Text of US HB 7585 (2022)

I 117TH CONGRESS 2D SESSION H. R. 7585 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 26, 2022 Ms. KELLY of Illinois (for herself, Ms. ADAMS, Ms. NORTON, Mr. BUTTERFIELD, Ms. WILSON of Florida, Mr. PAYNE, Mr. BROWN of Maryland, Ms. SCHAKOWSKY, Mr. KAHELE, Mr. DANNY K. DAVIS of Illi- nois, Ms. UNDERWOOD, Mr. TAKANO, Ms. MENG, Mr. GOMEZ, Mrs. HAYES, Mr. CARTER of Louisiana, Mr. HORSFORD, Ms. LEE of Cali- fornia, Ms. MOORE of Wisconsin, Mr. LAWSON of Florida, Ms. JAYAPAL, Mrs. WATSON COLEMAN, Ms. TITUS, Mrs. LAWRENCE, Ms. CHU, Mr. JOHNSON of Georgia, Ms. VELA´ZQUEZ, Mr. EVANS, Mr. LOWENTHAL, Ms. BROWN of Ohio, Ms. PRESSLEY, Mr. RUSH, Mrs. BEATTY, Mr. CARBAJAL, Mr. CARSON, Ms. BARRAGA´N, Ms. BLUNT ROCHESTER, Ms. BONAMICI, Mr. CA´RDENAS, Mrs. CHERFILUS-MCCORMICK, Mr. CASTRO of Texas, Mrs. NAPOLITANO, Mr. SCHIFF, Ms. JOHNSON of Texas, Ms. SA´NCHEZ, Ms. STRICKLAND, Mr. LIEU, Mr. GREEN of Texas, Mr. MCEACHIN, Mr. SMITH of Washington, Mr. GALLEGO, Ms. CLARK of Massachusetts, Mr. SIRES, Mr. SAN NICOLAS, Ms. CLARKE of New York, Mr. GRIJALVA, Mr. RUIZ, Ms. PLASKETT, and Mr. MEEKS) introduced the following bill; which was referred to the Committee 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, Homeland Security, Financial Services, and Transportation and Infrastructure, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To improve the health of minority individuals, and for other purposes. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 7585 IH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Accountability Act of 2022’’. 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. 1001. Strengthening data collection, improving data analysis, and expand- ing data reporting. Sec. 1002. Elimination of prerequisite of direct appropriations for data collec- tion and analysis. Sec. 1003. Collection of data for the Medicare program. Sec. 1004. Revision of HIPAA claims standards. Sec. 1005. National Center for Health Statistics. Sec. 1006. Disparities data collected by the Federal Government. Sec. 1007. Data collection and analysis grants to minority-serving institutions. Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Is- landers. Sec. 1010. Clarification of simplified administrative reporting requirement. Sec. 1011. Data collection regarding pandemic preparedness, testing, infections, and deaths. Sec. 1012. Commission on Ensuring Data for Health Equity. Sec. 1013. Task Force on Preventing Bias in AI and Algorithms. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH CARE Sec. 2001. Definitions; findings. Sec. 2002. Improving access to services for individuals with limited English proficiency. Sec. 2003. Ensuring standards for culturally and linguistically appropriate services in health care. Sec. 2004. Culturally and linguistically appropriate health care in the Public Health Service Act. Sec. 2005. Pilot program for improvement and development of State medical interpreting services. Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 7585 IH Sec. 2007. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 2008. Increasing understanding of and improving health literacy. Sec. 2009. Requirements for health programs or activities receiving Federal funds. Sec. 2010. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 2011. English instruction for individuals with limited English proficiency. Sec. 2012. Implementation. Sec. 2013. Language access services. Sec. 2014. Medically underserved populations. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 3001. Amendment to the Public Health Service Act. Sec. 3002. Hispanic-serving institutions, historically Black colleges and univer- sities, historically Black professional or graduate institutions, Asian American and Native American Pacific Islander-serving institutions, Tribal Colleges, regional community-based organi- zations, and national minority medical associations. Sec. 3003. Loan repayment program of Centers for Disease Control and Pre- vention. Sec. 3004. Allied health workforce diversity. Sec. 3005. Cooperative agreements for online degree programs at schools of public health and schools of allied health. Sec. 3006. National Health Care Workforce Commission. Sec. 3007. Scholarship and fellowship programs. Sec. 3008. McNair Postbaccalaureate Achievement Program. Sec. 3009. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 3010. Developing and implementing strategies for local health equity. Sec. 3011. Health Professions Workforce Fund. Sec. 3012. Future advancement of academic nursing. Sec. 3013. Findings; sense of Congress relating to graduate medical education. Sec. 3014. Career support for skilled, internationally educated health profes- sionals. Sec. 3015. Study and report on strategies for increasing diversity. Sec. 3016. Conrad State 30 program; physician retention. Sec. 3017. National Hispanic Nurses Day. Sec. 3018. Expanding medical education. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Sec. 4000. Definition. Subtitle A—Reducing Barriers to Accessing Care Sec. 4001. Protecting protected areas. Sec. 4002. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 4003. Availability of basic assistance to lawfully present noncitizens. Sec. 4004. Improve affordability and reduce premium costs of health insurance for consumers. Sec. 4005. Removing citizenship and immigration barriers to access to afford- able health care under the ACA. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 7585 IH Sec. 4006. Removing barriers to access to affordable health care for lawfully re- siding immigrants under Medicaid and CHIP. Sec. 4007. Consistency in health insurance coverage for individuals with feder- ally authorized presence, including deferred action. Sec. 4008. Study on the uninsured. Sec. 4009. Medicaid fallback coverage program for low-income adults in non- expansion States. Sec. 4010. Increase and extension of temporary enhanced FMAP for States which begin to expend amounts for certain mandatory individ- uals. Subtitle B—Improvement of Coverage Sec. 4101. Medicaid in the territories. Sec. 4102. Extension of the supplemental security income program to Puerto Rico, the United States Virgin Islands, Guam, and American Samoa. Sec. 4103. Extension of Medicare secondary payer. Sec. 4104. Indian defined in title I of the Patient Protection and Affordable Care Act. Sec. 4105. Removing Medicare barrier to health care. Sec. 4106. Lowering Medicare premiums and prescription drug costs. Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, simplifying enrollment, and other program improvements for low-income beneficiaries. Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian organizations. Sec. 4109. 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. 4110. Repeal of requirement for estate recovery under the Medicaid pro- gram. Sec. 4111. Allow for suspension of Medicare benefits and premium liability for individuals who are incarcerated and provide a special enroll- ment period around the date of release. Sec. 4112. Federal Employee Health Benefit Plans. Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant individuals and infants. Subtitle C—Expansion of Access PART 1—GENERAL PROVISIONS Sec. 4201. Amendment to the Public Health Service Act. Sec. 4202. Border health grants. Sec. 4203. Critical access hospital improvements. Sec. 4204. Medicare remote monitoring pilot projects. Sec. 4205. Community health center collaborative access expansion. Sec. 4206. Facilitating the provision of telehealth services across State lines. Sec. 4207. Scoring of preventive health savings. Sec. 4208. Sense of Congress on Maintenance of Effort Provisions Regarding Children’s Health. Sec. 4209. Protection of the HHS Offices of Minority Health. Sec. 4210. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 7585 IH Sec. 4211. Study of DSH payments to ensure hospital access for low-income patients. Sec. 4212. Reauthorization of the Native Hawaiian Health Care Improvement Act. PART 2—RURAL Sec. 4221. Establishment of Rural Community Hospital (RCH) Program. Sec. 4222. Rural Health Quality Advisory Commission and demonstration projects. Sec. 4223. Rural health care services. PART 3—INDIAN COMMUNITIES Sec. 4231. Assistant Secretary of the Indian Health Service. Sec. 4232. Extension of full Federal medical assistance percentage to Indian health care providers. Sec. 4233. Conferring with urban Indian organizations. PART 4—PROVIDERS Sec. 4241. Availability of non-English language speaking providers. Sec. 4242. Access to essential community providers. Sec. 4243. Provider network adequacy in communities of color. PART 5—DENTAL Sec. 4251. Improving access to dental care. Sec. 4252. Oral health literacy and awareness campaign. Subtitle D—Advancing Health Equity Through Payment and Delivery Reform Sec. 4301. Sense of Congress. Sec. 4302. Centers for Medicare & Medicaid Services reporting and value-based programs. Sec. 4303. Development and testing of disparity reducing delivery and payment models. Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation. Sec. 4305. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle E—Health Empowerment Zones Sec. 4401. Designation of health empowerment zones. Sec. 4402. Assistance to those seeking designation. Sec. 4403. Benefits of designation. Sec. 4404. Definition of Secretary. Sec. 4405. Authorization of appropriations. Subtitle F—Equitable Health Care For All Sec. 4501. Findings. Sec. 4502. Data collection and reporting. Sec. 4503. Requiring equitable health care in the hospital value-based pur- chasing program. Sec. 4504. Provision of inequitable health care as a basis for permissive exclu- sion from medicare and State health care programs. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 7585 IH Sec. 4505. Office for Civil Rights and Health Equity of the Department of Health and Human Services. Sec. 4506. Prohibiting discrimination in health care. Sec. 4507. Federal Health Equity Commission. Sec. 4508. Grants for hospitals to promote equitable health care and outcomes. Subtitle G—Investing in Equity Sec. 4601. Definitions. Sec. 4602. Strategy to incentivize health equity. Sec. 4603. Pay for Equity Advisory Council. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Subtitle A—In General Sec. 5001. Grants to promote health for underserved communities. Subtitle B—Pregnancy Screening Sec. 5101. Pregnancy intention screening initiative demonstration program. Sec. 5102. Birth defects prevention, risk reduction, and awareness. Subtitle C—Pregnancy-Related Care Sec. 5201. Mothers and Offspring Mortality and Morbidity Awareness. Sec. 5202. MOMMIES. Sec. 5203. Justice for Incarcerated Moms. Sec. 5204. IMPACT to Save Moms Act. Sec. 5205. Protecting moms and babies against climate change. Sec. 5206. Tech to Save Moms. Sec. 5207. Social Determinants for Moms. Sec. 5208. Data to Save Moms. Sec. 5209. Kira Johnson Act. Sec. 5210. Moms Matter. Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms. Sec. 5212. Protect Moms from Domestic Violence. Sec. 5213. Perinatal workforce. Sec. 5214. Midwives schools and programs expansion. Sec. 5215. Gestational diabetes. Sec. 5216. Consumer education campaign. Sec. 5217. Bibliographic database of systematic reviews for care of childbearing individuals and newborns. Sec. 5218. Development of interprofessional maternity care educational models and tools. Sec. 5219. Dissemination of the quality family planning guidelines. Subtitle D—Federal Agency Coordination on Maternal Health Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes. Sec. 5302. Expansion of CDC Prevention Research Centers Program to include Centers on Optimal Maternity Outcomes. Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid Innovation to explicitly include maternity care and children’s health models. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 7585 IH Sec. 5304. Interagency update to the quality family planning guidelines. Subtitle E—Reproductive and Sexual Health Sec. 5401. Findings; sense of Congress on urgent barriers to abortion access and vital solutions. Sec. 5402. Emergency contraception education and information programs. Sec. 5403. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 5404. Real Education and Access for Healthy Youth. Sec. 5405. Compassionate assistance for rape emergencies. Sec. 5406. Menstrual Equity For All Act of 2021. Sec. 5407. Additional focus area for the Office on Women’s Health. Sec. 5408. Including services furnished by certain students, interns, and resi- dents supervised by certified nurse midwives or certified mid- wives within inpatient hospital services under Medicare. Sec. 5409. Grants to professional organizations and minority-serving institu- tions to increase diversity in maternal, reproductive, and sexual health professionals. Subtitle F—Children’s Health Sec. 5501. CARING for Kids Act. Sec. 5502. End Diaper Need Act of 2021. Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Subtitle G—Nutrition for Women, Children, Families Sec. 5601. Removing barriers to health care and nutrition assistance for chil- dren, pregnant persons, and lawfully present individuals. Sec. 5602. Closing the meal gap. Sec. 5603. Repeal of denial of Supplemental Nutrition Assistance Program ben- efits. Subtitle H—Universal School Meals Program Sec. 5701. Short title. Sec. 5702. Effective date. Sec. 5703. Free school breakfast program. Sec. 5704. Apportionment to States. Sec. 5705. Nutritional and other program requirements. Sec. 5706. Special assistance program. Sec. 5707. Price for a paid lunch. Sec. 5708. Summer food service program for children. Sec. 5709. Summer Electronic Benefit Transfer for Children Program. Sec. 5710. Child and adult care food program. Sec. 5711. Meals and supplements for children in afterschool care. Sec. 5712. Access to local foods: farm to school program. Sec. 5713. Fresh fruit and vegetable program. Sec. 5714. Training, technical assistance, and Food Service Management Insti- tute. Sec. 5715. Reimbursement of school meal delinquent debt program. Sec. 5716. Conforming amendments. Sec. 5717. Measure of poverty. Sec. 5718. Supplemental nutrition assistance program. Sec. 5719. Higher Education Act of 1965. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 7585 IH Sec. 5720. Elementary and Secondary Education Act of 1965. Sec. 5721. America COMPETES Act. Sec. 5722. Workforce Innovation and Opportunity Act. Sec. 5723. National Science Foundation Authorization Act of 2002. Sec. 5724. Child care and development block grant. Sec. 5725. Children’s Health Act of 2000. Sec. 5726. Juvenile justice and delinquency prevention. Subtitle I—Elder Care Sec. 5801. Expenses for household and elder care services necessary for gainful employment. Subtitle J—Miscellaneous Provisions Sec. 5901. Clarification supporting permissible use of funds for stillbirth pre- vention activities. TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS Sec. 6001. Mental health findings. Sec. 6002. Sense of Congress. Subtitle A—Access to Care and Funding Streams Sec. 6011. Coverage of marriage and family therapist services, mental health counselor services, substance abuse counselor services, and peer support specialist services under part B of the Medicare pro- gram. Sec. 6012. Reauthorization of Minority Fellowship Program. Sec. 6013. Additional funds for National Institutes of Health. Sec. 6014. Additional funds for National Institute on Minority Health and Health Disparities. Sec. 6015. Grants for increasing racial and ethnic minority access to high-qual- ity trauma support services and mental health care. Sec. 6016. Grants for unarmed 9–1–1 response programs. Subtitle B—Interprofessional Care Sec. 6021. Health professions competencies to address racial and ethnic mental health inequities. Sec. 6022. Interprofessional health care teams for behavioral health care. Sec. 6023. Integrated Health Care Demonstration Program. Subtitle C—Workforce Development Sec. 6031. Building an effective workforce in mental health. Sec. 6032. Pilot program to increase language access at Federally qualified health centers. Sec. 6033. Health professions competencies to address racial and ethnic minor- ity mental health disparities. Subtitle D—Children’s Mental Health Sec. 6041. Pediatric behavioral health care. Sec. 6042. Mental health in schools. Sec. 6043. Additional support for youth and young adult mental health service provision. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 7585 IH Sec. 6044. Early intervention and prevention programs for transition-age youth. Sec. 6045. Strategies to increase access to telehealth under Medicaid and Chil- dren’s Health Insurance Program. Sec. 6046. Youth and young adult mental health promotion, prevention, inter- vention, and treatment. Sec. 6047. Study on the Effects of Smartphone and Social Media Use on Ado- lescents. Subtitle E—Community-Based Care Sec. 6051. Mental health at the border. Sec. 6052. Asian American, African American, Native Hawaiian, Pacific Is- lander, Indigenous, Middle Eastern and North African, and Hispanic and Latino behavioral and mental health outreach and education strategy. Subtitle F—Reports Sec. 6061. Addressing racial and ethnic mental health inequities research gaps. Sec. 6062. Research on adverse health effects associated with interactions with law enforcement. Sec. 6063. Geoaccess study. Sec. 6064. Cooccurring conditions. Sec. 6065. Technical correction. Subtitle G—Miscellaneous Provisions Sec. 6071. Children’s Mental Health Infrastructure Act. Sec. 6072. Mental Health for Latinos. Sec. 6073. Strengthening Mental Health Supports for BIPOC Communities. Sec. 6074. STRONG Support for Children. Sec. 6075. Improving access to mental health. Sec. 6076. Mental Health in Schools Excellence Program. Sec. 6077. School Social Workers Improving Student Success. Sec. 6078. Opioid grants to support caregivers, kinship care families, and kin- ship caregivers. Sec. 6079. Advancing Student Services In Schools Today Act (ASSIST Act). TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 7001. Lung cancer mortality reduction. Sec. 7002. Expanding prostate cancer research, outreach, screening, testing, access, and treatment effectiveness. Sec. 7003. Prostate Research, Imaging, and Men’s Education (PRIME). Sec. 7004. Prostate cancer detection research and education. Sec. 7005. National Prostate Cancer Council. Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories. Sec. 7007. Cancer prevention and treatment demonstration for ethnic and ra- cial minorities. Sec. 7008. Reducing cancer disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 7051. Viral hepatitis and liver cancer control and prevention. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 7585 IH Sec. 7052. Liver cancer and disease prevention, awareness, and patient track- ing grants. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 7101. Acquired bone marrow failure diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other Disease Issues Sec. 7151. Guidelines for disease screening for minority patients. Sec. 7152. CDC Wisewoman Screening Program. Sec. 7153. Report on cardiovascular care for women and minorities. Sec. 7154. Coverage of comprehensive tobacco cessation services in Medicaid, CHIP, and private health insurance. Sec. 7155. Clinical research funding for oral health. Sec. 7156. Guide on evidence-based strategies for public health department obe- sity prevention programs. Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education Act. Subtitle E—HIV/AIDS Sec. 7201. Statement of policy. Sec. 7202. Findings. Sec. 7203. Additional funding for AIDS drug assistance program treatments. Sec. 7204. Enhancing the national HIV surveillance system. Sec. 7205. Evidence-based strategies for improving linkage to, and retention in, appropriate care. Sec. 7206. Improving entry into, and retention in, care and antiretroviral ad- herence for persons with HIV. Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 7208. Minority AIDS initiative. Sec. 7209. Health care professionals treating individuals with HIV. Sec. 7210. HIV/AIDS provider loan repayment program. Sec. 7211. Dental education loan repayment program. Sec. 7212. Reducing new HIV infections among injecting drug users. Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations. Sec. 7214. National HIV/AIDS observance days. Sec. 7215. Review of all Federal and State laws, policies, and regulations re- garding the criminal prosecution of individuals for HIV-related offenses. Sec. 7216. Expanding support for condoms in prisons. Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 7218. Stop HIV in prison. Sec. 7219. Transfer of funds for implementation of Ending the HIV Epidemic: A Plan for America. Sec. 7220. PrEP access and coverage. Subtitle F—Diabetes Sec. 7251. Research, treatment, and education. Sec. 7252. Research, education, and other activities. Sec. 7253. Programs to educate health providers on the causes and effects of diabetes in minority populations. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 7585 IH Sec. 7254. Research, education, and other activities regarding diabetes in American Indian populations. Sec. 7255. Updated report on health disparities. Subtitle G—Lung Disease Sec. 7301. National asthma burden. Sec. 7302. Asthma-related activities of the Centers for Disease Control and Prevention. Sec. 7303. Influenza and pneumonia vaccination campaign. Sec. 7304. Chronic obstructive pulmonary disease. Subtitle H—Tuberculosis Sec. 7351. Elimination of all forms of tuberculosis. Sec. 7352. Additional funding for States in combating and eliminating tuber- culosis. Sec. 7353. Strengthening clinical research funding for tuberculosis. Subtitle I—Osteoarthritis and Musculoskeletal Diseases Sec. 7401. Findings. Sec. 7402. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. Subtitle J—Sleep and Circadian Rhythm Disorders Sec. 7451. Short title; findings. Sec. 7452. Sleep and circadian rhythm disorders research activities of the Na- tional Institutes of Health. Sec. 7453. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. Sec. 7454. Grants for comprehensive sleep and circadian health education with- in health professions schools. Sec. 7455. 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. 7501. Kidney disease, research, surveillance, prevention, and treatment. Sec. 7502. Kidney disease research in minority populations. Sec. 7503. Kidney disease action plan. Sec. 7504. Home dialysis and increasing end-stage renal disease treatment mo- dalities in minority communities action plan. Sec. 7505. Increasing kidney transplants in minority populations. Sec. 7506. Environmental and occupational health programs. Sec. 7507. Understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations. Sec. 7508. Improving access in underserved areas. Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap cov- erage for beneficiaries with end-stage renal disease. Subtitle L—Diversity in Clinical Trials Sec. 7551. FDA review of clinical trial best practices. