 14 (B) EXCEPTION.—In the case of a fiscal 15 year for which the Secretary determines that 16 there are not sufficient eligible applicants to 17 award up to 25 grants under section 4 that are 18 intended to serve rural populations and the Sec- 19 retary cannot satisfy the 20-percent require- 20 ment, the Secretary may reserve an amount 21 that is less than 20 percent of amounts made 22 available under paragraph (1) to award grants 23 for such purpose. 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00995 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 996 •HR 6637 IH (3) RULE OF CONSTRUCTION.—Nothing in this 1 Act shall prevent Federal agencies represented on 2 the Council from contributing additional funding 3 from other sources to support activities to improve 4 the effectiveness of the Council. 5 SEC. 1010. CORRECTING HURTFUL AND ALIENATING 6 NAMES IN GOVERNMENT EXPRESSION 7 (CHANGE). 8 (a) SHORT TITLE.—This section may be cited as the 9 ‘‘Correcting Hurtful and Alienating Names in Government 10 Expression (CHANGE) Act’’. 11 (b) MODERNIZATION OF LANGUAGE REFERRING TO 12 INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF 13 THE UNITED STATES.—An Executive agency (as defined 14 in section 105 of title 5, United States Code) shall not 15 use the following terms in any proposed or final rule, regu- 16 lation, interpretation, publication, other document, dis- 17 play, or sign issued by the agency after the date of the 18 enactment of this Act, except to the extent that the term 19 is used in quoting or reproducing text written by a source 20 other than an officer (as defined in section 2104 of title 21 5, United States Code) or employee (as defined in section 22 2105 of title 5, United States Code) of the agency: 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00996 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 997 •HR 6637 IH (1) The term ‘‘alien’’, when used to refer to an 1 individual who is not a citizen or national of the 2 United States. 3 (2) The term ‘‘illegal alien’’ when used to refer 4 to an individual who is unlawfully present in the 5 United States or who lacks a lawful immigration 6 status in the United States. 7 (c) UNIFORM DEFINITION.— 8 (1) IN GENERAL.—Chapter 1 of title 1, United 9 States Code, is amended by adding at the end the 10 following: 11 ‘‘§ 9. Definition of ‘foreign national’ 12 ‘‘In determining the meaning of any Act of Congress, 13 or of any ruling, regulation, or interpretation of various 14 administrative bureaus and agencies of the United States, 15 the term ‘foreign national’ means any individual other 16 than an individual— 17 ‘‘(1) who is a citizen of the United States; or 18 ‘‘(2) though not a citizen of the United States, 19 who owes permanent allegiance to the United 20 States.’’. 21 (2) TECHNICAL AMENDMENT.—The table of 22 sections for chapter 1 of title 1, United States Code, 23 is amended by adding at the end the following: 24 ‘‘9. Definition of ‘foreign national’.’’. (d) REFERENCES.— 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00997 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 998 •HR 6637 IH (1) IN GENERAL.—Any reference in any Fed- 1 eral statute, rule, regulation, Executive order, publi- 2 cation, or other document of the United States— 3 (A) to the term ‘‘alien’’, when used to refer 4 to an individual who is not a citizen or national 5 of the United States, is deemed to refer to the 6 term ‘‘foreign national’’; and 7 (B) to the term ‘‘illegal alien’’, when used 8 to refer to an individual who is unlawfully 9 present in the United States or who lacks a 10 lawful immigration status in the United States, 11 is deemed to refer to the term ‘‘undocumented 12 foreign national’’. 13 (2) CONFORMING AMENDMENTS.— 14 (A) Section 421(5)(A)(ii)(II) of the Con- 15 gressional Budget and Impoundment Control 16 Act of 1974 (2 U.S.C. 658(5)(A)(ii)(II)) is 17 amended by striking ‘‘illegal aliens’’ and insert- 18 ing ‘‘undocumented foreign nationals’’. 19 (B) Section 432(e) of the Homeland Secu- 20 rity Act of 2002 (6 U.S.C. 240(e)) is amended 21 by striking ‘‘illegal alien’’ and inserting ‘‘un- 22 documented foreign national’’. 23 (C) Section 439 of the Antiterrorism and 24 Effective Death Penalty Act of 1996 (8 U.S.C. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00998 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 999 •HR 6637 IH 1252c) is amended in the section heading by 1 striking ‘‘ILLEGAL ALIENS’’ and inserting 2 ‘‘UNDOCUMENTED FOREIGN NATIONALS’’. 3 (D) Section 280(b)(3)(A)(iii) of the Immi- 4 gration and Nationality Act (8 U.S.C. 5 1330(b)(3)(A)(iii)) is amended by striking ‘‘ille- 6 gal aliens’’ and inserting ‘‘undocumented for- 7 eign nationals’’. 8 (E) Section 286(r)(3)(ii) of the Immigra- 9 tion and Nationality Act (8 U.S.C. 10 1356(r)(3)(ii)) is amended by striking ‘‘illegal 11 aliens’’ and inserting ‘‘undocumented foreign 12 nationals’’. 