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 7585 IH Sec. 7552. Diversifying Investigations Via Equitable Research Studies for Ev- eryone Trials Act. Sec. 7553. Clinical trial diversity. Sec. 7554. Patient experience data. Subtitle M—Additional Provisions Addressing High Impact Minority Diseases Sec. 7601. Medicare coverage of multi-cancer early detection screening tests. Sec. 7602. Amputation Reduction and Compassion Act. Sec. 7603. Eliminating the coinsurance requirement for certain colorectal can- cer screening tests furnished under the Medicare program. Sec. 7604. Expanding the availability of medical nutrition therapy services under the Medicare program. Sec. 7605. Encouraging the development and use of DISARM antimicrobial drugs. Sec. 7606. Treat and Reduce Obesity Act. Sec. 7607. Incentives, improvements, and outreach to increase diversity in Alz- heimer’s disease research. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Sec. 8001. Definitions. Subtitle A—Reducing Health Disparities Through Health IT Sec. 8101. HRSA assistance to health centers for promotion of Health IT. Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such com- munities. Sec. 8103. Nondiscrimination and health equity in health information tech- nology. Sec. 8104. Language access in health information technology. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 8201. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 8202. 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. 8203. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 8301. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 8302. Study of health information technology in medically underserved communities. Sec. 8303. Assessment of use and misuse of de-identified health data. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 8402. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. Subtitle E—Expanding Access to Telehealth Services VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 7585 IH Sec. 8501. Removing geographic requirements for telehealth services. Sec. 8502. Expanding originating sites. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 9001. Prohibition on discrimination in Federal assisted health care serv- ices and research on the basis of sex (including sexual orienta- tion, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, familial status, or disability status. Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 9003. Accountability and transparency within the Department of Health and Human Services. Sec. 9004. United States Commission on Civil Rights. Sec. 9005. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 9006. GAO and NIH reports. Sec. 9007. Investigative and enforcement actions. Sec. 9008. Federal Health Equity Commission. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Subtitle A—In General Sec. 10001. Definitions. Sec. 10002. Findings. Sec. 10003. Health impact assessments. Sec. 10004. Grant program to conduct environmental health improvement ac- tivities and to improve social determinants of health. Sec. 10005. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 10006. Environment and public health restoration. Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig explo- sion in the Gulf Coast. Sec. 10008. Establish an interagency counsel and grant programs on social de- terminants of health. Sec. 10009. Correcting Hurtful and Alienating Names in Government Expres- sion (CHANGE). Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care. Sec. 10011. Investing in community healing. Sec. 10012. Environmental justice mapping and data collection. Sec. 10013. Antiracism in public health. Sec. 10014. LGBTQ essential data. Sec. 10015. Social determinants accelerator. Sec. 10016. Improving social determinants of health. Subtitle B—Gun Violence Sec. 10101. Reaffirming research authority of the Centers for Disease Control and Prevention. Sec. 10102. National Violent Death Reporting System. Sec. 10103. Report on effects of gun violence on public health. Sec. 10104. Report on effects of gun violence on mental health in minority communities. VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6211 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 14 •HR 7585 IH SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 (1) The population of racial and ethnic minori- 3 ties is expected to increase over the next few dec- 4 ades, yet racial and ethnic minorities have the poor- 5 est health status and face substantial cultural, so- 6 cial, and economic barriers to obtaining high-quality 7 health care. 8 (2) Health disparities are a function of not only 9 access to health care, but also the social deter- 10 minants of health—including the environment, the 11 physical structure of communities, nutrition and 12 food options, educational attainment, employment, 13 race, ethnicity, sex, geography, language preference, 14 immigrant or citizenship status, sexual orientation, 15 gender identity, socioeconomic status, or disability 16 status—that directly and indirectly affect the health, 17 health care, and wellness of individuals and commu- 18 nities. 19 (3) Over the next few decades, the United 20 States will face a shortage of health care providers 21 and allied health workers. 22 (4) All efforts to reduce health disparities and 23 barriers to high-quality health services require better 24 and more consistent data, and better and more con- 25 sistent collection of and access to data. 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 15 •HR 7585 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 16 •HR 7585 IH Quality, as well as critical resources such as the 1 2012 National Healthcare Quality and Disparities 2 Reports, will work to increase the number of people 3 in the United States who are healthy at every stage 4 of life. 5 (9) The Secretary of Health and Human Serv- 6 ices has also reviewed and advanced updated clinical 7 guidelines and developed other strategic planning 8 documents to combat health disparities with a high 9 impact on minority populations and to provide high- 10 quality family planning services. Such guidelines and 11 documents include the National HIV/AIDS Strategy, 12 the Action Plan for the Prevention, Care, and Treat- 13 ment of Viral Hepatitis, and recommendations of the 14 Centers for Disease Control and Prevention and the 15 Office of Population Affairs. 16 (10) The Patient Protection and Affordable 17 Care Act (Public Law 111–148), as amended by the 18 Health Care and Education Reconciliation Act (Pub- 19 lic Law 111–152), represents the biggest advance- 20 ment for minority health in the 40 years imme- 21 diately preceding the enactment of this Act. 22 (11) The Health Information Technology for 23 Educational and Clinical Health Act of 2009, part 24 of the American Recovery and Reinvestment Act of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 17 •HR 7585 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. 1001. STRENGTHENING DATA COLLECTION, IMPROV- 7 ING DATA ANALYSIS, AND EXPANDING DATA 8 REPORTING. 9 (a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 10 ACT.— 11 (1) PURPOSE.—The purpose of the amend- 12 ments made by this subsection is to promote cul- 13 turally and linguistically appropriate data collection, 14 analysis, and reporting by race, ethnicity, sex, pri- 15 mary language, sexual orientation, disability status, 16 gender identity, age, and socioeconomic status in 17 federally supported health programs. 18 (2) AHRQ GENERAL AUTHORITIES.—Section 19 902(a) of the Public Health Service Act (42 U.S.C. 20 299a(a)) is amended— 21 (A) in paragraph (8), by striking ‘‘and’’ at 22 the end; 23 (B) in paragraph (9), by striking the pe- 24 riod at the end and inserting ‘‘; and’’; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 18 •HR 7585 IH (C) by adding at the end the following: 1 ‘‘(10) cultural and linguistic competence of 2 health care services and of data collection activities 3 described under section 3101.’’. 4 (3) OFFICE OF MINORITY HEALTH.—Section 5 1707(g)(1) of the Public Health Service Act (42 6 U.S.C. 300u–6(g)(1)) is amended by inserting ‘‘Mid- 7 dle Easterners and North Africans;’’ after 8 ‘‘Blacks;’’. 9 (4) OFFICE OF THE NATIONAL COORDINATOR 10 FOR HEALTH INFORMATION TECHNOLOGY.—Section 11 3001 of the Public Health Service Act (42 U.S.C. 12 300jj–11) is amended— 13 (A) in subsection (b)— 14 (i) in paragraph (10), by striking 15 ‘‘and’’ at the end; 16 (ii) in paragraph (11), by striking the 17 period at the end and inserting ‘‘; and’’; 18 and 19 (iii) by adding at the end the fol- 20 lowing: 21 ‘‘(12) ensures the interoperability of health in- 22 formation systems among federally conducted or 23 supported health care or public health programs, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 19 •HR 7585 IH State health agencies, and social service agencies.’’; 1 and 2 (B) by amending clause (vii) in subsection 3 (c)(3)(A) to read as follows: 4 ‘‘(vii) Strategies to enhance the use of 5 health information technology in improving 6 the quality of health care; reducing medical 7 errors; reducing health disparities and en- 8 suring the provision of equitable health 9 services; improving public health; increas- 10 ing prevention and coordination with com- 11 munity resources; ensuring interoperability 12 among federally conducted or supported 13 health care or public health programs, 14 State health agencies, and social service 15 agencies; and improving the continuity of 16 care among health care settings.’’. 17 (5) DATA COLLECTION, ANALYSIS, AND QUAL- 18 ITY.—Section 3101 of the Public Health Service Act 19 (42 U.S.C. 300kk) is amended— 20 (A) in subsections (a)(1)(A), (a)(1)(C), 21 (a)(2)(B), and (a)(2)(E), by inserting ‘‘sexual 22 orientation, gender identity, age,’’ before ‘‘and 23 disability status’’; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 20 •HR 7585 IH (B) in subsection (a)(1), by amending sub- 1 paragraph (D) to read as follows: 2 ‘‘(D) data for additional population groups 3 if such groups can be aggregated into the data 4 collection standards described under paragraph 5 (2).’’; 6 (C) in subsection (a)(2)— 7 (i) in subparagraph (C)— 8 (I) in clause (i), by striking 9 ‘‘and’’ at the end; 10 (II) in clause (ii)— 11 (aa) by striking ‘‘is a minor 12 or legally incapacitated’’ and in- 13 serting ‘‘is a minor, requires as- 14 sistance with communication in 15 speech or writing, or is legally in- 16 capacitated’’; and 17 (bb) by striking the semi- 18 colon at the end and inserting ‘‘; 19 and’’; and 20 (III) by adding at the end the 21 following: 22 ‘‘(iii) collects data in a manner that is 23 culturally and linguistically appropriate;’’; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 21 •HR 7585 IH (ii) in subparagraph (D)(iii), by strik- 1 ing ‘‘and’’ at the end; 2 (iii) in subparagraph (E), by striking 3 the period at the end and inserting ‘‘; 4 and’’; and 5 (iv) by adding at the end the fol- 6 lowing: 7 ‘‘(F) use, where practicable, the standards 8 developed by the Health and Medicine Division 9 of the National Academies of Sciences, Engi- 10 neering, and Medicine (formerly known as the 11 ‘Institute of Medicine’) in the 2009 publication 12 titled ‘Race, Ethnicity, and Language Data: 13 Standardization for Health Care Quality Im- 14 provement’.’’; and 15 (D) in subsection (a)(3), by amending sub- 16 paragraph (B) to read as follows: 17 ‘‘(B) develop interoperability and security 18 systems for data management among federally 19 conducted and supported health care and public 20 health programs, State health agencies, and so- 21 cial service agencies.’’. 22 (b) COROLLARY PROVISIONS.— 23 (1) RECOMMENDATIONS BY THE DATA COUN- 24 CIL.—The Data Council of the Department of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 22 •HR 7585 IH Health and Human Services, in consultation with 1 the Director of the National Center for Health Sta- 2 tistics, the Deputy Assistant Secretary for Minority 3 Health, the Deputy Assistant Secretary for Women’s 4 Health, the Administrator of the Centers for Medi- 5 care & Medicaid, the head of the Office of the Na- 6 tional Coordinator for Health Information Tech- 7 nology, and other appropriate public and private en- 8 tities and officials, shall make recommendations to 9 the Secretary of Health and Human Services con- 10 cerning how to— 11 (A) implement the amendments made by 12 this section, while minimizing the cost and ad- 13 ministrative burdens of data collection and re- 14 porting on all parties, including patients and 15 providers; 16 (B) expand awareness among Federal 17 agencies, States, territories, Indian Tribes, 18 counties, municipalities, health providers, health 19 plans, and the general public that data collec- 20 tion, analysis, and reporting by race, ethnicity, 21 sex, primary language, sexual orientation, gen- 22 der identity, age, socioeconomic status, and dis- 23 ability status is legal and necessary to ensure 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 23 •HR 7585 IH equity and nondiscrimination in the quality of 1 health care services; 2 (C) ensure that future patient record sys- 3 tems follow Federal standards promulgated 4 under the HITECH Act (42 U.S.C. 201 note) 5 for the collection and meaningful use of elec- 6 tronic health data on race, ethnicity, sex, pri- 7 mary language, sexual orientation, gender iden- 8 tity, age, socioeconomic status, and disability 9 status; 10 (D) improve health and health care data 11 collection and analysis for more population 12 groups if such groups can be aggregated into 13 minimum race and ethnicity categories, includ- 14 ing exploring the feasibility of enhancing collec- 15 tion efforts in States, counties, and municipali- 16 ties for racial and ethnic groups that comprise 17 a significant proportion of the population of the 18 State, county, or municipality; 19 (E) provide researchers with greater access 20 to racial, ethnic, primary language, sex, sexual 21 orientation, gender identity, age, socioeconomic 22 status, and disability status data, subject to all 23 applicable privacy and confidentiality require- 24 ments, including HIPAA privacy and security 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 24 •HR 7585 IH law as defined in section 3009 of the Public 1 Health Service Act (42 U.S.C. 300jj–19); 2 (F) ensure the cultural and linguistic com- 3 petence of entities that receive Federal support 4 to collect and report data pursuant to the 5 amendments made by subsection (a); and 6 (G) safeguard and prevent the misuse of 7 data collected under section 3101 of the Public 8 Health Service Act (42 U.S.C. 300kk), as 9 amended by subsection (a)(5). 10 (2) RULES OF CONSTRUCTION.—Nothing in 11 this section shall be construed to— 12 (A) permit the use of information collected 13 under this section or any provision amended by 14 this section in a manner that would adversely 15 affect any individual providing any such infor- 16 mation; or 17 (B) diminish any requirements on health 18 care providers to collect data, including such re- 19 quirements in effect on or after the date of en- 20 actment of this Act. 21 (3) TECHNICAL ASSISTANCE FOR THE ANALYSIS 22 OF HEALTH DISPARITY DATA.—The Secretary of 23 Health and Human Services, acting through the Di- 24 rector of the Agency for Healthcare Research and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 25 •HR 7585 IH Quality, and in coordination with the Assistant Sec- 1 retary for Planning and Evaluation, the Adminis- 2 trator of the Centers for Medicare & Medicaid Serv- 3 ices, the Director of the National Center for Health 4 Statistics, the Director of the National Institutes of 5 Health, and the head of the Office of the National 6 Coordinator for Health Information Technology, 7 shall provide technical assistance to agencies of the 8 Department of Health and Human Services in meet- 9 ing Federal standards for health disparity data col- 10 lection and for analysis of racial, ethnic, and other 11 disparities in health and health care in programs 12 conducted or supported by such agencies by— 13 (A) identifying appropriate quality assur- 14 ance mechanisms to monitor for health dispari- 15 ties; 16 (B) specifying the clinical, diagnostic, or 17 therapeutic measures which should be mon- 18 itored; 19 (C) developing new quality measures relat- 20 ing to racial and ethnic disparities and their 21 overlap with other disparity factors in health 22 and health care; 23 (D) identifying the level at which data 24 analysis should be conducted; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 26 •HR 7585 IH (E) sharing data with external organiza- 1 tions for research and quality improvement pur- 2 poses; and 3 (F) identifying and addressing issues relat- 4 ing to the interoperability of Federal- and 5 State-level health information systems which 6 undermine the ability of health-related pro- 7 grams collecting data under this section to 8 achieve the purpose described in subsection 9 (a)(1). 10 (4) REFERENCES.—Except as otherwise speci- 11 fied, any reference to the term ‘‘racial and ethnic 12 minority group’’ in any Federal regulation, guid- 13 ance, order, or document for establishment or imple- 14 mentation of any federally conducted or supported 15 health care or public health program, activity, or 16 survey shall be treated as having the definition given 17 to such term in section 1707(g) of the Public Health 18 Service Act (42 U.S.C. 300u–6(g)). 19 (5) AUTHORIZATION OF APPROPRIATIONS.—To 20 carry out this subsection, subsection (a), and the 21 amendments made by subsection (a), there are au- 22 thorized to be appropriated such sums as may be 23 necessary for each of fiscal years 2023 through 24 2027. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 27 •HR 7585 IH (c) ADDITIONS TO THE PUBLIC HEALTH SERVICE 1 ACT.—Title XXXIV of the Public Health Service Act, as 2 added by titles II and III of this Act, is further amended 3 by inserting after subtitle B the following: 4 ‘‘Subtitle C—Strengthening Data 5 Collection, Improving Data 6 Analysis, and Expanding Data 7 Reporting 8 ‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION 9 IMPROVEMENT ACTIVITIES. 10 ‘‘(a) IN GENERAL.—The Secretary, acting through 11 the Director of the Agency for Healthcare Research and 12 Quality and in consultation with the Deputy Assistant 13 Secretary for Minority Health, the Director of the Na- 14 tional Institutes of Health, the Assistant Secretary for 15 Planning and Evaluation, the head of the Office of the 16 National Coordinator for Health Information Technology, 17 and the Director of the National Center for Health Statis- 18 tics, shall establish a technical assistance program under 19 which the Secretary provides grants to eligible entities to 20 assist such entities in complying with section 3101 of the 21 Public Health Service Act. 22 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 23 under this section may be used to— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 28 •HR 7585 IH ‘‘(1) enhance or upgrade computer technology 1 that will facilitate collection, analysis, and reporting 2 of racial, ethnic, primary language, sexual orienta- 3 tion, sex, gender identity, socioeconomic status, and 4 disability status data; 5 ‘‘(2) improve methods for health data collection 6 and analysis, including additional population groups 7 if such groups can be aggregated into the race and 8 ethnicity categories outlined by standards developed 9 under section 3101; 10 ‘‘(3) develop mechanisms for submitting col- 11 lected data subject to any applicable privacy and 12 confidentiality regulations; 13 ‘‘(4) develop educational programs to inform 14 health plans, health providers, health-related agen- 15 cies, and the general public that data collection and 16 reporting by race, ethnicity, primary language, sex- 17 ual orientation, sex, gender identity, disability sta- 18 tus, and socioeconomic status are legal and essential 19 for eliminating health and health care disparities; 20 and 21 ‘‘(5) develop educational programs to train 22 health providers, health care organizations, health 23 plans, health-related agencies, and frontline health 24 care workers on how to collect and report 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 29 •HR 7585 IH disaggregated data in a culturally and linguistically 1 appropriate manner. 2 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 3 under this section, an entity shall be a State, territory, 4 Indian Tribe, municipality, county, health provider, health 5 care organization, or health plan making a demonstrated 6 effort to bring data collections into compliance with sec- 7 tion 3101. 8 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2023 through 2027. 12 ‘‘SEC. 3432. OVERSAMPLING OF UNDERREPRESENTED 13 GROUPS IN FEDERAL HEALTH SURVEYS. 14 ‘‘(a) NATIONAL STRATEGY.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the National Center for 17 Health Statistics, and other officials within the De- 18 partment of Health and Human Services as the Sec- 19 retary determines appropriate, shall develop and im- 20 plement a sustainable national strategy for oversam- 21 pling underrepresented populations within the cat- 22 egories of race, ethnicity, sex, primary language, sex- 23 ual orientation, disability status, gender identity, 24 and socioeconomic status as determined appropriate 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 30 •HR 7585 IH by the Secretary in Federal health surveys and pro- 1 gram data collections. Such national strategy shall 2 include a strategy for oversampling of Middle East- 3 erners and North Africans, Asian Americans, Native 4 Hawaiians, and Pacific Islanders. 5 ‘‘(2) CONSULTATION.—In developing and imple- 6 menting a national strategy, as described in para- 7 graph (1), not later than 180 days after the date of 8 the enactment of this section, the Secretary shall— 9 ‘‘(A) consult with representatives of com- 10 munity groups, nonprofit organizations, non- 11 governmental organizations, and government 12 agencies working with underrepresented popu- 13 lations; 14 ‘‘(B) solicit the participation of representa- 15 tives from other Federal departments and agen- 16 cies, including subagencies of the Department 17 of Health and Human Services; and 18 ‘‘(C) consult on, and use as models, the 19 2014 National Health Interview Survey over- 20 sample of Native Hawaiian and Pacific Islander 21 populations, the 2016 Behavioral Risk Factor 22 Survey of Health Risk Behaviors Among Arab 23 Adults Within the State of Michigan, and the 24 2017 Behavioral Risk Factor Surveillance Sys- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 31 •HR 7585 IH tem oversample of American Indian and Alaska 1 Native communities. 2 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 3 after the date of enactment of this section, the Secretary 4 shall submit to the Congress a progress report, which shall 5 include the national strategy required by subsection 6 (a)(1). 7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there are authorized to be appro- 9 priated such sums as may be necessary for fiscal years 10 2023 through 2027.’’. 11 SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP- 12 PROPRIATIONS FOR DATA COLLECTION AND 13 ANALYSIS. 14 Section 3101 of the Public Health Service Act (42 15 U.S.C. 300kk), as amended by section 1001(a), is further 16 amended— 17 (1) by striking subsection (h); and 18 (2) by redesignating subsection (i) as subsection 19 (h). 20 SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO- 21 GRAM. 22 Part A of title XI of the Social Security Act (42 23 U.S.C. 1301 et seq.) is amended by adding at the end 24 the following: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 32 •HR 7585 IH ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM 1 ‘‘SEC. 1150D. 2 ‘‘(a) REQUIREMENT.— 3 ‘‘(1) IN GENERAL.—The Commissioner of So- 4 cial Security, in consultation with the Administrator 5 of the Centers for Medicare & Medicaid Services, 6 shall collect data on the race, ethnicity, sex, primary 7 language, sexual orientation, gender identity, socio- 8 economic status, and disability status of all appli- 9 cants for Social Security benefits under title II or 10 Medicare benefits under title XVIII. 11 ‘‘(2) DATA COLLECTION STANDARDS.—In col- 12 lecting data under paragraph (1), the Commissioner 13 of Social Security shall at least use the standards 14 for data collection developed under section 3101 of 15 the Public Health Service Act or the standards de- 16 veloped by the Office of Management and Budget, 17 whichever is more disaggregated. In the event there 18 are no standards for the demographic groups listed 19 under paragraph (1), the Commissioner shall consult 20 with stakeholder groups representing the various 21 identities as well as with the Office of Minority 22 Health within the Centers for Medicare & Medicaid 23 Services to develop appropriate standards. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 33 •HR 7585 IH ‘‘(3) DATA FOR ADDITIONAL POPULATION 1 GROUPS.—Where practicable, the information col- 2 lected by the Commissioner of Social Security under 3 paragraph (1) shall include data for additional popu- 4 lation groups if such groups can be aggregated into 5 the race and ethnicity categories outlined by the 6 data collection standards described in paragraph (2). 7 ‘‘(4) COLLECTION OF DATA FOR MINORS AND 8 LEGALLY INCAPACITATED INDIVIDUALS.—With re- 9 spect to the collection of the data described in para- 10 graph (1) of applicants who are under 18 years of 11 age or otherwise legally incapacitated, the Commis- 12 sioner of Social Security shall require that— 13 ‘‘(A) such data be collected from the par- 14 ent or legal guardian of such an applicant; and 15 ‘‘(B) the primary language of the parent 16 or legal guardian of such an applicant or recipi- 17 ent be used in collecting the data. 18 ‘‘(5) QUALITY OF DATA.—The Commissioner of 19 Social Security shall periodically review the quality 20 and completeness of the data collected under para- 21 graph (1) and make adjustments as necessary to im- 22 prove both. 23 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll- 24 ment in Medicare benefits under title XVIII, the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 34 •HR 7585 IH Commissioner of Social Security shall transmit an 1 individual’s demographic data as collected under 2 paragraph (1) to the Centers for Medicare & Med- 3 icaid Services. 4 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 5 With respect to data transmitted under paragraph 6 (5), the Administrator of the Centers for Medicare 7 & Medicaid Services, in consultation with the Com- 8 missioner of Social Security shall— 9 ‘‘(A) require that such data be uniformly 10 analyzed and that such analysis be reported at 11 least annually to Congress; 12 ‘‘(B) incorporate such data in other anal- 13 ysis and reporting on health disparities and the 14 provision of inequitable health care services by 15 a health care provider, as appropriate; 16 ‘‘(C) make such data available to research- 17 ers, under the protections outlined in paragraph 18 (7); 19 ‘‘(D) provide opportunities to individuals 20 enrolled in Medicare to submit updated data; 21 and 22 ‘‘(E) ensure that the provision of assist- 23 ance or benefits to an applicant is not denied 24 or otherwise adversely affected because of the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 35 •HR 7585 IH failure of the applicant to provide any of the 1 data collected under paragraph (1). 2 ‘‘(8) PROTECTION OF DATA.—The Commis- 3 sioner of Social Security shall ensure (through the 4 promulgation of regulations or otherwise) that all 5 data collected pursuant to subsection (a) is pro- 6 tected— 7 ‘‘(A) under the same privacy protections as 8 the Secretary applies to health data under the 9 regulations promulgated under section 264(c) of 10 the Health Insurance Portability and Account- 11 ability Act of 1996 (relating to the privacy of 12 individually identifiable health information and 13 other protections); and 14 ‘‘(B) from all inappropriate internal use by 15 any entity that collects, stores, or receives the 16 data, including use of such data in determina- 17 tions of eligibility (or continued eligibility) in 18 health plans, and from other inappropriate 19 uses, as defined by the Secretary. 20 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec- 21 tion shall be construed to permit the use of information 22 collected under this section in a manner that would ad- 23 versely affect any individual providing any such informa- 24 tion. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 36 •HR 7585 IH ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary of 1 Health and Human Services may, either directly or by 2 grant or contract, provide technical assistance to enable 3 any entity to comply with the requirements of this section 4 or with regulations implementing this section. 5 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 $500 million for 2022 and $100 million for each fiscal 8 year thereafter.’’. 9 SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS. 10 (a) IN GENERAL.—Not later than 1 year after the 11 date of enactment of this Act, the Secretary of Health and 12 Human Services shall revise the regulations promulgated 13 under part C of title XI of the Social Security Act (42 14 U.S.C. 1320d et seq.) (relating to the collection of data 15 on race, ethnicity, and primary language in a health-re- 16 lated transaction) to require— 17 (1) the use, at a minimum, of standards for 18 data collection on race, ethnicity, primary language, 19 disability, sex, sexual orientation, gender identity, 20 and socioeconomic status developed under section 21 3101 of the Public Health Service Act (42 U.S.C. 22 300kk); and 23 (2) in consultation with the Office of the Na- 24 tional Coordinator for Health Information Tech- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 37 •HR 7585 IH nology, the designation of the appropriate racial, 1 ethnic, primary language, disability, sex, and other 2 code sets as required for claims and enrollment data. 3 (b) DISSEMINATION.—The Secretary of Health and 4 Human Services shall disseminate the new standards de- 5 veloped under subsection (a) to all entities that are subject 6 to the regulations described in such subsection and provide 7 technical assistance with respect to the collection of the 8 data involved. 9 (c) COMPLIANCE.—The Secretary of Health and 10 Human Services shall require that entities comply with the 11 new standards developed under subsection (a) not later 12 than 2 years after the final promulgation of such stand- 13 ards. 14 SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS. 15 Section 306(n) of the Public Health Service Act (42 16 U.S.C. 242k(n)) is amended— 17 (1) in paragraph (1), by striking ‘‘2003’’ and 18 inserting ‘‘2024’’; 19 (2) in paragraph (2), in the first sentence, by 20 striking ‘‘2003’’ and inserting ‘‘2024’’; and 21 (3) in paragraph (3), by striking ‘‘2002’’ and 22 inserting ‘‘2024’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 38 •HR 7585 IH SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED- 1 ERAL GOVERNMENT. 2 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec- 3 retary of Health and Human Services, in coordination 4 with the officials referenced in subsection (b), shall estab- 5 lish a centralized electronic repository of Government data 6 on factors related to the health and well-being of the popu- 7 lation of the United States. 8 (b) COLLECTION; SUBMISSION.—Not later than 180 9 days after the date of enactment of this Act, and January 10 31 of each year thereafter, each department, agency, and 11 office of the Federal Government that has collected data 12 on race, ethnicity, sex, primary language, sexual orienta- 13 tion, disability status, gender identity, age, or socio- 14 economic status during the preceding calendar year shall 15 submit such data to the repository of Government data 16 established under subsection (a). 17 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 18 Not later than April 30, 2021, and April 30 of each year 19 thereafter, the Secretary of Health and Human Services, 20 acting through the Assistant Secretary for Planning and 21 Evaluation, the Assistant Secretary for Health, the Direc- 22 tor of the Agency for Healthcare Research and Quality, 23 the Director of the National Center for Health Statistics, 24 the Administrator of the Centers for Medicare & Medicaid 25 Services, the Director of the National Institute on Minor- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 39 •HR 7585 IH ity Health and Health Disparities, and the Deputy Assist- 1 ant Secretary for Minority Health, shall— 2 (1) prepare and make available datasets for 3 public use that relate to disparities in health status, 4 health care access, health care quality, health out- 5 comes, public health, the provision of equitable 6 health services, and other areas of health and well- 7 being by factors that include race, ethnicity, sex, pri- 8 mary language, sexual orientation, disability status, 9 gender identity, and socioeconomic status; 10 (2) ensure that these datasets are publicly iden- 11 tified on the repository established under subsection 12 (a) as ‘‘disparities’’ data; and 13 (3) submit a report to the Congress on the 14 availability and use of such data by public stake- 15 holders. 16 SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO 17 MINORITY-SERVING INSTITUTIONS. 18 (a) AUTHORITY.—The Secretary of Health and 19 Human Services, acting through the Director of the Na- 20 tional Institute on Minority Health and Health Disparities 21 and the Deputy Assistant Secretary for Minority Health, 22 shall award grants to eligible entities to access and analyze 23 racial and ethnic data on disparities in health and health 24 care, and where possible other data on disparities in health 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 40 •HR 7585 IH and health care, to monitor and report on progress to re- 1 duce and eliminate disparities in health and health care. 2 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 3 igible entity’’ means an entity that has an accredited pub- 4 lic health, health policy, or health services research pro- 5 gram and is any of the following: 6 (1) A part B institution, as defined in section 7 322 of the Higher Education Act of 1965 (20 8 U.S.C. 1061). 9 (2) A Hispanic-serving institution, as defined in 10 section 502 of such Act (20 U.S.C. 1101a). 11 (3) A Tribal College or University, as defined in 12 section 316 of such Act (20 U.S.C. 1059c). 13 (4) An Asian American and Native American 14 Pacific Islander-serving institution, as defined in 15 section 371(c) of such Act (20 U.S.C. 1067q(c)). 16 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 17 out this section, there are authorized to be appropriated 18 such sums as may be necessary for fiscal years 2023 19 through 2027. 20 SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH 21 RESPECT TO RACIAL AND ETHNIC BACK- 22 GROUND. 23 (a) IN GENERAL.—Chapter V of the Federal Food, 24 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 41 •HR 7585 IH ed by inserting after section 505G (21 U.S.C. 355h) the 1 following: 2 ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 3 RESPECT TO RACIAL AND ETHNIC BACK- 4 GROUND. 5 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence of 6 a racial or ethnic disparity in safety or effectiveness with 7 respect to a drug or biological product, then— 8 ‘‘(1)(A) in the case of a drug, the investigations 9 required under section 505(b)(1)(A) shall include 10 adequate and well-controlled investigations of the 11 disparity; or 12 ‘‘(B) in the case of a biological product, the evi- 13 dence required under section 351(a) of the Public 14 Health Service Act for approval of a biologics license 15 application for the biological product shall include 16 adequate and well-controlled investigations of the 17 disparity; and 18 ‘‘(2) if the investigations described in subpara- 19 graph (A) or (B) of paragraph (1) confirm that 20 there is such a disparity, the labeling of the drug or 21 biological product shall include appropriate informa- 22 tion about the disparity. 23 ‘‘(b) POSTMARKET STUDIES.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 42 •HR 7585 IH ‘‘(1) IN GENERAL.—If there is evidence of a ra- 1 cial or ethnic disparity in safety or effectiveness with 2 respect to a drug for which there is an approved ap- 3 plication under section 505 of this Act or of a bio- 4 logical product for which there is an approved li- 5 cense under section 351 of the Public Health Service 6 Act, the Secretary may by order require the holder 7 of the approved application or license to conduct, by 8 a date specified by the Secretary, postmarket studies 9 to investigate the disparity. 10 ‘‘(2) LABELING.—If the Secretary determines 11 that the postmarket studies confirm that there is a 12 disparity described in paragraph (1), the labeling of 13 the drug or biological product shall include appro- 14 priate information about the disparity. 15 ‘‘(3) STUDY DESIGN.—The Secretary may, in 16 an order under paragraph (1), specify all aspects of 17 the design of the postmarket studies required under 18 such paragraph for a drug or biological product, in- 19 cluding the number of studies and study partici- 20 pants, and the other demographic characteristics of 21 the study participants. 22 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 23 Secretary may, by order and as necessary, modify 24 any aspect of the design of a postmarket study re- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 43 •HR 7585 IH quired in an order under paragraph (1) after issuing 1 such order. 2 ‘‘(5) STUDY RESULTS.—The results from a 3 study required under paragraph (1) shall be sub- 4 mitted to the Secretary as a supplement to the drug 5 application or biologics license application. 6 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 7 ‘‘(1) IN GENERAL.—A drug for which an appli- 8 cation has been submitted or approved under section 9 505(j) shall not be considered ineligible for approval 10 under that section or misbranded under section 502 11 on the basis that the labeling of the drug omits in- 12 formation relating to a disparity on the basis of ra- 13 cial or ethnic background as to the safety or effec- 14 tiveness of the drug, whether derived from investiga- 15 tions or studies required under this section or de- 16 rived from other sources, when the omitted informa- 17 tion is protected by patent or by exclusivity under 18 section 505(j)(5)(F). 19 ‘‘(2) LABELING.—Notwithstanding paragraph 20 (1), the Secretary may require that the labeling of 21 a drug approved under section 505(j) that 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 include a statement of any ap- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 44 •HR 7585 IH propriate contraindications, warnings, or precautions 1 related to the disparity that the Secretary considers 2 necessary. 3 ‘‘(d) DEFINITION.—In this section, the term ‘evi- 4 dence of a racial or ethnic disparity in safety or effective- 5 ness’, with respect to a drug or biological product, in- 6 cludes— 7 ‘‘(1) evidence that there is a disparity on the 8 basis of racial or ethnic background as to safety or 9 effectiveness of a drug or biological product in the 10 same chemical class as the drug or biological prod- 11 uct; 12 ‘‘(2) evidence that there is a disparity on the 13 basis of racial or ethnic background in the way the 14 drug or biological product is metabolized; and 15 ‘‘(3) other evidence as the Secretary may deter- 16 mine appropriate.’’. 17 (b) ENFORCEMENT.—Section 502 of the Federal 18 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 19 ed by adding at the end the following: 20 ‘‘(gg) If it is a drug and the holder of the approved 21 application under section 505 or license under section 351 22 of the Public Health Service Act for the drug has failed 23 to complete the investigations or studies required under 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 45 •HR 7585 IH section 505H, or comply with any other requirement of 1 such section 505H.’’. 2 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 3 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 4 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 5 required’’ the following: ‘‘, including postmarket studies 6 required under section 505H’’. 7 SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE 8 HAWAIIANS AND PACIFIC ISLANDERS. 9 Part B of title III of the Public Health Service Act 10 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 11 tion 317U the following: 12 ‘‘SEC. 317V. NATIVE HAWAIIAN AND PACIFIC ISLANDER 13 HEALTH DATA. 14 ‘‘(a) DEFINITIONS.—In this section: 15 ‘‘(1) INSULAR AREA.—The term ‘insular area’ 16 means Guam, the Commonwealth of Northern Mar- 17 iana Islands, American Samoa, the United States 18 Virgin Islands, the Federated States of Micronesia, 19 the Republic of Palau, or the Republic of the Mar- 20 shall Islands. 21 ‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND- 22 ERS (NHPI).—The term ‘Native Hawaiians and Pa- 23 cific Islanders’ or ‘NHPI’ means people having ori- 24 gins in any of the original peoples of American 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 46 •HR 7585 IH Samoa, the Commonwealth of the Northern Mariana 1 Islands, the Federated States of Micronesia, Guam, 2 Hawaii, the Republic of the Marshall Islands, the 3 Republic of Palau, or any other Pacific Island. 4 ‘‘(3) NHPI STAKEHOLDER GROUPS.—The term 5 ‘NHPI stakeholder group’ includes each of the fol- 6 lowing: 7 ‘‘(A) COMMUNITY GROUP.—A group of 8 NHPI who are organized at the community 9 level, and may include a church group, social 10 service group, national advocacy organization, 11 or cultural group. 12 ‘‘(B) NONPROFIT, NONGOVERNMENTAL 13 ORGANIZATION.—A group of NHPI with a dem- 14 onstrated history of addressing NHPI issues, 15 including a NHPI coalition. 16 ‘‘(C) DESIGNATED ORGANIZATION.—An 17 entity established to represent NHPI popu- 18 lations and which has statutory responsibilities 19 to provide, or has community support for pro- 20 viding, health care. 21 ‘‘(D) GOVERNMENT REPRESENTATIVES OF 22 NHPI POPULATIONS.—Representatives from Ha- 23 waii, American Samoa, the Commonwealth of 24 the Northern Mariana Islands, the Federated 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 47 •HR 7585 IH States of Micronesia, Guam, the Republic of 1 Palau, and the Republic of the Marshall Is- 2 lands. 3 ‘‘(b) PRELIMINARY HEALTH SURVEY.— 4 ‘‘(1) IN GENERAL.—The Secretary, acting 5 through the Director of NCHS, shall conduct a pre- 6 liminary health survey in order to identify the major 7 areas and regions in the continental United States, 8 Hawaii, American Samoa, the Commonwealth of the 9 Northern Mariana Islands, the Federated States of 10 Micronesia, Guam, the Republic of Palau, and the 11 Republic of the Marshall Islands in which NHPI 12 people reside. 13 ‘‘(2) CONTENTS.—The health survey described 14 in paragraph (1) shall include health data and any 15 other data the Secretary determines to be— 16 ‘‘(A) useful in determining health status 17 and health care needs of NHPI populations; or 18 ‘‘(B) required for developing or imple- 19 menting the national strategy under subsection 20 (c). 21 ‘‘(3) METHODOLOGY.—Methodology for the 22 health survey described in paragraph (1), including 23 plans for designing questions, implementation, sam- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 48 •HR 7585 IH pling, and analysis, shall be developed in consulta- 1 tion with NHPI stakeholder groups. 2 ‘‘(4) TIMEFRAME.—The survey required under 3 this subsection shall be completed not later than 18 4 months after the date of enactment of the Health 5 Equity and Accountability Act of 2022. 6 ‘‘(c) NATIONAL STRATEGY.— 7 ‘‘(1) IN GENERAL.—The Secretary, acting 8 through the Director of the National Center for 9 Health Statistics (referred to in this section as 10 ‘NCHS’) of the Centers for Disease Control and 11 Prevention, and other agencies within the Depart- 12 ment of Health and Human Services as the Sec- 13 retary determines appropriate, shall develop and im- 14 plement a sustainable national strategy for identi- 15 fying and evaluating the health status and health 16 care needs of NHPI populations living in the conti- 17 nental United States, Hawaii, American Samoa, the 18 Commonwealth of the Northern Mariana Islands, 19 the Federated States of Micronesia, Guam, the Re- 20 public of Palau, and the Republic of the Marshall Is- 21 lands. 22 ‘‘(2) CONSULTATION.—In developing and imple- 23 menting a national strategy, as described in para- 24 graph (1), not later than 180 days after the date of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 49 •HR 7585 IH enactment of the Health Equity and Accountability 1 Act of 2022, the Secretary— 2 ‘‘(A) shall consult with representatives of 3 NHPI stakeholder groups; and 4 ‘‘(B) may solicit the participation of rep- 5 resentatives from other Federal agencies. 6 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 7 after the date of enactment of the Health Equity and Ac- 8 countability Act of 2022, the Secretary shall submit to 9 Congress a progress report, which shall include the na- 10 tional strategy described in subsection (c)(1). 11 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND 12 MEDICINE DIVISION.— 13 ‘‘(1) IN GENERAL.—The Secretary shall enter 14 into an agreement with the Health and Medicine Di- 15 vision of the National Academies of Sciences, Engi- 16 neering, and Medicine to conduct a study, with input 17 from stakeholders in insular areas, on each of the 18 following: 19 ‘‘(A) The standards and definitions of 20 health care applied to health care systems in in- 21 sular areas and the appropriateness of such 22 standards and definitions. 23 ‘‘(B) The status and performance of health 24 care systems in insular areas, evaluated based 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 50 •HR 7585 IH upon standards and definitions, as the Sec- 1 retary determines appropriate. 2 ‘‘(C) The effectiveness of donor aid in ad- 3 dressing health care needs and priorities in in- 4 sular areas. 5 ‘‘(D) The progress toward implementation 6 of recommendations of the Committee on 7 Health Care Services in the United States—As- 8 sociated Pacific Basin that are set forth in the 9 1998 report entitled ‘Pacific Partnerships for 10 Health: Charting a New Course’. 11 ‘‘(2) REPORT.