13 (F) Section 501 of the Immigration Re- 14 form and Control Act of 1986 (8 U.S.C. 1365) 15 is amended— 16 (i) in the section heading, by striking 17 ‘‘ILLEGAL ALIENS’’ and inserting ‘‘UN- 18 DOCUMENTED FOREIGN NATIONALS’’; 19 (ii) in the subsection heading for sub- 20 section (b), by striking ‘‘ILLEGAL ALIENS’’ 21 and inserting ‘‘UNDOCUMENTED FOREIGN 22 NATIONALS’’; and 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00999 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 1000 •HR 6637 IH (iii) by striking ‘‘illegal alien’’ each 1 place such term appears and inserting 2 ‘‘undocumented foreign national’’. 3 (G) Section 332 of the Omnibus Consoli- 4 dated Appropriations Act, 1997 (8 U.S.C. 5 1366) is amended by striking ‘‘illegal aliens’’ 6 each place such term appears and inserting 7 ‘‘undocumented foreign nationals’’. 8 (H) Section 411(d) of the Personal Re- 9 sponsibility and Work Opportunity Reconcili- 10 ation Act of 1996 (8 U.S.C. 1621(d)) is amend- 11 ed in the subsection heading by striking ‘‘ILLE- 12 GAL ALIENS’’ and inserting ‘‘UNDOCUMENTED 13 FOREIGN NATIONALS’’. 14 (I) Section 106(e) of the Public Works 15 Employment Act of 1976 (42 U.S.C. 6705(e)) 16 is amended in the subsection heading by strik- 17 ing ‘‘ILLEGAL ALIENS’’ and inserting ‘‘UN- 18 DOCUMENTED FOREIGN NATIONALS’’. 19 (J) Section 40125(a)(2) of title 49, United 20 States Code, is amended by striking ‘‘illegal 21 aliens’’ and inserting ‘‘undocumented foreign 22 nationals’’. 23 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 01000 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 1001 •HR 6637 IH Subtitle B—Gun Violence 1 SEC. 1011. FINDINGS. 2 Congress finds as follows: 3 (1) On average, 86 Americans are killed by 4 guns each day. 5 (2) An estimated 39,773 people were killed by 6 guns in 2017, of which two-thirds committed suicide. 7 (3) Gun violence disproportionately affects com- 8 munities of color, especially African Americans (who 9 comprise around 14 percent of the United States 10 population but account for more than half the coun- 11 try’s gun homicide victims). 12 (4) On average, there is more than one mass 13 shooting each day in the United States. 14 SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE 15 CENTERS FOR DISEASE CONTROL AND PRE- 16 VENTION. 17 (a) IN GENERAL.—Section 391 of the Public Health 18 Service Act (42 U.S.C. 280b) is amended— 19 (1) in subsection (a)(1), by striking ‘‘research 20 relating to the causes, mechanisms, prevention, diag- 21 nosis, treatment of injuries, and rehabilitation from 22 injuries;’’ and inserting: ‘‘research, including data 23 collection, relating to— 24 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 01001 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 1002 •HR 6637 IH ‘‘(A) the causes, mechanisms, prevention, 1 diagnosis, and treatment of injuries, including 2 with respect to gun violence; and 3 ‘‘(B) rehabilitation from such injuries;’’; 4 and 5 (2) by adding at the end the following new sub- 6 section: 7 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON- 8 TROL.—Nothing in this section shall be construed to— 9 ‘‘(1) authorize the Secretary to give assistance, 10 make grants, or enter into cooperative agreements or 11 contracts for the purpose of advocating or promoting 12 gun control; or 13 ‘‘(2) permit a recipient of any assistance, grant, 14 cooperative agreement, or contract under this section 15 to use such assistance, grant, agreement, or contract 16 for the purpose of advocating or promoting gun con- 17 trol.’’. 18 SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 19 The Secretary of Health and Human Services, acting 20 through the Director of the Centers for Disease Control 21 and Prevention, shall improve, particularly through the in- 22 clusion of additional States, the National Violent Death 23 Reporting System, as authorized by sections 301(a) and 24 391(a) of the Public Service Health Act (42 U.S.C. 25 VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 01002 Fmt 6652 Sfmt 6201 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS 1003 •HR 6637 IH 241(a), 280(b)). Participation in the system by the States 1 shall be voluntary. 2 SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON 3 PUBLIC HEALTH. 4 Not later than one year after the date of the enact- 5 ment of this Act, and annually thereafter, the Surgeon 6 General shall submit to Congress a report on the effects 7 on public health, including mental health, of gun violence 8 in the United States during the preceding year, and the 9 status of actions taken to address such effects. 10 SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON 11 MENTAL HEALTH IN MINORITY COMMU- 12 NITIES. 13 Not later than one year after the date of the enact- 14 ment of this Act, the Deputy Assistant Secretary for Mi- 15 nority Health in the Office of the Secretary of Health and 16 Human Services shall submit to the Congress a report on 17 the effects of gun violence on public health, including men- 18 tal health, in minority communities in the United States, 19 and the status of actions taken to address such effects. 20 Æ VerDate Sep 11 2014 23:08 Jul 08, 2020 Jkt 099200 PO 00000 Frm 01003 Fmt 6652 Sfmt 6301 E:\BILLS\H6637.IH H6637 pbinns on DSKJLVW7X2PROD with BILLS