—An agreement described in 12 paragraph (1) shall require the Health and Medicine 13 Division to submit to the Secretary and to Congress, 14 not later than 2 years after the date of the enact- 15 ment of the Health Equity and Accountability Act of 16 2022, a report containing a description of the results 17 of the study conducted under paragraph (1), includ- 18 ing the conclusions and recommendations of the 19 Health and Medicine Division for each of the items 20 described in subparagraphs (A) through (D) of such 21 paragraph. 22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 23 carry out this section, there are authorized to be appro- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 51 •HR 7585 IH priated such sums as may be necessary for fiscal years 1 2023 through 2027.’’. 2 SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA- 3 TIVE REPORTING REQUIREMENT. 4 Section 11(a) of the Food and Nutrition Act of 2008 5 (7 U.S.C. 2020(a)) is amended by adding at the end the 6 following: 7 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 8 REQUIREMENT.—With respect to any obligation of a 9 State agency to comply with the notification require- 10 ment under paragraph (2) of section 421(e) of the 11 Personal Responsibility and Work Opportunity Rec- 12 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith- 13 standing the requirement to include in that notifica- 14 tion the names of the sponsor and the sponsored 15 alien involved, the State agency shall be considered 16 to have complied with the notification requirement if 17 the State agency submits to the Attorney General a 18 report that includes the aggregate number of excep- 19 tions granted by the State agency under paragraph 20 (1) of that section.’’. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 52 •HR 7585 IH SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE- 1 PAREDNESS, TESTING, INFECTIONS, AND 2 DEATHS. 3 (a) SKILLED NURSING FACILITIES QUALITY RE- 4 PORTING.—Section 1819 of the Social Security Act (42 5 U.S.C. 1395i–3) is amended by adding at the end the fol- 6 lowing new subsection: 7 ‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR- 8 ING PUBLIC HEALTH EMERGENCIES.—During a public 9 health emergency declared by the Secretary pursuant to 10 section 319 of the Public Health Service Act, a skilled 11 nursing facility shall, not later than one year after the first 12 day of such declaration, and monthly thereafter during the 13 application of such declaration, submit to the Secretary 14 the following information, with respect to such facility and 15 the residents of such facility: 16 ‘‘(1) Information described in section 17 483.80(g)(1) of title 42, Code of Federal Regula- 18 tions. 19 ‘‘(2) The age, race, ethnicity, sex, sexual ori- 20 entation, gender identity, socioeconomic status, dis- 21 ability status, and preferred language of the resi- 22 dents of such skilled nursing facility.’’. 23 (b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION 24 IN CERTAIN SETTINGS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 53 •HR 7585 IH (1) DEMOGRAPHIC INFORMATION.—The Sec- 1 retary of Health and Human Services shall post the 2 following information with respect to skilled nursing 3 facilities (as defined in section 1819(a) of the Social 4 Security Act (42 U.S.C. 1395i–3(a))), congregate 5 care settings (including skilled nursing facilities, as- 6 sisted living facilities, prisons and jails, residential 7 behavioral health care and psychiatric facilities, and 8 facilities providing services for aging adults and peo- 9 ple with disabilities), and nursing facilities (as de- 10 fined in section 1919(a) of such Act (42 U.S.C. 11 1396r(a))) on the Nursing Home Compare website 12 (as described in section 1819(i) of the Social Secu- 13 rity Act (42 U.S.C. 1395i–3(i))), or a successor 14 website, aggregated by State: 15 (A) The age, race, ethnicity, sex, sexual 16 orientation, gender identity, socioeconomic sta- 17 tus, disability status, and preferred language of 18 the residents of such skilled nursing facilities, 19 congregate care settings (including skilled nurs- 20 ing facilities, assisted living facilities, prisons 21 and jails, residential behavioral health care and 22 psychiatric facilities, and facilities providing 23 services for aging adults and people with dis- 24 abilities), and nursing facilities with suspected 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 54 •HR 7585 IH or confirmed infections, including residents pre- 1 viously treated for COVID–19. 2 (B) The age, race, ethnicity, sex, sexual 3 orientation, gender identity, socioeconomic sta- 4 tus, disability status, and preferred language 5 relating to total deaths and public health emer- 6 gency-related deaths among residents of such 7 skilled nursing facilities, congregate settings 8 (including skilled nursing facilities, assisted liv- 9 ing facilities, prisons and jails, residential be- 10 havioral health care and psychiatric facilities, 11 and facilities providing services for aging adults 12 and people with disabilities), and nursing facili- 13 ties. 14 (2) CONFIDENTIALITY.—Any information re- 15 ported under this subsection that is made available 16 to the public shall be made so available in a manner 17 that protects the identity of residents of skilled nurs- 18 ing facilities, congregate care settings (including 19 skilled nursing facilities, assisted living facilities, 20 prisons and jails, residential behavioral health care 21 and psychiatric facilities, and facilities providing 22 services for aging adults and people with disabil- 23 ities), and nursing facilities. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 55 •HR 7585 IH (3) IMPLEMENTATION.—The Secretary may im- 1 plement the provisions of this subsection by program 2 instruction or otherwise. 3 (c) EQUITABLE DATA COLLECTION AND DISCLOSURE 4 REGARDING PANDEMICS.—Part A of title XI of the Social 5 Security Act (42 U.S.C. 1301 et seq.) as amended by sec- 6 tion 1003, is further amended by adding at the end the 7 following new section: 8 ‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO- 9 SURE REGARDING PANDEMICS. 10 ‘‘(a) IN GENERAL.—Not later than 60 days after the 11 Secretary submits to Congress written notification of the 12 determination that a disease or disorder presents a public 13 health emergency or that a public health emergency other- 14 wise exists, subject to the succeeding subsections, the Sec- 15 retary, acting through the Director of the Centers for Dis- 16 ease Control and Prevention and the Administrator of the 17 Centers for Medicare & Medicaid Services and in consulta- 18 tion with the Director of the Indian Health Service, shall 19 collect and make publicly available on the website of the 20 Centers for Disease Control and Prevention and the Cen- 21 ters for Medicare & Medicaid Services, and update every 22 day during a pandemic, data collected across all surveil- 23 lance systems relating to a public health emergency de- 24 clared under section 319 of the Public Health Service Act 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 56 •HR 7585 IH that is caused by a disease (as determined by the Sec- 1 retary), disaggregated by race, ethnicity, sex, sexual ori- 2 entation, gender identity, age, preferred language, socio- 3 economic status, disability status, and county, including 4 the following: 5 ‘‘(1) Data relating to all testing for the patho- 6 gen or pathogens causing the pandemic, including 7 the number of individuals tested and the number of 8 tests that were positive. 9 ‘‘(2) Data relating to treatment for the patho- 10 gen causing the pandemic, including hospitalizations 11 and intensive care unit admissions. 12 ‘‘(3) Data relating to pandemic outcomes, in- 13 cluding total fatalities and case fatality rates (ex- 14 pressed as the proportion of individuals who were in- 15 fected with the pathogen causing the pandemic and 16 died from the pathogen). 17 ‘‘(4) In the case a vaccine is developed in re- 18 sponse to a pandemic, data relating to such vaccina- 19 tion, including— 20 ‘‘(A) the number of vaccines administered; 21 ‘‘(B) the number of vaccinations offered, 22 accepted, and refused; 23 ‘‘(C) the most common reasons for refusal; 24 and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 57 •HR 7585 IH ‘‘(D) the percentage of vaccine doses allo- 1 cated and administered to each priority group. 2 ‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH 3 RESPECT TO DATA COLLECTION.—To the extent prac- 4 ticable, data collected under subsection (a) shall follow 5 standards developed by the Department of Health and 6 Human Services Office of Minority Health and be col- 7 lected, analyzed, and reported in accordance with the 8 standards promulgated by the Assistant Secretary for 9 Planning and Evaluation under title XXXI of the Public 10 Health Service Act. 11 ‘‘(c) PRIVACY.—In publishing data pursuant to sub- 12 section (a), the Secretary shall take all necessary steps to 13 protect the privacy of individuals whose information is in- 14 cluded in such data, including— 15 ‘‘(1) complying with privacy protections pro- 16 vided under the regulations promulgated under sec- 17 tion 264(c) of the Health Insurance and Account- 18 ability Act of 1996; and 19 ‘‘(2) protections from all inappropriate internal 20 use by an entity that collects, stores, or receives the 21 data, including use of such data in determinations of 22 eligibility (or continued eligibility) in health plans, 23 and from inappropriate uses.’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 58 •HR 7585 IH (d) REPORT REQUIREMENTS FOLLOWING PUBLIC 1 HEALTH EMERGENCIES.— 2 (1) PUBLICLY AVAILABLE SUMMARY.—Not later 3 than 60 days after the date on which the Secretary 4 of Health and Human Services certifies that a public 5 health emergency declared under section 319 of the 6 Public Health Service Act has ended, the Secretary 7 shall make publicly available on the website of the 8 Department of Health and Human Services a sum- 9 mary of the final statistics related to such emer- 10 gency. 11 (2) REPORT TO CONGRESS.—Not later than 60 12 days after the date on which the Secretary certifies 13 that a public health emergency declared under sec- 14 tion 319 of the Public Health Service Act has ended, 15 the Secretary shall submit the Committee on Health, 16 Education, Labor, and Pensions and the Committee 17 on Finance of the Senate and the Committee on En- 18 ergy and Commerce and the Committee on Ways 19 and Means of the House of Representatives a re- 20 port— 21 (A) describing the testing, hospitalization, 22 mortality rates, vaccination rates, and preferred 23 language of patients associated with the pan- 24 demic by race and ethnicity, rural and urban 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 59 •HR 7585 IH areas (as defined in section 1886(d)(2)(D) of 1 the Social Security Act (42 U.S.C. 2 1395ww(d)(2)(D)), and congregate care set- 3 tings (including skilled nursing facilities, as- 4 sisted living facilities, prisons and jails, residen- 5 tial behavioral health care and psychiatric facili- 6 ties, and facilities providing services for aging 7 adults and people with disabilities) and noncon- 8 gregate care settings (as such terms are defined 9 by the Secretary); and 10 (B) proposing evidenced-based response 11 strategies to safeguard the health of these com- 12 munities in future pandemics. 13 SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH 14 EQUITY. 15 (a) IN GENERAL.—Not later than 30 days after the 16 date of enactment of this Act, the Secretary of Health and 17 Human Services (referred to in this section as the ‘‘Sec- 18 retary’’) shall establish a commission, to be known as the 19 ‘‘Commission on Ensuring Data for Health Equity’’ (re- 20 ferred to in this section as the ‘‘Commission’’) to provide 21 clear and robust guidance to improve the collection, anal- 22 ysis, and use of demographic data in responding to future 23 public health emergencies. 24 (b) MEMBERSHIP AND CHAIRPERSON.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 60 •HR 7585 IH (1) MEMBERSHIP.—The Commission shall be 1 composed of— 2 (A) the Assistant Secretary for Prepared- 3 ness and Response; 4 (B) the Director of the Centers for Disease 5 Control and Prevention; 6 (C) the Director of the National Institutes 7 of Health; 8 (D) the Commissioner of Food and Drugs; 9 (E) the Administrator of the Federal 10 Emergency Management Agency; 11 (F) the Director of the National Institute 12 on Minority Health and Health Disparities; 13 (G) the Director of the Indian Health 14 Service; 15 (H) the Administrator of the Centers for 16 Medicare & Medicaid Services; 17 (I) the Director of the Agency for 18 Healthcare Research and Quality; 19 (J) the Surgeon General; 20 (K) the Administrator of the Health Re- 21 sources and Services Administration; 22 (L) the Director of the Office of Minority 23 Health; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 61 •HR 7585 IH (M) the Director of the Office of Women’s 1 Health; 2 (N) the Chairperson of the National Coun- 3 cil on Disability; 4 (O) at least 4 State, local, territorial, and 5 Tribal public health officials representing de- 6 partments of public health, or an Urban Indian 7 health representative, who shall represent juris- 8 dictions from different regions of the United 9 States with relatively high concentrations of 10 historically marginalized populations and rural 11 populations, to be appointed by the Secretary; 12 (P) the National Coordinator for Health 13 Information Technology; 14 (Q) at least 3 independent individuals with 15 expertise on racially and ethnically diverse rep- 16 resentation with knowledge or field experience 17 with community-based participatory research on 18 racial and ethnic disparities in public health, to 19 be appointed by the Secretary; and 20 (R) at least 4 individuals with expertise on 21 health equity and demographic data disparities 22 with knowledge of, or field experience in, lan- 23 guage, ability, sex, sexual orientation, gender 24 identity, or socioeconomic status. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 62 •HR 7585 IH (2) CHAIRPERSON.—The Assistant Secretary 1 for Preparedness and Response shall serve as the 2 Chairperson of the Commission. 3 (c) DUTIES.—The Commission shall— 4 (1) examine barriers to collecting, analyzing, 5 and using demographic data in public health; 6 (2) determine how to best use such data to pro- 7 mote health equity across the United States and re- 8 duce racial, Tribal, and other demographic dispari- 9 ties in health outcomes; 10 (3) gather available data related to treatment of 11 individuals with disabilities during the COVID–19 12 pandemic and other public health emergencies, in- 13 cluding access to vaccinations, denial of treatment 14 for preexisting conditions, removal or denial of dis- 15 ability related equipment (including ventilators and 16 continuous positive airway pressure (commonly re- 17 ferred to as CPAP) machines), and data on comple- 18 tion of do-not-resuscitate orders, and identify bar- 19 riers to obtaining accurate and timely data related 20 to treatment of such individuals; 21 (4) solicit input from public health officials, 22 community-connected organizations, health care pro- 23 viders, State and local agency officials, Tribal offi- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 63 •HR 7585 IH cials, and other experts on barriers to, and best 1 practices for, collecting demographic data; and 2 (5) recommend policy changes that the data in- 3 dicates are necessary to reduce demographic dispari- 4 ties in health outcomes. 5 (d) REPORT.—Not later than 1 year after the date 6 of the enactment of this Act, the Commission shall submit 7 to Congress, and publish on the website of the Department 8 of Health and Human Services, a report containing— 9 (1) the findings of the Commission pursuant to 10 subsection (c); 11 (2) to the extent possible, an analysis of— 12 (A) racial and other demographic dispari- 13 ties in COVID–19 mortality, including an anal- 14 ysis of comorbidities and case fatality rates; 15 (B) sex, sexual orientation, and gender 16 identity disparities in COVID–19 treatment and 17 mortality; and 18 (C) Federal Government policies that dis- 19 parately exacerbate the COVID–19 impact, and 20 recommendations to improve racial and other 21 demographic disparities in health outcomes; 22 (3) an analysis of COVID–19 treatment of indi- 23 viduals with disabilities, including equity of access to 24 treatment and equipment and intersections of dis- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 64 •HR 7585 IH ability status with other demographic factors, includ- 1 ing race; 2 (4) an analysis of what demographic data is 3 currently being collected, the accuracy of that data 4 and any gaps, how this data is currently being used 5 to inform efforts to combat COVID–19, and what 6 resources are needed to supplement existing public 7 health data collection; and 8 (5) the Commission’s recommendations with re- 9 spect to— 10 (A) how to enhance State, local, territorial, 11 and Tribal capacity to conduct public health re- 12 search on COVID–19 and in future public 13 health emergencies, with a focus on expanded 14 capacity to analyze data on disparities cor- 15 related with race, ethnicity, income, sex, sexual 16 orientation, gender identity, age, disability sta- 17 tus, specific geographic areas, and other rel- 18 evant demographic characteristics; 19 (B) how to collect, process, and disclose to 20 the public the data described in subparagraph 21 (A) in a way that maintains individual privacy 22 while helping direct the State, local, and Tribal 23 response to public health emergencies; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 65 •HR 7585 IH (C) how to improve demographic data col- 1 lection related to COVID–19 and other public 2 health emergencies in the short-term and long- 3 term, including how to continue to grow and 4 value the Tribal sovereignty of data and infor- 5 mation concerning urban and rural Tribal com- 6 munities; 7 (D) how to improve transparency and eq- 8 uity of treatment for individuals with disabil- 9 ities during the COVID–19 public health emer- 10 gency and future emergencies; and 11 (E) how to support State, local, and Tribal 12 capacity to eliminate barriers to vaccinations, 13 testing, and treatment during the COVID–19 14 pandemic and future public health emergencies. 15 (e) STAFF OF COMMISSION.— 16 (1) ADDITIONAL STAFF.—The Chairperson of 17 the Commission may appoint and fix the pay of ad- 18 ditional staff to the Commission as the Chairperson 19 considers appropriate. 20 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE 21 LAWS.—The staff of the Commission may be ap- 22 pointed without regard to the provisions of title 5, 23 United States Code, governing appointments in the 24 competitive service, and may be paid without regard 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 66 •HR 7585 IH to the provisions of chapter 51 and subchapter III 1 of chapter 53 of that title relating to classification 2 and General Schedule pay rates. 3 (3) DETAILEES.—Any Federal Government em- 4 ployee may be detailed to the Commission without 5 reimbursement from the Commission, and the 6 detailee shall retain the rights, status, and privileges 7 of his or her regular employment without interrup- 8 tion. 9 (f) COORDINATION WITH OTHER EFFORTS.—The 10 Secretary shall, in establishing the Commission under this 11 section, take such steps as may be necessary to ensure 12 that the work of the Commission does not overlap with, 13 or otherwise duplicate, other Federal Government efforts 14 with respect to ensuring health equity in data collection 15 in public health emergencies. 16 (g) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated such sums as may be 18 necessary to carry out this section. 19 SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND 20 ALGORITHMS. 21 (a) IN GENERAL.—Not later than 30 days after the 22 date of enactment of this Act, the Secretary of Health and 23 Human Services (referred to in this section as the ‘‘Sec- 24 retary’’) shall establish a Task Force to be known as the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 67 •HR 7585 IH ‘‘Task Force on Preventing AI and Algorithmic Bias in 1 Healthcare’’ (referred to in this section as the ‘‘Task 2 Force’’) to provide clear and robust guidance on how to 3 ensure that the development and integration of artificial 4 intelligence and algorithmic technologies within the health 5 care service delivery process does not exacerbate health 6 disparities and expands access to health care services. 7 (b) MEMBERSHIP AND CHAIRPERSON.— 8 (1) MEMBERSHIP.—The Task Force shall be 9 composed of— 10 (A) the Chief Information Officer of the 11 Department of Health and Human Services; 12 (B) the Director of the Centers for Disease 13 Control and Prevention; 14 (C) the Director of the National Institutes 15 of Health; 16 (D) the Commissioner of Food and Drugs; 17 (E) the Administrator of the Federal 18 Emergency Management Agency; 19 (F) the Director of the National Institute 20 on Minority Health and Health Disparities; 21 (G) the Director of the Indian Health 22 Service; 23 (H) the Administrator of the Centers for 24 Medicare & Medicaid Services; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 68 •HR 7585 IH (I) the Director of the Agency for 1 Healthcare Research and Quality; 2 (J) the Surgeon General; 3 (K) the Administrator of the Health Re- 4 sources and Services Administration; 5 (L) the Director of the Office of Minority 6 Health; 7 (M) the Director of the Office of Women’s 8 Health; 9 (N) the Chairperson of the National Coun- 10 cil on Disability; 11 (O) the National Coordinator for Health 12 Information Technology; 13 (P) at least 4 State, local, territorial, and 14 Tribal public health officials representing de- 15 partments of public health, or an Urban Indian 16 health representative, who shall represent juris- 17 dictions from different regions of the United 18 States with relatively high concentrations of 19 historically marginalized populations, to be ap- 20 pointed by the Secretary; 21 (Q) at least 3 independent individuals with 22 expertise on racially and ethnically diverse rep- 23 resentation with knowledge or field experience 24 with community-based participatory research on 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 69 •HR 7585 IH racial and ethnic disparities in public health, to 1 be appointed by the Secretary; and 2 (R) at least 4 individuals with expertise on 3 health equity and demographic data disparities 4 with knowledge of, or field experience in, lan- 5 guage, ability, sex, sexual orientation, gender 6 identity, or socioeconomic status. 7 (2) CHAIRPERSON.—The Chief Information Of- 8 ficer of the Department of Health and Human Serv- 9 ices (or the Chief Information Officer’s designee) 10 shall serve as the Chairperson of the Task Force. 11 (c) DUTIES.—The Task Force shall— 12 (1) examine where to place artificial intelligence 13 and algorithms in the health care service delivery 14 process relative to the use of autonomous human de- 15 cision-makers; 16 (2) identify the risks of health care system utili- 17 zation of artificial intelligence and algorithms in 18 terms of civil rights, civil liberties, and discrimina- 19 tory bias in health care access, quality, and out- 20 comes; and 21 (3) prepare and submit the report under sub- 22 section (d). 23 (d) REPORT.—Not later than 1 year after the date 24 of enactment of this Act, the Task Force shall— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 70 •HR 7585 IH (1) submit a written report of the findings of 1 the examination under paragraph (1) and rec- 2 ommendations to Congress with respect to imple- 3 mentation of artificial intelligence and algorithms in 4 health care delivery and mitigation of the risks asso- 5 ciated with that implementation; and 6 (2) publish such report on the website of the 7 Department of Health and Human Services. 8 (e) PUBLIC COMMENT.—Not later than 60 days after 9 the date of the date of the enactment of this Act, the Task 10 Force shall publish in the Federal Register a notice pro- 11 viding for a public comment period on the duties and ac- 12 tivities of the Task Force of not less than 90 days, begin- 13 ning on the date of that publication. 14 (f) STAFF OF COMMISSION.— 15 (1) ADDITIONAL STAFF.—The Chairperson of 16 the Task Force may appoint and fix the pay of addi- 17 tional staff to the Task Force as the Chairperson 18 considers appropriate. 19 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE 20 LAWS.—The staff of the Task Force may be ap- 21 pointed without regard to the provisions of title 5, 22 United States Code, governing appointments in the 23 competitive service, and may be paid without regard 24 to the provisions of chapter 51 and subchapter III 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 71 •HR 7585 IH of chapter 53 of that title relating to classification 1 and General Schedule pay rates. 2 (3) DETAILEES.—Any Federal Government em- 3 ployee may be detailed to the Task Force without re- 4 imbursement from the Task Force, and the detailee 5 shall retain the rights, status, and privileges of his 6 or her regular employment without interruption. 7 TITLE II—CULTURALLY AND LIN- 8 GUISTICALLY APPROPRIATE 9 HEALTH AND HEALTH CARE 10 SEC. 2001. DEFINITIONS; FINDINGS. 11 (a) DEFINITIONS.—In this title, the definitions in 12 section 3400 of the Public Health Service Act, as added 13 by section 2004, shall apply. 14 (b) FINDINGS.—Congress finds the following: 15 (1) Effective communication is essential to 16 meaningful access to quality physical and mental 17 health care. 18 (2) Research indicates that the lack of appro- 19 priate language services creates language barriers 20 that result in increased risk of misdiagnosis, ineffec- 21 tive treatment plans, and poor health outcomes for 22 individuals with limited English proficiency and indi- 23 viduals with communication disabilities such as cog- 24 nitive, hearing, vision, or print impairments. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 72 •HR 7585 IH (3) The number of limited English speaking 1 residents in the United States who speak English 2 less than very well and, therefore, cannot effectively 3 communicate with health and social service providers 4 continues to increase significantly. 5 (4) The responsibility to fund language services 6 in the provision of health care and health care-re- 7 lated services to individuals with limited English 8 proficiency and individuals with communication dis- 9 abilities such as cognitive hearing, vision, or print 10 impairments is a societal one that cannot fairly be 11 placed solely upon the health care, public health, or 12 social services community. 13 (5) Title VI of the Civil Rights Act of 1964 (42 14 U.S.C. 2000d et seq.) prohibits discrimination based 15 on the grounds of race, color, or national origin by 16 any entity receiving Federal financial assistance. In 17 order to avoid discrimination on the grounds of na- 18 tional origin, all programs or activities administered 19 by the Federal Government must take adequate 20 steps to ensure that their policies and procedures do 21 not deny or have the effect of denying individuals 22 with limited English proficiency with equal access to 23 benefits and services for which such persons qualify. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 73 •HR 7585 IH (6) Both the Americans with Disabilities Act of 1 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita- 2 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 3 discrimination on the basis of disability and require 4 the provision of appropriate auxiliary aids and serv- 5 ices necessary to ensure effective communication 6 with individuals with disabilities. The type of auxil- 7 iary aid or service necessary to ensure effective com- 8 munication will vary in accordance with the method 9 of communication used by the individual; the nature, 10 length, and complexity of the communication in- 11 volved; and the context in which the communication 12 is taking place. A public accommodation should con- 13 sult with individuals with disabilities whenever pos- 14 sible to determine what type of auxiliary aid is need- 15 ed to ensure effective communication. The public ac- 16 commodation should use the individual’s preferred 17 method of communication whenever possible, unless 18 it would be an undue burden to the public accommo- 19 dation and an alternative would provide an equally 20 effective means of communication. The ultimate de- 21 cision as to what measures to take rests with the 22 public accommodation, provided that the method 23 chosen results in effective communication. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 74 •HR 7585 IH (7) Section 1557 of the Patient Protection and 1 Affordable Care Act (42 U.S.C. 18116) builds on 2 title VI of the Civil Rights Act of 1964 (42 U.S.C. 3 2000d et seq.) and section 504 of the Rehabilitation 4 Act of 1973 (29 U.S.C. 794), prohibits discrimina- 5 tion on the basis of race, color, national origin, dis- 6 ability, sex, and age, requires the provision of lan- 7 guage services to ensure effective communication 8 with individuals with limited English proficiency, 9 and requires the provision of appropriate auxiliary 10 aids and services necessary to ensure effective com- 11 munication with individuals with disabilities. 12 (8) Linguistic diversity in the health care and 13 health care-related services workforce is important 14 for providing all patients the environment most con- 15 ducive to positive health outcomes. 16 (9) All members of the health care and health 17 care-related services community should continue to 18 educate their staff and constituents about limited 19 English proficient and disability communication 20 issues and help them identify resources to improve 21 access to quality care for individuals with limited 22 English proficiency and individuals with communica- 23 tion disabilities such as cognitive, hearing, vision, or 24 print impairments. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 75 •HR 7585 IH (10) Access to English as a second language, 1 foreign language, and sign language interpreters, 2 translated and alternative format documents, read- 3 ers, and other auxiliary aids and services, are essen- 4 tial to ensure effective communication and eliminate 5 the language barriers that impede access to health 6 care. 7 (11) Culturally competent language services in 8 health care settings should be available as a matter 9 of course. 10 SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID- 11 UALS WITH LIMITED ENGLISH PROFICIENCY. 12 (a) PURPOSE.—Consistent with the goals provided in 13 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 14 to improving access to services for persons with limited 15 English proficiency), it is the purpose of this section— 16 (1) to improve Federal agency performance re- 17 garding access to federally conducted and federally 18 assisted programs and activities for individuals with 19 limited English proficiency; 20 (2) to require each Federal agency to examine 21 the services it provides and develop and implement 22 a system by which individuals with limited English 23 proficiency can obtain culturally competent services 24 and meaningful access to those services consistent 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 76 •HR 7585 IH with, and without substantially burdening, the fun- 1 damental mission of the agency; 2 (3) to require each Federal agency to translate 3 any English language written material prepared for 4 the general public relating to a public health emer- 5 gency, including vaccine distribution and education, 6 into the top 15 non-English languages in the United 7 States (according to the most recent data from the 8 American Community Survey or its replacement) not 9 later than 7 days after any such material is made 10 available in English; 11 (4) to require each Federal agency to ensure 12 that recipients of Federal financial assistance pro- 13 vide culturally competent services and meaningful 14 access to applicants and beneficiaries who are indi- 15 viduals with limited English proficiency; 16 (5) to ensure that recipients of Federal finan- 17 cial assistance take reasonable steps, consistent with 18 the guidelines set forth in the ‘‘Guidance to Federal 19 Financial Assistance Recipients Regarding Title VI 20 Prohibition Against National Origin Discrimination 21 Affecting Limited English Proficient Persons (67 22 Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul- 23 turally and linguistically appropriate access to their 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 77 •HR 7585 IH programs and activities by individuals with limited 1 English proficiency; and 2 (6) to ensure compliance with title VI of the 3 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 4 and section 1557 of the Patient Protection and Af- 5 fordable Care Act (42 U.S.C. 18116) (prohibiting 6 health care providers and organizations from dis- 7 criminating in the provision of services). 8 (b) FEDERALLY CONDUCTED PROGRAMS AND AC- 9 TIVITIES.— 10 (1) IN GENERAL.—Not later than 120 days 11 after the date of enactment of this Act, each Federal 12 agency providing financial assistance to, or admin- 13 istering, a health program or activity described in 14 section 2003(a) shall prepare a plan or update a 15 plan to improve culturally and linguistically appro- 16 priate access to such program or activity with re- 17 spect to individuals with limited English proficiency. 18 Not later than 1 year after the date of enactment 19 of this title, each such Federal agency shall ensure 20 that such plan is fully implemented. 21 (2) PLAN REQUIREMENT.—Each plan under 22 paragraph (1) shall include— 23 (A) the steps the agency will take to en- 24 sure that individuals with limited English pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 78 •HR 7585 IH ficiency have access to each health program or 1 activity supported or administered by the agen- 2 cy; 3 (B) the policies and procedures for identi- 4 fying, assessing, and meeting the culturally and 5 linguistically appropriate language needs of its 6 beneficiaries that are individuals with limited 7 English proficiency served by such program or 8 activity; 9 (C) the steps the agency will take for such 10 program or activity to be culturally and linguis- 11 tically appropriate by— 12 (i) providing a range of language as- 13 sistance options; 14 (ii) giving notice to individuals with 15 limited English proficiency of the right to 16 competent language services; 17 (iii) training staff (at least annually); 18 and 19 (iv) monitoring and assessing the 20 quality of the language services (at least 21 annually); 22 (D) the steps the agency will take for such 23 program or activity to provide reasonable ac- 24 commodations necessary for individuals with 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 79 •HR 7585 IH limited English proficiency, including those in- 1 dividuals with a communication disability, to 2 understand communications from the agency; 3 (E) the steps the agency will take to en- 4 sure that applications, forms, and other signifi- 5 cant documents for such program or activity 6 are competently translated into the primary 7 language of a client that is an individual with 8 limited English proficiency where such mate- 9 rials are needed to improve access of such client 10 to such program or activity; 11 (F) the resources the agency will provide 12 to improve cultural and linguistic appropriate- 13 ness to assist recipients of Federal funds to im- 14 prove access to health care-related programs 15 and activities for individuals with limited 16 English proficiency; 17 (G) the resources the agency will provide 18 to ensure that competent language assistance is 19 provided to patients that are individuals with 20 limited English proficiency by interpreters or 21 trained bilingual staff; 22 (H) the resources the agency will provide 23 to ensure that family, particularly minor chil- 24 dren, and friends are not used to provide inter- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 80 •HR 7585 IH pretation services, except as permitted under 1 section 1557 of the Patient Protection and Af- 2 fordable Care Act (42 U.S.C. 18116); and 3 (I) the steps the agency will take and re- 4 sources the agency will provide to ensure that 5 individuals know their rights, including the abil- 6 ity to file a complaint. 7 (3) SUBMISSION OF PLAN TO DOJ.—Each agen- 8 cy that is required to prepare a plan under para- 9 graph (1) shall— 10 (A) consult with populations who are di- 11 rectly impacted by policies in the plan and their 12 representatives in the development of the plan; 13 and 14 (B) when the plan is finalized, send a copy 15 of such plan to the Attorney General, to serve 16 as the central repository of all such plans. 17 SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 18 LINGUISTICALLY APPROPRIATE SERVICES IN 19 HEALTH CARE. 20 (a) APPLICABILITY.—This section shall apply to any 21 health program or activity— 22 (1) of which any part is receiving Federal fi- 23 nancial assistance, including credits, subsidies, or 24 contracts of insurance; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 81 •HR 7585 IH (2) that is carried out (including indirectly 1 through contracts, subcontracts, or other support) 2 by an executive agency or any entity established 3 under title I of the Patient Protection and Afford- 4 able Care Act (42 U.S.C. 18001 et seq.) (or amend- 5 ments made thereby). 6 (b) STANDARDS.—Each program or activity de- 7 scribed in subsection (a)— 8 (1) shall implement strategies to recruit, retain, 9 and promote individuals at all levels to maintain a 10 diverse staff and leadership that can provide cul- 11 turally and linguistically appropriate health care to 12 patient populations of the service area of the pro- 13 gram or activity; 14 (2) shall educate and train governance, leader- 15 ship, and workforce at all levels and across all dis- 16 ciplines of the program or activity in culturally and 17 linguistically appropriate policies and practices on an 18 ongoing basis at least yearly; 19 (3) shall offer and provide language assistance, 20 including trained and competent bilingual staff and 21 interpreter services, to individuals with limited 22 English proficiency or who have other communica- 23 tion needs, at no cost to the individual at all points 24 of contact, and during all hours of operation, to fa- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 82 •HR 7585 IH cilitate timely access to health care services and 1 health care-related services; 2 (4) shall for each language group consisting of 3 individuals with limited English proficiency that con- 4 stitutes 5 percent or 500 individuals, whichever is 5 less, of the population of persons eligible to be 6 served or likely to be affected or encountered in the 7 service area of the program or activity, make avail- 8 able at a fifth grade reading level— 9 (A) easily understood patient-related mate- 10 rials, including print and multimedia materials, 11 in the language of such language group; 12 (B) information or notices about termi- 13 nation of benefits in such language; 14 (C) signage; and 15 (D) any other documents or types of docu- 16 ments designated by the Secretary; 17 (5) shall develop and implement clear goals, 18 policies, operational plans, and management, ac- 19 countability, and oversight mechanisms to provide 20 culturally and linguistically appropriate services and 21 infuse them throughout the planning and operations 22 of the program or activity; 23 (6) shall conduct initial and ongoing, at least 24 annually, organizational assessments of culturally 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 83 •HR 7585 IH and linguistically appropriate services-related activi- 1 ties and integrate valid linguistic, competence-related 2 National Standards for Culturally and Linguistically 3 Appropriate Services (CLAS) measures into the in- 4 ternal audits, performance improvement programs, 5 patient satisfaction assessments, continuous quality 6 improvement activities, and outcomes-based evalua- 7 tions of the program or activity and develop ways to 8 standardize assessments; 9 (7) shall ensure that, consistent with the pri- 10 vacy protections provided for under the regulations 11 promulgated under section 264(c) of the Health In- 12 surance Portability and Accountability Act of 1996 13 (42 U.S.C. 1320–2 note), data on an individual re- 14 quired to be collected pursuant to section 3101, in- 15 cluding the individual’s alternative format pref- 16 erences and policy modification needs, are— 17 (A) collected in health records; 18 (B) integrated into the management infor- 19 mation systems of the program or activity; 20 (C) reported in such a way as to be inter- 21 operable with health information systems at the 22 Federal and State levels; and 23 (D) periodically updated; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 84 •HR 7585 IH (8) shall maintain a current demographic, cul- 1 tural, and epidemiological profile of the community, 2 conduct regular assessments of community health 3 assets and needs, and use the results of such assess- 4 ments to accurately plan for and implement services 5 that respond to the cultural and linguistic character- 6 istics of the service area of the program or activity; 7 (9) shall develop participatory, collaborative 8 partnerships with community-based organizations 9 and utilize a variety of formal and informal mecha- 10 nisms to facilitate community and patient involve- 11 ment in designing, implementing, and evaluating 12 policies and practices to ensure culturally and lin- 13 guistically appropriate service-related activities; 14 (10) shall ensure that conflict and grievance 15 resolution processes are culturally and linguistically 16 appropriate and capable of identifying, preventing, 17 and resolving cross-cultural conflicts or complaints 18 by patients; 19 (11) shall annually make available to the public 20 information about their progress and successful in- 21 novations in implementing the standards under this 22 section, translated materials of such information 23 that is culturally and linguistically appropriate to 24 the communities served under this section, and pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 85 •HR 7585 IH vide public notice in such communities about the 1 availability of this information; and 2 (12) shall, if requested, regularly make avail- 3 able to the head of each Federal entity from which 4 Federal funds are provided, information about the 5 progress and successful innovations of the program 6 or activity in implementing the standards under this 7 section as required by the head of such entity. 8 (c) COMMENTS ACCEPTED THROUGH NOTICE AND 9 COMMENT RULEMAKING.—An agency carrying out a pro- 10 gram or activity described in subsection (a)— 11 (1) shall ensure that comments with respect to 12 such program or activity that are accepted through 13 notice and comment rulemaking are accepted in all 14 languages; 15 (2) may not require such comments to be sub- 16 mitted only in English; and 17 (3) shall ensure that any such comments that 18 are not submitted in English are considered, during 19 the agency’s review of such comments, equally as 20 such comments that are submitted in English. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 86 •HR 7585 IH SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO- 1 PRIATE HEALTH CARE IN THE PUBLIC 2 HEALTH SERVICE ACT. 3 The Public Health Service Act (42 U.S.C. 201 et 4 seq.) is amended by adding at the end the following: 5 ‘‘TITLE XXXIV—CULTURALLY 6 AND LINGUISTICALLY APPRO- 7 PRIATE HEALTH CARE 8 ‘‘SEC. 3400. DEFINITIONS. 9 ‘‘(a) IN GENERAL.—In this title: 10 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 11 respect to an individual, means an individual who 12 has a sufficient degree of proficiency in 2 languages. 13 ‘‘(2) CULTURAL.—The term ‘cultural’ means 14 relating to integrated patterns of human behavior 15 that include the language, thoughts, communica- 16 tions, actions, customs, beliefs, values, age, and in- 17 stitutions of racial, ethnic, religious, or social 18 groups, including lesbian, gay, bisexual, transgender, 19 queer, and questioning individuals, and individuals 20 with physical and mental disabilities. 21 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP- 22 PROPRIATE.—The term ‘culturally and linguistically 23 appropriate’ means being respectful of and respon- 24 sive to the cultural and linguistic needs of all indi- 25 viduals. 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 87 •HR 7585 IH ‘‘(4) EFFECTIVE COMMUNICATION.—The term 1 ‘effective communication’ means an exchange of in- 2 formation between the provider of health care or 3 health care-related services and the recipient of such 4 services who is limited in English proficiency, or has 5 a communication impairment such as a hearing, vi- 6 sion, speaking, or cognitive disability, that enables 7 access to, understanding of, and benefit from health 8 care or health care-related services, and full partici- 9 pation in the development of their treatment plan. 10 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 11 term ‘grievance resolution process’ means all aspects 12 of dispute resolution including filing complaints, 13 grievance and appeal procedures, and court action. 14 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 15 care group’ means a group of physicians organized, 16 at least in part, for the purposes of providing physi- 17 cian services under the Medicaid program under title 18 XIX of the Social Security Act, the State Children’s 19 Health Insurance Program under title XXI of such 20 Act, or the Medicare program under title XVIII of 21 such Act, including a provider of services under part 22 B of such title XVIII, and may include a hospital, 23 a hospice provider, a palliative care provider, and 24 any other individual or entity furnishing services 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 88 •HR 7585 IH covered under any such program that is affiliated 1 with the health care group. 2 ‘‘(7) HEALTH CARE.—The term ‘health care’ 3 includes all health care needed throughout the life 4 cycle and the end of life. 5 ‘‘(8) HEALTH CARE SERVICES.—The term 6 ‘health care services’ means services that address 7 physical and mental health conditions, as well as 8 conditions impacted by social determinants of health, 9 in all care settings throughout the life cycle and the 10 end of life. 11 ‘‘(9) HEALTH CARE-RELATED SERVICES.—The 12 term ‘health care-related services’ means human or 13 social services programs or activities that provide ac- 14 cess, referrals, or links to health care services. 15 ‘‘(10) HEALTH EDUCATOR.—The term ‘health 16 educator’ includes a professional with a bacca- 17 laureate degree who is responsible for designing, im- 18 plementing, and evaluating individual and population 19 health promotion, health education (including edu- 20 cation on end-of-life care options), end-of-life care, 21 or chronic disease prevention programs. 22 ‘‘(11) INDIAN; INDIAN TRIBE.—The terms ‘In- 23 dian’ and ‘Indian Tribe’ have the meanings given 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 89 •HR 7585 IH such terms in section 4 of the Indian Self-Deter- 1 mination and Education Assistance Act. 2 ‘‘(12) INDIVIDUAL WITH A DISABILITY.—The 3 term ‘individual with a disability’ means any indi- 4 vidual who has a disability as defined for the pur- 5 pose of section 504 of the Rehabilitation Act of 6 1973. 7 ‘‘(13) INDIVIDUAL WITH LIMITED ENGLISH 8 PROFICIENCY.—The term ‘individual with limited 9 English proficiency’ means an individual who self- 10 identifies on the Census as speaking English less 11 than ‘very well’. 12 ‘‘(14) INTEGRATED HEALTH CARE DELIVERY 13 SYSTEM.—The term ‘integrated health care delivery 14 system’ means an interdisciplinary system that 15 brings together providers from the primary health, 16 mental health, substance use disorder, hospice and 17 palliative care, and related disciplines to improve the 18 health outcomes of an individual and the community. 19 Such providers may include hospitals, health, mental 20 health, or substance use prevention and treatment 21 clinics and providers, home health agencies, home- 22 and community-based services providers, congregate 23 care settings (including any skilled nursing facilities, 24 assisted living facilities, prisons and jails, residential 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 90 •HR 7585 IH behavioral health care and psychiatric facilities, and 1 facilities providing services for aging adults and peo- 2 ple with disabilities), ambulatory surgery centers, re- 3 habilitation centers, and employed, independent, or 4 contracted physicians. 5 ‘‘(15) INTERPRETING; INTERPRETATION.—The 6 terms ‘interpreting’ and ‘interpretation’ mean the 7 transmission of a spoken, written, or signed message 8 from one language or format into another, faithfully, 9 accurately, and objectively. 10 ‘‘(16) LANGUAGE ACCESS.—The term ‘language 11 access’ means the provision of language services to 12 an individual with limited English proficiency or an 13 individual with communication disabilities designed 14 to enhance that individual’s access to, understanding 15 of, or benefit from health care services or health 16 care-related services. 17 ‘‘(17) LANGUAGE ASSISTANCE SERVICES.—The 18 term ‘language assistance services’ includes— 19 ‘‘(A) oral language assistance, including in- 20 terpretation in non-English languages provided 21 in-person or remotely by a qualified interpreter 22 for an individual with limited English pro- 23 ficiency, and the use of qualified bilingual or 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 91 •HR 7585 IH multilingual staff to communicate directly with 1 individuals with limited English proficiency; 2 ‘‘(B) written translation, performed by a 3 qualified translator, of written content in paper 4 or electronic form into languages other than 5 English; and 6 ‘‘(C) taglines. 7 ‘‘(18) MINORITY.— 8 ‘‘(A) IN GENERAL.—The terms ‘minority’ 9 and ‘minorities’ refer to individuals from a mi- 10 nority group. 11 ‘‘(B) POPULATIONS.—The term ‘minority’, 12 with respect to populations, refers to racial and 13 ethnic minority groups, members of sexual and 14 gender minority groups, and individuals with a 15 disability. 16 ‘‘(19) MINORITY GROUP.—The term ‘minority 17 group’ means a racial and ethnic minority group as 18 defined in this section. 19 ‘‘(20) ONSITE INTERPRETATION.—The term 20 ‘onsite interpretation’ means a method of inter- 21 preting or interpretation for which the interpreter is 22 in the physical presence of the provider of health 23 care services or health care-related services and the 24 recipient of such services who is limited in English 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 92 •HR 7585 IH proficiency or has a communication impairment such 1 as an impairment in hearing, vision, or learning. 2 ‘‘(21) QUALIFIED INDIVIDUAL WITH A DIS- 3 ABILITY.—The term ‘qualified individual with a dis- 4 ability’ means, with respect to a health program or 5 activity, an individual with a disability who, with or 6 without reasonable modifications to policies, prac- 7 tices, or procedures, the removal of architectural, 8 communication, or transportation barriers, or the 9 provision of auxiliary aids and services, meets the es- 10 sential eligibility requirements for the receipt of aids, 11 benefits, or services offered or provided by the health 12 program or activity. 13 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI- 14 VIDUAL WITH A DISABILITY.—The term ‘qualified 15 interpreter for an individual with a disability’, with 16 respect to an individual with a disability— 17 ‘‘(A) means an interpreter for such indi- 18 vidual who by means of a remote interpreting 19 service or an onsite appearance— 20 ‘‘(i) adheres to generally accepted in- 21 terpreter ethics principles, including client 22 confidentiality; and 23 ‘‘(ii) is able to interpret effectively, ac- 24 curately, and impartially, both receptively 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 93 •HR 7585 IH and expressively, using any necessary spe- 1 cialized vocabulary, terminology, and phra- 2 seology; and 3 ‘‘(B) may include— 4 ‘‘(i) sign language interpreters; 5 ‘‘(ii) oral transliterators, which are in- 6 dividuals who represent or spell in the 7 characters of another alphabet; and 8 ‘‘(iii) cued language transliterators, 9 which are individuals who represent or 10 spell by using a small number of 11 handshapes. 12 ‘‘(23) QUALIFIED INTERPRETER FOR AN INDI- 13 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 14 The term ‘qualified interpreter for an individual with 15 limited English proficiency’ means an interpreter 16 who by means of a remote interpreting service or an 17 onsite appearance— 18 ‘‘(A) adheres to generally accepted inter- 19 preter ethics principles, including client con- 20 fidentiality; 21 ‘‘(B) has demonstrated proficiency in 22 speaking and understanding both spoken 23 English and one or more other spoken lan- 24 guages; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 94 •HR 7585 IH ‘‘(C) is able to interpret effectively, accu- 1 rately, and impartially, both receptively and ex- 2 pressly, to and from such languages and 3 English, using any necessary specialized vocab- 4 ulary, terminology, and phraseology. 5 ‘‘(24) QUALIFIED TRANSLATOR.—The term 6 ‘qualified translator’ means a translator who— 7 ‘‘(A) adheres to generally accepted trans- 8 lator ethics principles, including client confiden- 9 tiality; 10 ‘‘(B) has demonstrated proficiency in writ- 11 ing and understanding both written English 12 and one or more other written non-English lan- 13 guages; and 14 ‘‘(C) is able to translate effectively, accu- 15 rately, and impartially to and from such lan- 16 guages and English, using any necessary spe- 17 cialized vocabulary, terminology, and phrase- 18 ology. 19 ‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 20 The term ‘racial and ethnic minority group’ means 21 Indians and Alaska Natives, African Americans (in- 22 cluding Caribbean Blacks, Africans, and other 23 Blacks), Asian Americans, Hispanics (including 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 95 •HR 7585 IH Latinos), Middle Easterners and North Africans, 1 and Native Hawaiians and other Pacific Islanders. 2 ‘‘(26) SECRETARY.—The term ‘Secretary’ 3 means the Secretary of Health and Human Services, 4 acting through the Director of the Agency for 5 Healthcare Research and Quality. 6 ‘‘(27) SEXUAL AND GENDER MINORITY 7 GROUP.—The term ‘sexual and gender minority 8 group’ encompasses lesbian, gay, bisexual, and 9 transgender populations, as well as those whose sex- 10 ual orientation, gender identity and expression, or 11 reproductive development varies from traditional, so- 12 cietal, cultural, or physiological norms. 13 ‘‘(28) SIGHT TRANSLATION.—The term ‘sight 14 translation’ means the transmission of a written 15 message in one language into a spoken or signed 16 message in another language, or an alternative for- 17 mat in English or another language. 18 ‘‘(29) STATE.—Notwithstanding section 2, the 19 term ‘State’ means each of the several States, the 20 District of Columbia, the Commonwealth of Puerto 21 Rico, the United States Virgin Islands, Guam, 22 American Samoa, and the Commonwealth of the 23 Northern Mariana Islands. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 96 •HR 7585 IH ‘‘(30) TELEPHONIC INTERPRETATION.—The 1 term ‘telephonic interpretation’ (also known as ‘over 2 the phone interpretation’ or ‘OPI’) means, with re- 3 spect to interpretation for an individual with limited 4 English proficiency, a method of interpretation in 5 which the interpreter is not in the physical presence 6 of the provider of health care services or health care- 7 related services and such individual receiving such 8 services, but the interpreter is connected via tele- 9 phone. 10 ‘‘(31) TRANSLATION.—The term ‘translation’ 11 means the transmission of a written message in one 12 language into a written or signed message in an- 13 other language, and includes translation into an- 14 other language or alternative format, such as large 15 print font, Braille, audio recording, or CD. 16 ‘‘(32) UNDERSERVED COMMUNITIES.—The 17 term ‘underserved communities’ means populations 18 sharing a particular characteristic, as well as geo- 19 graphic communities, who have been systematically 20 denied a full opportunity to participate in aspects of 21 economic, social, and civic life, such as— 22 ‘‘(A) Black, Latino, and Indigenous and 23 Native American persons, Asian Americans and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 97 •HR 7585 IH Pacific Islanders, Middle Easterners and North 1 Africans, and other persons of color; 2 ‘‘(B) members of religious minorities; 3 ‘‘(C) lesbian, gay, bisexual, transgender, 4 and queer persons; 5 ‘‘(D) persons with disabilities; 6 ‘‘(E) persons who live in rural areas; and 7 ‘‘(F) persons otherwise adversely affected 8 by persistent poverty or inequality as defined in 9 Executive Order 13985. 10 ‘‘(33) UNDERSERVED POPULATIONS.—The 11 term ‘underserved populations’ means populations 12 sharing a particular characteristic, as well as geo- 13 graphic communities, who have been systematically 14 denied a full opportunity to participate in aspects of 15 economic, social, and civic life, as defined in Execu- 16 tive Order 13985. 17 ‘‘(34) VIDEO REMOTE INTERPRETING SERV- 18 ICES.—The term ‘video remote interpreting services’ 19 means the provision, in health care services or health 20 care-related services, through a qualified interpreter 21 for an individual with limited English proficiency, of 22 video remote interpreting services that are— 23 ‘‘(A) in real-time, full-motion video, and 24 audio over a dedicated high-speed, wide-band- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 98 •HR 7585 IH width video connection or wireless connection 1 that delivers high-quality video images that do 2 not produce lags, choppy, blurry, or grainy im- 3 ages, or irregular pauses in communication; and 4 ‘‘(B) in a sharply delineated image that is 5 large enough to display. 6 ‘‘(35) VITAL DOCUMENT.—The term ‘vital doc- 7 ument’ includes applications for government pro- 8 grams that provide health care services, medical or 9 financial consent forms, financial assistance docu- 10 ments, letters containing important information re- 11 garding patient instructions (such as prescriptions, 12 referrals to other providers, and discharge plans) 13 and participation in a program (such as a Medicaid 14 managed care program), notices pertaining to the 15 reduction, denial, or termination of services or bene- 16 fits, notices of the right to appeal such actions, and 17 notices advising individuals with limited English pro- 18 ficiency with communication disabilities of the avail- 19 ability of free language services, alternative formats, 20 and other outreach materials. 21 ‘‘(b) REFERENCE.—In any reference in this title to 22 a regulatory provision applicable to a ‘handicapped indi- 23 vidual’, the term ‘handicapped individual’ in such provi- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 99 •HR 7585 IH sion shall have the same meaning as the term ‘individual 1 with a disability’ as defined in subsection (a). 2 ‘‘Subtitle A—Resources and Innova- 3 tion for Culturally and Linguis- 4 tically Appropriate Health Care 5 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 6 AND LINGUISTICALLY APPROPRIATE HEALTH 7 CARE. 8 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab- 9 lish and support a center to be known as the ‘Robert T. 10 Matsui Center for Culturally and Linguistically Appro- 11 priate Health Care’ (referred to in this section as the 12 ‘Center’) to carry out each of the following activities: 13 ‘‘(1) INTERPRETATION SERVICES.— 14 ‘‘(A) IN GENERAL.—The Center shall pro- 15 vide resources via the internet to identify and 16 link health care providers to competent and 17 qualified interpreter and translation services. 18 ‘‘(B) TRAINING.—For purposes of pro- 19 viding the services described in subparagraph 20 (A), the Center shall adopt a language access 21 plan that includes training requirements for 22 Center staff to provide such services. 23 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 100 •HR 7585 IH ‘‘(A) VITAL DOCUMENTS.—The Center 1 shall provide, directly or through contract, to 2 providers of health care services and health 3 care-related services, at no cost to such pro- 4 viders and in a timely and reasonable manner, 5 vital documents— 6 ‘‘(i) which may be submitted by cov- 7 ered entities (as defined in section 92.4 of 8 title 45, Code of Federal Regulations, as in 9 effect on May 18, 2016) for translation 10 into non-English languages or alternative 11 formats at a fifth-grade reading level; and 12 ‘‘(ii) from competent translation serv- 13 ices, the quality of which shall be mon- 14 itored and reported publicly. 15 ‘‘(B) FORMS.—For each form developed or 16 revised by the Secretary that will be used by in- 17 dividuals with limited English proficiency in 18 health care or health care-related settings, the 19 Center shall, not later than 45 calendar days of 20 the Secretary receiving final approval of the 21 form from the Office of Management and 22 Budget— 23 ‘‘(i) translate the form, at a min- 24 imum, into the top 15 non-English lan- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 101 •HR 7585 IH guages in the United States according to 1 the most recent data from the American 2 Community Survey or its replacement; and 3 ‘‘(ii) post all translated forms on the 4 Center’s website. 5 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 6 PHONE NUMBER.—The Center shall provide, 7 through a toll-free number, a customer service line 8 for individuals with limited English proficiency that 9 is linked to the toll-free telephone number 1–800– 10 MEDICARE and a toll-free telephone hotline pro- 11 vided for pursuant to section 1311(d)(4)(B) of the 12 Patient Protection and Affordable Care Act by an 13 Exchange established under title I of such Act— 14 ‘‘(A) to obtain information about federally 15 conducted or funded health programs, including 16 the Medicare program under title XVIII of the 17 Social Security Act, the Medicaid program 18 under title XIX of such Act, and the State Chil- 19 dren’s Health Insurance Program under title 20 XXI of such Act, and coverage available 21 through an Exchange established under title I 22 of the Patient Protection and Affordable Care 23 Act, and other sources of free or reduced care 24 including federally qualified health centers, enti- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 102 •HR 7585 IH ties receiving assistance under title X, and pub- 1 lic health departments; 2 ‘‘(B) to obtain assistance with applying for 3 or accessing these programs and understanding 4 Federal notices written in English; and 5 ‘‘(C) to learn how to access language serv- 6 ices. 7 ‘‘(4) HEALTH INFORMATION CLEARING- 8 HOUSE.— 9 ‘‘(A) IN GENERAL.—The Center shall de- 10 velop and maintain, and make available on the 11 internet and in print, an information clearing- 12 house that includes the information described in 13 subparagraphs (B) through (F)— 14 ‘‘(i) to facilitate the provision of lan- 15 guage services by providers of health care 16 services and health care-related services to 17 reduce medical errors; 18 ‘‘(ii) to improve medical outcomes, im- 19 prove cultural competence, reduce health 20 care costs caused by miscommunication 21 with individuals with limited English pro- 22 ficiency; and 23 ‘‘(iii) to reduce or eliminate the dupli- 24 cation of efforts to translate materials. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 103 •HR 7585 IH ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 1 ter shall collect and evaluate for accuracy, de- 2 velop, and make available templates for stand- 3 ard documents that are necessary for patients 4 and consumers to access and make educated de- 5 cisions about their health care, including tem- 6 plates for each of the following: 7 ‘‘(i) Administrative and legal docu- 8 ments, including— 9 ‘‘(I) intake forms; 10 ‘‘(II) forms related to the Medi- 11 care program under title XVIII of the 12 Social Security Act, the Medicaid pro- 13 gram under title XIX of such Act, 14 and the State Children’s Health In- 15 surance Program under title XXI of 16 such Act, including eligibility informa- 17 tion for such programs; 18 ‘‘(III) forms informing patients 19 of the compliance and consent re- 20 quirements pursuant to the regula- 21 tions under section 264(c) of the 22 Health Insurance Portability and Ac- 23 countability Act of 1996 (42 U.S.C. 24 1320–2 note); and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 104 •HR 7585 IH ‘‘(IV) documents concerning in- 1 formed consent, advanced directives, 2 and waivers of rights. 3 ‘‘(ii) Clinical information, such as how 4 to take medications, how to prevent trans- 5 mission of a contagious disease, and other 6 prevention and treatment instructions. 7 ‘‘(iii) Public health, patient education, 8 and outreach materials, such as immuniza- 9 tion notices, health warnings, or screening 10 notices. 11 ‘‘(iv) Additional health or health care- 12 related materials as determined appro- 13 priate by the Director of the Center. 14 ‘‘(C) STRUCTURE OF FORMS.—In oper- 15 ating the clearinghouse, the Center shall— 16 ‘‘(i) ensure that the documents posted 17 in English and non-English languages are 18 culturally and linguistically appropriate; 19 ‘‘(ii) allow public review of the docu- 20 ments before dissemination in order to en- 21 sure that the documents are understand- 22 able and culturally and linguistically ap- 23 propriate for the target populations; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 105 •HR 7585 IH ‘‘(iii) allow health care providers to 1 customize the documents for their use; 2 ‘‘(iv) facilitate access to such docu- 3 ments; 4 ‘‘(v) provide technical assistance with 5 respect to the access and use of such infor- 6 mation; and 7 ‘‘(vi) carry out any other activities the 8 Secretary determines to be useful to fulfill 9 the purposes of the clearinghouse. 10 ‘‘(D) LANGUAGE ASSISTANCE PRO- 11 GRAMS.—The Center shall provide for the col- 12 lection and dissemination of information on cur- 13 rent examples of language assistance programs 14 and strategies to improve language services for 15 individuals with limited English proficiency, in- 16 cluding case studies using de-identified patient 17 information, program summaries, and program 18 evaluations. 19 ‘‘(E) CULTURALLY AND LINGUISTICALLY 20 APPROPRIATE MATERIALS.—The Center shall 21 provide, at no cost, to all health care providers 22 and all providers of health care-related services, 23 information relating to culturally and linguis- 24 tically appropriate health care for minority pop- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 106 •HR 7585 IH ulations residing in the United States, includ- 1 ing— 2 ‘‘(i) tenets of culturally and linguis- 3 tically appropriate care; 4 ‘‘(ii) culturally and linguistically ap- 5 propriate self-assessment tools; 6 ‘‘(iii) culturally and linguistically ap- 7 propriate training tools; 8 ‘‘(iv) strategic plans to increase cul- 9 tural and linguistic appropriateness in dif- 10 ferent types of providers of health care 11 services and health care-related services, 12 including regional collaborations among 13 health care organizations for health care 14 services and health care-related services; 15 and 16 ‘‘(v) culturally and linguistically ap- 17 propriate information for educators, practi- 18 tioners, students, and researchers. 19 ‘‘(F) TRANSLATION GLOSSARIES.—The 20 Center shall— 21 ‘‘(i) develop and publish on its website 22 translation glossaries that provide stand- 23 ardized translations of commonly used 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 107 •HR 7585 IH terms and phrases utilized in documents 1 translated by the Center; and 2 ‘‘(ii) make such glossaries available— 3 ‘‘(I) free of charge; 4 ‘‘(II) in each language in which 5 the Center translates forms under 6 paragraph (2)(B); 7 ‘‘(III) in alternative formats in 8 accordance with the Americans with 9 Disabilities Act of 1990 (42 U.S.C. 10 12101 et seq.); and 11 ‘‘(IV) in paper format upon re- 12 quest. 13 ‘‘(G) INFORMATION ABOUT PROGRESS.— 14 The Center shall— 15 ‘‘(i) regularly collect and make pub- 16 licly available information about the 17 progress of entities receiving grants under 18 section 3402 regarding successful innova- 19 tions in implementing the requirements of 20 this subsection; and 21 ‘‘(ii) provide public notice in the enti- 22 ties’ communities about the availability of 23 such information. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 108 •HR 7585 IH ‘‘(b) DIRECTOR.—The Center shall be headed by a 1 Director who shall be appointed by, and who shall report 2 to, the Director of the Agency for Healthcare Research 3 and Quality. 4 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 5 rector of the Center shall collaborate with the Deputy As- 6 sistant Secretary for Minority Health, the Administrator 7 of the Centers for Medicare & Medicaid Services, and the 8 Administrator of the Health Resources and Services Ad- 9 ministration to notify health care providers and health 10 care organizations about the availability of language ac- 11 cess services by the Center. 12 ‘‘(d) EDUCATION.—The Secretary, directly or 13 through contract, shall undertake a national education 14 campaign to inform providers, individuals with limited 15 English proficiency, individuals with hearing or vision im- 16 pairments, health professionals, graduate schools, commu- 17 nity health centers, social service providers, and commu- 18 nity-based organizations about— 19 ‘‘(1) Federal and State laws and guidelines gov- 20 erning access to language services; 21 ‘‘(2) the value of using trained and competent 22 interpreters and the risks associated with using fam- 23 ily members, friends, minors, and untrained bilin- 24 gual staff; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 109 •HR 7585 IH ‘‘(3) funding sources for developing and imple- 1 menting language services; and 2 ‘‘(4) promising practices to effectively provide 3 language services. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated to carry out this section 6 $5,000,000 for each of fiscal years 2023 through 2027. 7 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS- 8 TICALLY APPROPRIATE HEALTH CARE 9 GRANTS. 10 ‘‘(a) IN GENERAL.— 11 ‘‘(1) GRANTS.—The Secretary shall award 12 grants to eligible entities to enable such entities to 13 design, implement, and evaluate innovative, cost-ef- 14 fective programs to improve culturally and linguis- 15 tically appropriate access to health care services for 16 individuals with limited English proficiency and com- 17 munication disabilities. 18 ‘‘(2) COORDINATION.—In making grants under 19 this section, and in the design and implementation 20 of the program established under this section, the 21 Secretary shall coordinate with, and ensure the par- 22 ticipation of, other agencies including the Health Re- 23 sources and Services Administration, the National 24 Institute on Minority Health and Health Disparities 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 110 •HR 7585 IH at the National Institutes of Health, and the Office 1 of Minority Health. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 3 under subsection (a), an entity shall be— 4 ‘‘(1) a city, county, Indian Tribe, State, or sub- 5 division thereof; 6 ‘‘(2) an organization described in section 7 501(c)(3) of the Internal Revenue Code of 1986 and 8 exempt from tax under section 501(a) of such Code; 9 ‘‘(3) a community health, mental health, or 10 substance use disorder center or clinic; 11 ‘‘(4) a solo or group physician practice; 12 ‘‘(5) an integrated health care delivery system; 13 ‘‘(6) a public hospital; 14 ‘‘(7) a health care group, university, or college; 15 or 16 ‘‘(8) any other entity designated by the Sec- 17 retary. 18 ‘‘(c) APPLICATION.—An eligible entity seeking a 19 grant under this section shall prepare and submit to the 20 Secretary an application, at such time, in such manner, 21 and containing such additional information as the Sec- 22 retary may reasonably require. 23 ‘‘(d) USE OF FUNDS.—An entity shall use funds re- 24 ceived through a grant under this section to— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 111 •HR 7585 IH ‘‘(1) develop, implement, and evaluate models of 1 providing competent interpretation services through 2 onsite interpretation, telephonic interpretation, or 3 video remote interpreting services; 4 ‘‘(2) implement strategies to recruit, retain, and 5 promote individuals at all levels of the organization 6 to maintain a diverse staff and leadership that can 7 promote and provide language services to patient 8 populations of the service area of the entity; 9 ‘‘(3) develop and maintain a needs assessment 10 that identifies the current demographic, cultural, 11 and epidemiological profile of the community to ac- 12 curately plan for and implement language services 13 needed in the service area of the entity; 14 ‘‘(4) develop a strategic plan to implement lan- 15 guage services; 16 ‘‘(5) develop participatory, collaborative part- 17 nerships with communities encompassing the patient 18 populations of individuals with limited English pro- 19 ficiency served by the grant to gain input in design- 20 ing and implementing language services; 21 ‘‘(6) develop and implement grievance resolu- 22 tion processes that are culturally and linguistically 23 appropriate and capable of identifying, preventing, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 112 •HR 7585 IH and resolving complaints by individuals with limited 1 English proficiency; 2 ‘‘(7) develop short-term medical and mental 3 health interpretation training courses and incentives 4 for bilingual health care staff who are asked to pro- 5 vide interpretation services in the workplace; 6 ‘‘(8) develop formal training programs, includ- 7 ing continued professional development and edu- 8 cation programs as well as supervision, for individ- 9 uals interested in becoming dedicated health care in- 10 terpreters and culturally and linguistically appro- 11 priate providers; 12 ‘‘(9) provide staff language training instruction, 13 which shall include information on the practical limi- 14 tations of such instruction for nonnative speakers; 15 ‘‘(10) develop policies that address compensa- 16 tion in salary for staff who receive training to be- 17 come either a staff interpreter or bilingual provider; 18 ‘‘(11) develop other language assistance services 19 as determined appropriate by the Secretary; 20 ‘‘(12) develop, implement, and evaluate models 21 of improving cultural competence, including cultural 22 competence programs for community health workers; 23 ‘‘(13) ensure that, consistent with the privacy 24 protections provided for under the regulations pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 113 •HR 7585 IH mulgated under section 264(c) of the Health Insur- 1 ance Portability and Accountability Act of 1996 and 2 any applicable State privacy laws, data on the indi- 3 vidual patient or recipient’s race, ethnicity, and pri- 4 mary language are collected (and periodically up- 5 dated) in health records and integrated into the or- 6 ganization’s information management systems or 7 any similar system used to store and retrieve data; 8 and 9 ‘‘(14) ensure that culturally competent care and 10 language assistance are available to individuals with 11 limited English proficiency. 12 ‘‘(e) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to entities that pri- 14 marily engage in providing direct care and that have devel- 15 oped partnerships with community organizations or with 16 agencies with experience in improving language access. 17 ‘‘(f) EVALUATION.— 18 ‘‘(1) BY GRANTEES.—An entity that receives a 19 grant under this section shall submit to the Sec- 20 retary an evaluation that describes, in the manner 21 and to the extent required by the Secretary, the ac- 22 tivities carried out with funds received under the 23 grant, and how such activities improved access to 24 health care services and health care-related services 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 114 •HR 7585 IH and the quality of health care for individuals with 1 limited English proficiency. Such evaluation shall be 2 collected and disseminated through the Robert T. 3 Matsui Center for Culturally and Linguistically Ap- 4 propriate Health Care established under section 5 3401. The Director of the Agency for Healthcare 6 Research and Quality shall notify grantees of the 7 availability of technical assistance for the evaluation 8 and provide such assistance upon request. 9 ‘‘(2) BY SECRETARY.—The Director of the 10 Agency for Healthcare Research and Quality shall 11 evaluate or arrange with other individuals or organi- 12 zations to evaluate projects funded under this sec- 13 tion. 14 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 15 is authorized to be appropriated to carry out this section 16 $5,000,000 for each of fiscal years 2023 through 2027. 17 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM- 18 PETENCE. 19 ‘‘(a) IN GENERAL.—The Secretary shall expand re- 20 search concerning language access in the provision of 21 health care services. 22 ‘‘(b) ELIGIBILITY.—The Secretary may conduct the 23 research described in subsection (a) or enter into contracts 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 115 •HR 7585 IH with other individuals or organizations to conduct such re- 1 search. 2 ‘‘(c) USE OF FUNDS.—Research conducted under 3 this section shall be designed to do one or more of the 4 following: 5 ‘‘(1) To identify the barriers to mental and be- 6 havioral services that are faced by individuals with 7 limited English proficiency. 8 ‘‘(2) To identify health care providers’ and 9 health administrators’ knowledge and awareness of 10 the barriers to quality health care services that are 11 faced by individuals with limited English proficiency 12 and communication disabilities. 13 ‘‘(3) To identify optimal approaches for deliv- 14 ering language access. 15 ‘‘(4) To identify best practices for data collec- 16 tion, including— 17 ‘‘(A) the collection by providers of health 18 care services and health care-related services of 19 data on the race, ethnicity, and primary lan- 20 guage of recipients of such services, taking into 21 account existing research conducted by the Gov- 22 ernment or private sector; 23 ‘‘(B) the development and implementation 24 of data collection and reporting systems; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 116 •HR 7585 IH ‘‘(C) effective privacy safeguards for col- 1 lected data. 2 ‘‘(5) To develop a minimum data collection set 3 for primary language. 4 ‘‘(6) To evaluate the most effective ways in 5 which the Secretary can create or coordinate, and 6 subsidize or otherwise fund, telephonic interpretation 7 services for health care providers, taking into consid- 8 eration, among other factors, the flexibility necessary 9 for such a system to accommodate variations in— 10 ‘‘(A) provider type; 11 ‘‘(B) languages needed and their frequency 12 of use; 13 ‘‘(C) type of encounter; 14 ‘‘(D) time of encounter, including whether 15 the encounter occurs during regular business 16 hours and after hours; and 17 ‘‘(E) location of encounter. 18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 $5,000,000 for each of fiscal years 2023 through 2027.’’. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 117 •HR 7585 IH SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE- 1 VELOPMENT OF STATE MEDICAL INTER- 2 PRETING SERVICES. 3 (a) GRANTS AUTHORIZED.—The Secretary of Health 4 and Human Services shall award 1 grant in accordance 5 with this section to each of 3 States (to be selected by 6 the Secretary) to assist each such State in designing, im- 7 plementing, and evaluating a statewide program to provide 8 onsite interpreter services under the State Medicaid plan. 9 (b) GRANT PERIOD.—A grant awarded under this 10 section is authorized for the period of 3 fiscal years begin- 11 ning on October 1, 2023, and ending on September 30, 12 2026. 13 (c) PREFERENCE.—In awarding a grant under this 14 section, the Secretary shall give preference to a State— 15 (1) that has a high proportion of qualified LEP 16 enrollees, as determined by the Secretary; 17 (2) that has a large number of qualified LEP 18 enrollees, as determined by the Secretary; 19 (3) that has a high growth rate of the popu- 20 lation of individuals with limited English proficiency, 21 as determined by the Secretary; and 22 (4) that has a population of qualified LEP en- 23 rollees that is linguistically diverse, requiring inter- 24 preter services in at least 200 non-English lan- 25 guages. 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 118 •HR 7585 IH (d) USE OF FUNDS.—A State receiving a grant under 1 this section shall use the grant funds to— 2 (1) ensure that all health care providers in the 3 State participating in the State Medicaid plan have 4 access to onsite interpreter services, for the purpose 5 of enabling effective communication between such 6 providers and qualified LEP enrollees during the 7 furnishing of items and services and administrative 8 interactions; 9 (2) establish, expand, procure, or contract for— 10 (A) a statewide health care information 11 technology system that is designed to achieve 12 efficiencies and economies of scale with respect 13 to onsite interpreter services provided to health 14 care providers in the State participating in the 15 State Medicaid plan; and 16 (B) an entity to administer such system, 17 the duties of which shall include— 18 (i) procuring and scheduling inter- 19 preter services for qualified LEP enrollees; 20 (ii) procuring and scheduling inter- 21 preter services for individuals with limited 22 English proficiency seeking to enroll in the 23 State Medicaid plan; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 119 •HR 7585 IH (iii) ensuring that interpreters receive 1 payment for interpreter services rendered 2 under the system; and 3 (iv) consulting regularly with organi- 4 zations representing LEP consumers, in- 5 terpreters, and health care providers; and 6 (3) develop mechanisms to establish, improve, 7 and strengthen the competency of the medical inter- 8 pretation workforce that serves qualified LEP enroll- 9 ees in the State, including a national certification 10 process that is valid, credible, and vendor-neutral. 11 (e) APPLICATION.—To receive a grant under this sec- 12 tion, a State shall submit an application at such time and 13 containing such information as the Secretary may require, 14 which shall include the following: 15 (1) A description of the language access needs 16 of individuals in the State enrolled in the State Med- 17 icaid plan. 18 (2) A description of the extent to which the 19 program will— 20 (A) use the grant funds for the purposes 21 described in subsection (d); 22 (B) meet the health care needs of rural 23 populations of the State; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 120 •HR 7585 IH (C) collect information that accurately 1 tracks the language services requested by con- 2 sumers as compared to the language services 3 provided by health care providers in the State 4 participating in the State Medicaid plan. 5 (3) A description of how the program will be 6 evaluated, including a proposal for collaboration with 7 organizations representing interpreters, consumers, 8 and individuals with limited English proficiency. 9 (f) DEFINITIONS.—In this section: 10 (1) QUALIFIED LEP ENROLLEE.—The term 11 ‘‘qualified LEP enrollee’’ means an individual— 12 (A) who is limited English proficient; and 13 (B) who is enrolled in a State Medicaid 14 plan. 15 (2) STATE.—The term ‘‘State’’ has the mean- 16 ing given the term in section 1101(a)(1) of the So- 17 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 18 poses of title XIX of such Act (42 U.S.C. 1396 et 19 seq.). 20 (3) STATE MEDICAID PLAN.—The term ‘‘State 21 Medicaid plan’’ means a State plan under title XIX 22 of the Social Security Act (42 U.S.C. 1396 et seq.) 23 or a waiver of such a plan. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 121 •HR 7585 IH (4) UNITED STATES.—The term ‘‘United 1 States’’ has the meaning given the term in section 2 1101(a)(2) of the Social Security Act (42 U.S.C. 3 1301(a)(2)), for purposes of title XIX of such Act 4 (42 U.S.C. 1396 et seq.). 5 (g) CONTINUATION PAST DEMONSTRATION.—Any 6 State receiving a grant under this section must agree to 7 directly pay for language services in Medicaid for all Med- 8 icaid providers by the end of the grant period. 9 (h) FUNDING.— 10 (1) AUTHORIZATION OF APPROPRIATIONS.— 11 There is authorized to be appropriated $5,000,000 12 to carry out this section. 13 (2) AVAILABILITY OF FUNDS.—Amounts appro- 14 priated pursuant to the authorization in paragraph 15 (1) are authorized to remain available without fiscal 16 year limitation. 17 (3) INCREASED FEDERAL FINANCIAL PARTICI- 18 PATION.—Section 1903(a)(2)(E) of the Social Secu- 19 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 20 inserting ‘‘(or, in the case of a State that was 21 awarded a grant under section 2003 of the Health 22 Equity and Accountability Act of 2022, 100 percent 23 for each quarter occurring during the grant period 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 122 •HR 7585 IH specified in subsection (b) of such section)’’ after 1 ‘‘75 percent’’. 2 (i) LIMITATION.—No Federal funds awarded under 3 this section may be used to provide interpreter services 4 from a location outside the United States. 5 SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL- 6 TURALLY AND LINGUISTICALLY APPRO- 7 PRIATE CARE: GRADUATE MEDICAL EDU- 8 CATION. 9 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 10 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 11 1395ww(h)(4)) is amended by adding at the end the fol- 12 lowing new subparagraph: 13 ‘‘(L) TREATMENT OF CULTURALLY AND 14 LINGUISTICALLY APPROPRIATE TRAINING.—In 15 determining a hospital’s number of full-time 16 equivalent residents for purposes of this sub- 17 section, all the time that is spent by an intern 18 or resident in an approved medical residency 19 training program for education and training in 20 culturally and linguistically appropriate service 21 delivery, which shall include all medically under- 22 served populations (as defined in section 23 330(b)(3) of the Public Health Service Act).’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 123 •HR 7585 IH (b) INDIRECT MEDICAL EDUCATION.—Section 1 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 2 1395ww(d)(5)(B)) is amended— 3 (1) by redesignating the clause (x) added by 4 section 5505(b) of the Patient Protection and Af- 5 fordable Care Act as clause (xi) and moving the left 6 margin of such clause and each subclause and item 7 therein 2 ems to the left; and 8 (2) by adding at the end the following new 9 clause: 10 ‘‘(xii) The provisions of subparagraph (L) of 11 subsection (h)(4) shall apply under this subpara- 12 graph in the same manner as they apply under such 13 subsection.’’. 14 (c) EFFECTIVE DATE.—The amendments made by 15 subsections (a) and (b) shall apply with respect to pay- 16 ments made to hospitals on or after the date that is one 17 year after the date of the enactment of this Act. 18 SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 19 AND LINGUISTICALLY APPROPRIATE SERV- 20 ICES UNDER THE MEDICARE, MEDICAID, AND 21 STATE CHILDREN’S HEALTH INSURANCE 22 PROGRAMS. 23 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 24 PROVIDERS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 124 •HR 7585 IH (1) ESTABLISHMENT.— 1 (A) IN GENERAL.—Not later than 6 2 months after the date of the enactment of this 3 Act, the Secretary of Health and Human Serv- 4 ices, acting through the Centers for Medicare & 5 Medicaid Services and in consultation with the 6 Center for Medicare and Medicaid Innovation 7 (as referred to in section 1115A of the Social 8 Security Act (42 U.S.C. 1315a)), shall establish 9 a demonstration program under which the Sec- 10 retary shall award grants to eligible Medicare 11 service providers to provide culturally and lin- 12 guistically appropriate services to Medicare 13 beneficiaries who are limited English proficient, 14 including beneficiaries who live in diverse and 15 underserved communities. 16 (B) APPLICATION OF INNOVATION 17 RULES.—The demonstration project under sub- 18 paragraph (A) shall be conducted in a manner 19 that is consistent with the applicable provisions 20 of subsections (b), (c), and (d) of section 1115A 21 of the Social Security Act (42 U.S.C. 1315a). 22 (C) NUMBER OF GRANTS.—To the extent 23 practicable, the Secretary shall award not less 24 than 24 grants under this subsection. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 125 •HR 7585 IH (D) GRANT PERIOD.—Except as provided 1 under paragraph (2)(D), each grant awarded 2 under this subsection shall be for a 3-year pe- 3 riod. 4 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 5 ble for a grant under this subsection, an entity must 6 meet the following requirements: 7 (A) MEDICARE PROVIDER.—The entity 8 must be— 9 (i) a provider of services under part A 10 of title XVIII of the Social Security Act 11 (42 U.S.C. 1395c et seq.); 12 (ii) a provider of services under part 13 B of such title (42 U.S.C. 1395j et seq.); 14 (iii) a Medicare Advantage organiza- 15 tion offering a Medicare Advantage plan 16 under part C of such title (42 U.S.C. 17 1395w–21 et seq.); or 18 (iv) a PDP sponsor offering a pre- 19 scription drug plan under part D of such 20 title (42 U.S.C. 1395w–101 et seq.). 21 (B) UNDERSERVED COMMUNITIES.—The 22 entity must serve a community that, with re- 23 spect to necessary language services for improv- 24 ing access and utilization of health care among 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 126 •HR 7585 IH individuals with limited English proficiency, is 1 disproportionally underserved. 2 (C) APPLICATION.—The entity must pre- 3 pare and submit to the Secretary an applica- 4 tion, at such time, in such manner, and accom- 5 panied by such additional information as the 6 Secretary may require. 7 (D) REPORTING.—In the case of a grantee 8 that received a grant under this subsection in 9 a previous year, such grantee is only eligible for 10 continued payments under a grant under this 11 subsection if the grantee met the reporting re- 12 quirements under paragraph (9) for such year. 13 If a grantee fails to meet the requirement of 14 such paragraph for the first year of a grant, the 15 Secretary may terminate the grant and solicit 16 applications from new grantees to participate in 17 the demonstration program. 18 (3) DISTRIBUTION.—To the extent feasible, the 19 Secretary shall award— 20 (A) at least 10 grants to providers of serv- 21 ices described in paragraph (2)(A)(i); 22 (B) at least 10 grants to service providers 23 described in paragraph (2)(A)(ii); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 127 •HR 7585 IH (C) at least 10 grants to organizations de- 1 scribed in paragraph (2)(A)(iii); and 2 (D) at least 10 grants to sponsors de- 3 scribed in paragraph (2)(A)(iv). 4 (4) CONSIDERATIONS IN AWARDING GRANTS.— 5 (A) VARIATION AMONG GRANTEES.—In 6 awarding grants under this subsection, the Sec- 7 retary shall select grantees to ensure the fol- 8 lowing: 9 (i) The grantees provide many dif- 10 ferent types of language services. 11 (ii) The grantees serve Medicare bene- 12 ficiaries who speak different languages, 13 and who, as a population, have differing 14 needs for language services. 15 (iii) The grantees serve Medicare 16 beneficiaries in both urban and rural set- 17 tings. 18 (iv) The grantees represent each Cen- 19 ters for Medicare & Medicaid Services re- 20 gion, as defined by the Secretary. 21 (v) The grantees serve Medicare bene- 22 ficiaries in at least two large metropolitan 23 statistical areas with racial, ethnic, sexual, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 128 •HR 7585 IH gender, disability, and economically diverse 1 populations. 2 (B) PRIORITY FOR PARTNERSHIPS WITH 3 COMMUNITY ORGANIZATIONS AND AGENCIES.— 4 In awarding grants under this subsection, the 5 Secretary shall give priority to eligible entities 6 that have a partnership with— 7 (i) a community organization; or 8 (ii) a consortia of community organi- 9 zations, State agencies, and local agencies, 10 that has experience in providing language serv- 11 ices. 12 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 13 SERVICES.— 14 (A) IN GENERAL.—Subject to subpara- 15 graph (E), a grantee may only use grant funds 16 received under this subsection to pay for the 17 provision of competent language services to 18 Medicare beneficiaries who are individuals with 19 limited English proficiency. 20 (B) COMPETENT LANGUAGE SERVICES DE- 21 FINED.—For purposes of this subsection, the 22 term ‘‘competent language services’’ means— 23 (i) interpreter and translation services 24 that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 129 •HR 7585 IH (I) subject to the exceptions 1 under subparagraph (C)— 2 (aa) if the grantee operates 3 in a State that has statewide 4 health care interpreter standards, 5 meet the State standards cur- 6 rently in effect; or 7 (bb) if the grantee operates 8 in a State that does not have 9 statewide health care interpreter 10 standards, utilizes competent in- 11 terpreters who follow the Na- 12 tional Council on Interpreting in 13 Health Care’s Code of Ethics and 14 Standards of Practice and com- 15 ply with the requirements of sec- 16 tion 1557 of the Patient Protec- 17 tion and Affordable Care Act (42 18 U.S.C. 18116) as published in 19 the Federal Register on May 18, 20 2016; and 21 (II) that, in the case of inter- 22 preter services, are provided 23 through— 24 (aa) onsite interpretation; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 130 •HR 7585 IH (bb) telephonic interpreta- 1 tion; or 2 (cc) video interpretation; 3 and 4 (ii) the direct provision of health care 5 or health care-related services by a com- 6 petent bilingual health care provider. 7 (C) EXCEPTIONS.—The requirements of 8 subparagraph (B)(i)(I) do not apply, with re- 9 spect to interpreter and translation services and 10 a grantee— 11 (i) in the case of a Medicare bene- 12 ficiary who is limited English proficient, 13 if— 14 (I) such beneficiary has been in- 15 formed, in the beneficiary’s primary 16 language, of the availability of free in- 17 terpreter and translation services and 18 the beneficiary instead requests that a 19 family member, friend, or other per- 20 son provide such services; and 21 (II) the grantee documents such 22 request in the beneficiary’s medical 23 record; or 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 131 •HR 7585 IH (ii) in the case of a medical emergency 1 where the delay directly associated with ob- 2 taining a competent interpreter or trans- 3 lation services would jeopardize the health 4 of the patient. 5 Clause (ii) shall not be construed to exempt 6 emergency rooms or similar entities that regu- 7 larly provide health care services in medical 8 emergencies to patients who are individuals 9 with limited English proficiency from any appli- 10 cable legal or regulatory requirements related to 11 providing competent interpreter and translation 12 services without undue delay. 13 (D) MEDICARE ADVANTAGE ORGANIZA- 14 TIONS AND PDP SPONSORS.—A grantee that is 15 an MA organization or prescription drug spon- 16 sor must provide at least 50 percent of the 17 grant funds that the grantee receives under this 18 subsection directly to the entity’s network pro- 19 viders (including all health providers and phar- 20 macists) for the purpose of providing support 21 for such providers to provide competent lan- 22 guage services to Medicare beneficiaries who are 23 individuals with limited English proficiency. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 132 •HR 7585 IH (E) ADMINISTRATIVE AND REPORTING 1 COSTS.—A grantee may use up to 10 percent of 2 the grant funds to pay for administrative costs 3 associated with the provision of competent lan- 4 guage services and for reporting required under 5 paragraph (9). 6 (6) DETERMINATION OF AMOUNT OF GRANT 7 PAYMENTS.— 8 (A) IN GENERAL.—Payments to grantees 9 under this subsection shall be calculated based 10 on the estimated numbers of Medicare bene- 11 ficiaries who are limited English proficiency in 12 a grantee’s service area utilizing— 13 (i) data on the numbers of English 14 learners who speak English less than ‘‘very 15 well’’ from the most recently available data 16 from the Bureau of the Census or other 17 State-based study the Secretary determines 18 likely to yield accurate data regarding the 19 number of such individuals in such service 20 area; or 21 (ii) data provided by the grantee, if 22 the grantee routinely collects data on the 23 primary language of the Medicare bene- 24 ficiaries that the grantee serves and the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 133 •HR 7585 IH Secretary determines that the data is accu- 1 rate and shows a greater number of indi- 2 viduals with limited English proficiency 3 than would be estimated using the data 4 under clause (i). 5 (B) DISCRETION OF SECRETARY.—Subject 6 to subparagraph (C), the amount of payment 7 made to a grantee under this subsection may be 8 modified annually at the discretion of the Sec- 9 retary, based on changes in the data under sub- 10 paragraph (A) with respect to the service area 11 of a grantee for the year. 12 (C) LIMITATION ON AMOUNT.—The 13 amount of a grant made under this subsection 14 to a grantee may not exceed $500,000 for the 15 period under paragraph (1)(D). 16 (7) ASSURANCES.—Grantees under this sub- 17 section shall, as a condition of receiving a grant 18 under this subsection— 19 (A) ensure that clinical and support staff 20 receive appropriate ongoing education and 21 training in linguistically appropriate service de- 22 livery; 23 (B) ensure the linguistic competence of bi- 24 lingual providers; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 134 •HR 7585 IH (C) offer and provide appropriate language 1 services at no additional charge to each patient 2 who is limited English proficient for all points 3 of contact between the patient and the grantee, 4 in a timely manner during all hours of oper- 5 ation; 6 (D) notify Medicare beneficiaries of their 7 right to receive language services in their pri- 8 mary language at least annually; 9 (E) post signage in the primary languages 10 commonly used by the patient population in the 11 service area of the organization; and 12 (F) ensure that— 13 (i) primary language data are col- 14 lected for recipients of language services 15 and such data are consistent with stand- 16 ards developed under title XXXIV of the 17 Public Health Service Act, as added by 18 section 2002 of this Act, to the extent such 19 standards are available upon the initiation 20 of the demonstration program; and 21 (ii) consistent with the privacy protec- 22 tions provided under the regulations pro- 23 mulgated pursuant to section 264(c) of the 24 Health Insurance Portability and Account- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 135 •HR 7585 IH ability Act of 1996 (42 U.S.C. 1320d–2 1 note), if the recipient of language services 2 is a minor or is incapacitated, primary lan- 3 guage data must also be collected on the 4 parent or legal guardian of such recipient. 5 (8) NO COST SHARING.—Medicare beneficiaries 6 who are limited English proficient shall not have to 7 pay cost sharing or co-payments for competent lan- 8 guage services provided under this demonstration 9 program. 10 (9) REPORTING REQUIREMENTS FOR GRANT- 11 EES.—Not later than the end of each calendar year, 12 a grantee that receives funds under this subsection 13 in such year shall submit to the Secretary a report 14 that includes the following information: 15 (A) The number of Medicare beneficiaries 16 to whom competent language services are pro- 17 vided, disaggregated by age and entitlement 18 basis (on the basis of age, disability, or deter- 19 mination of end stage renal disease). 20 (B) The primary languages of those Medi- 21 care beneficiaries. 22 (C) The types of language services pro- 23 vided to such beneficiaries. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 136 •HR 7585 IH (D) Whether such language services were 1 provided by employees of the grantee or 2 through a contract with external contractors or 3 agencies. 4 (E) The types of interpretation services 5 provided to such beneficiaries, and the approxi- 6 mate length of time such service is provided to 7 such beneficiaries. 8 (F) The costs of providing competent lan- 9 guage services. 10 (G) An account of the training or accredi- 11 tation of bilingual staff, interpreters, and trans- 12 lators providing services funded by the grant 13 under this subsection. 14 (10) EVALUATION AND REPORT TO CON- 15 GRESS.—Not later than 1 year after the completion 16 of a 3-year grant under this subsection, the Sec- 17 retary shall conduct an evaluation of the demonstra- 18 tion program under this subsection and shall submit 19 to the Congress a report that includes the following: 20 (A) An analysis of the patient outcomes 21 and the costs of furnishing care to the Medicare 22 beneficiaries who are individuals with limited 23 English proficiency participating in the project 24 as compared to such outcomes and costs for 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 137 •HR 7585 IH such Medicare beneficiaries not participating, 1 based on the data provided under paragraph (9) 2 and any other information available to the Sec- 3 retary. 4 (B) The effect of delivering language serv- 5 ices on— 6 (i) Medicare beneficiary access to care 7 and utilization of services; 8 (ii) the efficiency and cost effective- 9 ness of health care delivery; 10 (iii) patient satisfaction with respect 11 to both health service delivery and lan- 12 guage assistance; 13 (iv) health outcomes; and 14 (v) the provision of culturally appro- 15 priate services provided to such bene- 16 ficiaries. 17 (C) The extent to which bilingual staff, in- 18 terpreters, and translators providing services 19 under such demonstration were trained or ac- 20 credited and the nature of accreditation or 21 training needed by type of provider, service, or 22 other category as determined by the Secretary 23 to ensure the provision of high-quality interpre- 24 tation, translation, or other language services to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 138 •HR 7585 IH Medicare beneficiaries if such services are ex- 1 panded pursuant to section 1115A(c) of the So- 2 cial Security Act (42 U.S.C. 1315a(c)). 3 (D) Recommendations, if any, regarding 4 the extension of such project to the entire Medi- 5 care Program, subject to the provisions of such 6 section 1115A(c). 7 (11) APPROPRIATIONS.—There is appropriated 8 to carry out this subsection, in equal parts from the 9 Federal Hospital Insurance Trust Fund under sec- 10 tion 1817 of the Social Security Act (42 U.S.C. 11 1395i) and the Federal Supplementary Medical In- 12 surance Trust Fund under section 1841 of such Act 13 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 14 of the demonstration program. 15 (12) LIMITED ENGLISH PROFICIENT DE- 16 FINED.—In this subsection, the term ‘‘limited 17 English proficient’’ refers to individuals who self- 18 identify on the Census as speaking English less than 19 ‘‘very well’’. 20 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE 21 MEDICARE PROGRAM.— 22 (1) INCLUSION AS RURAL HEALTH CLINIC 23 SERVICES.—Section 1861 of the Social Security Act 24 (42 U.S.C. 1395x) is amended— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 139 •HR 7585 IH (A) in subsection (aa)(1)— 1 (i) in subparagraph (B), by striking 2 ‘‘and’’ at the end; 3 (ii) by adding ‘‘and’’ at the end of 4 subparagraph (C); and 5 (iii) by inserting after subparagraph 6 (C) the following new subparagraph: 7 ‘‘(D) language assistance services as defined in 8 subsection (lll),’’; and 9 (B) by adding at the end the following new 10 subsection: 11 ‘‘Language Assistance Services and Related Terms 12 ‘‘(lll) The term ‘language assistance services’ means 13 ‘language access’ or ‘language assistance services’ (as 14 those terms are defined in section 3400 of the Public 15 Health Service Act) furnished by a ‘qualified interpreter 16 for an individual with limited English proficiency’ or a 17 ‘qualified translator’ (as those terms are defined in such 18 section 3400) to an ‘individual with limited English pro- 19 ficiency’ (as defined in such section 3400).’’. 20 (2) COVERAGE.—Section 1832(a)(2) of the So- 21 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 22 ed— 23 (A) by striking ‘‘and’’ at the end of sub- 24 paragraph (I); 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 140 •HR 7585 IH (B) by striking the period at the end of 1 subparagraph (J) and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(K) language assistance services (as de- 5 fined in section 1861(lll)).’’. 6 (3) PAYMENT.—Section 1833(a) of the Social 7 Security Act (42 U.S.C. 1395l(a)) is amended— 8 (A) by striking ‘‘and’’ at the end of para- 9 graph (9); 10 (B) by striking the period at the end of 11 paragraph (10) and inserting ‘‘; and’’; and 12 (C) by inserting after paragraph (10) the 13 following new paragraph: 14 ‘‘(11) in the case of language assistance serv- 15 ices (as defined in section 1861(lll)), 100 percent of 16 the reasonable charges for such services, as deter- 17 mined in consultation with the Medicare Payment 18 Advisory Commission.’’. 19 (4) WAIVER OF BUDGET NEUTRALITY.—For 20 the 3-year period beginning on the date of enact- 21 ment of this section, the budget neutrality provision 22 of section 1848(c)(2)(B)(ii) of the Social Security 23 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 141 •HR 7585 IH apply with respect to language assistance services 1 (as defined in section 1861(lll) of such Act). 2 (c) MEDICARE PARTS C AND D.— 3 (1) IN GENERAL.—Medicare Advantage plans 4 under part C of title XVIII of the Social Security 5 Act (42 U.S.C. 1395w–21 et seq.) and prescription 6 drug plans under part D of such title (42 U.S.C. 7 1395q–101) shall comply with title VI of the Civil 8 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 9 section 1557 of the Patient Protection and Afford- 10 able Care Act (42 U.S.C. 18116) to provide effective 11 language services to enrollees of such plans. 12 (2) MEDICARE ADVANTAGE PLANS AND PRE- 13 SCRIPTION DRUG PLANS REPORTING REQUIRE- 14 MENT.—Section 1857(e) of the Social Security Act 15 (42 U.S.C. 1395w–27(e)) is amended by adding at 16 the end the following new paragraph: 17 ‘‘(6) REPORTING REQUIREMENTS RELATING TO 18 EFFECTIVE LANGUAGE SERVICES.—A contract under 19 this part shall require a Medicare Advantage organi- 20 zation (and, through application of section 1860D– 21 12(b)(3)(D), a contract under section 1860D–12 22 shall require a PDP sponsor) to annually submit 23 (for each year of the contract) a report that contains 24 information on the internal policies and procedures 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 142 •HR 7585 IH of the organization (or sponsor) related to recruit- 1 ment and retention efforts directed to workforce di- 2 versity and linguistically and culturally appropriate 3 provision of services in each of the following con- 4 texts: 5 ‘‘(A) The collection of data in a manner 6 that meets the requirements of title I of the 7 Health Equity and Accountability Act of 2022, 8 regarding the enrollee population. 9 ‘‘(B) Education of staff and contractors 10 who have routine contact with enrollees regard- 11 ing the various needs of the diverse enrollee 12 population. 13 ‘‘(C) Evaluation of the language services 14 programs and services offered by the organiza- 15 tion (or sponsor) with respect to the enrollee 16 population, such as through analysis of com- 17 plaints or satisfaction survey results. 18 ‘‘(D) Methods by which the plan provides 19 to the Secretary information regarding the eth- 20 nic diversity of the enrollee population. 21 ‘‘(E) The periodic provision of educational 22 information to plan enrollees on the language 23 services and programs offered by the organiza- 24 tion (or sponsor).’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 143 •HR 7585 IH (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 1 AND CHIP.— 2 (1) PAYMENTS TO STATES.—Section 3 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 4 1396b(a)(2)(E)), as amended by section 2005(h)(3), 5 is further amended by— 6 (A) striking ‘‘75’’ and inserting ‘‘95’’; 7 (B) striking ‘‘translation or interpretation 8 services’’ and inserting ‘‘language assistance 9 services’’; and 10 (C) striking ‘‘children of families’’ and in- 11 serting ‘‘individuals’’. 12 (2) STATE PLAN REQUIREMENTS.—Section 13 1902(a)(10)(A) of the Social Security Act (42 14 U.S.C. 1396a(a)(10)(A)) is amended by striking 15 ‘‘and (30)’’ and inserting ‘‘(30), and (31)’’. 16 (3) DEFINITION OF MEDICAL ASSISTANCE.— 17 Section 1905(a) of the Social Security Act (42 18 U.S.C. 1396d(a)) is amended— 19 (A) in paragraph (29), by striking ‘‘and’’ 20 at the end; 21 (B) by redesignating paragraph (31) as 22 paragraph (32); and 23 (C) by inserting after paragraph (30) the 24 following new paragraph: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 144 •HR 7585 IH ‘‘(31) language assistance services, as such 1 term is defined in section 1861(lll), provided in a 2 timely manner to individuals with limited English 3 proficiency as defined in section 3400 of the Public 4 Health Service Act; and’’. 5 (4) USE OF DEDUCTIONS AND COST SHAR- 6 ING.—Section 1916(a)(2) of the Social Security Act 7 (42 U.S.C. 1396o(a)(2)) is amended— 8 (A) in subparagraph (G), by inserting at 9 the end ‘‘, and’’; and 10 (B) by adding at the end the following new 11 subparagraph: 12 ‘‘(H) language assistance services de- 13 scribed in section 1905(a)(31);’’. 14 (5) CHIP COVERAGE REQUIREMENTS.—Section 15 2103 of the Social Security Act (42 U.S.C. 1397cc) 16 is amended— 17 (A) in subsection (a), in the matter before 18 paragraph (1), by striking ‘‘(7), and (8)’’ and 19 inserting ‘‘(7), (8), (9), (10), (11), and (12)’’; 20 (B) in subsection (c), by adding at the end 21 the following new paragraph: 22 ‘‘(12) LANGUAGE ASSISTANCE SERVICES.—The 23 child health assistance provided to a targeted low-in- 24 come child shall include coverage of language assist- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 145 •HR 7585 IH ance services, as such term is defined in section 1 1861(l), provided in a timely manner to individuals 2 with limited English proficiency (as defined in sec- 3 tion 3400 of the Public Health Service Act).’’; and 4 (C) in subsection (e)(2)— 5 (i) in the heading, by striking ‘‘PRE- 6 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 7 (ii) by inserting ‘‘language assistance 8 services described in subsection (c)(12),’’ 9 before ‘‘visits described in’’. 10 (6) DEFINITION OF CHILD HEALTH ASSIST- 11 ANCE.—Section 2110(a)(27) of the Social Security 12 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik- 13 ing ‘‘translation’’ and inserting ‘‘language assistance 14 services as described in section 2103(c)(12)’’. 15 (7) STATE DATA COLLECTION.—Pursuant to 16 the reporting requirement described in section 17 2107(b)(1) of the Social Security Act (42 U.S.C. 18 1397gg(b)(1)), the Secretary of Health and Human 19 Services shall require that States collect data on— 20 (A) the primary language of individuals re- 21 ceiving child health assistance under title XXI 22 of the Social Security Act (42 U.S.C. 1397aa et 23 seq.); and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 146 •HR 7585 IH (B) in the case of such individuals who are 1 minors or incapacitated, the primary language 2 of the individual’s parent or guardian. 3 (8) CHIP PAYMENTS TO STATES.—Section 4 2105 of the Social Security Act (42 U.S.C. 1397ee) 5 is amended— 6 (A) in subsection (a)(1)— 7 (i) in the matter preceding subpara- 8 graph (A), by striking ‘‘75’’ and inserting 9 ‘‘95’’; and 10 (ii) in subparagraph (D)(iv), by strik- 11 ing ‘‘translation or interpretation services’’ 12 and inserting ‘‘language assistance serv- 13 ices’’; and 14 (B) in subsection (c)(2)(A), by inserting 15 before the period at the end the following: ‘‘, 16 except that expenditures pursuant to clause (iv) 17 of subparagraph (D) of such paragraph shall 18 not count towards this total’’. 19 (e) FUNDING LANGUAGE ASSISTANCE SERVICES 20 FURNISHED BY PROVIDERS OF HEALTH CARE AND 21 HEALTH CARE-RELATED SERVICES THAT SERVE HIGH 22 RATES OF UNINSURED LEP INDIVIDUALS.— 23 (1) PAYMENT OF COSTS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 147 •HR 7585 IH (A) IN GENERAL.—Subject to subpara- 1 graph (B), the Secretary of Health and Human 2 Services (referred to in this subsection as the 3 ‘‘Secretary’’) shall make payments (on a quar- 4 terly basis) directly to eligible entities to sup- 5 port the provision of language assistance serv- 6 ices to individuals with limited English pro- 7 ficiency in an amount equal to an eligible enti- 8 ty’s eligible costs for providing such services for 9 the quarter. 10 (B) FUNDING.—Out of any funds in the 11 Treasury not otherwise appropriated, there are 12 appropriated to the Secretary of Health and 13 Human Services such sums as may be nec- 14 essary for each of fiscal years 2022 through 15 2026. 16 (C) RELATION TO MEDICAID DSH.—Pay- 17 ments under this subsection shall not offset or 18 reduce payments under section 1923 of the So- 19 cial Security Act (42 U.S.C. 1396r–4), nor 20 shall payments under such section be consid- 21 ered when determining uncompensated costs as- 22 sociated with the provision of language assist- 23 ance services for the purposes of this section. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 148 •HR 7585 IH (2) METHODOLOGY FOR PAYMENT OF 1 CLAIMS.— 2 (A) IN GENERAL.—The Secretary shall es- 3 tablish a methodology to determine the average 4 per person cost of language assistance services. 5 (B) DIFFERENT ENTITIES.—In estab- 6 lishing such methodology, the Secretary may es- 7 tablish different methodologies for different 8 types of eligible entities. 9 (C) NO INDIVIDUAL CLAIMS.—The Sec- 10 retary may not require eligible entities to sub- 11 mit individual claims for language assistance 12 services for individual patients as a requirement 13 for payment under this subsection. 14 (3) DATA COLLECTION INSTRUMENT.—For pur- 15 poses of this subsection, the Secretary shall create a 16 standard data collection instrument that is con- 17 sistent with any existing reporting requirements by 18 the Secretary or relevant accrediting organizations 19 regarding the number of individuals to whom lan- 20 guage access is provided. 21 (4) GUIDELINES.—Not later than 6 months 22 after the date of enactment of this Act, the Sec- 23 retary shall establish and distribute guidelines con- 24 cerning the implementation of this subsection. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 149 •HR 7585 IH (5) REPORTING REQUIREMENTS.— 1 (A) REPORT TO SECRETARY.—Entities re- 2 ceiving payment under this subsection shall pro- 3 vide the Secretary with a quarterly report on 4 how the entity used such funds. Such report 5 shall contain aggregate (and may not contain 6 individualized) data collected using the instru- 7 ment under paragraph (3) and shall otherwise 8 be in a form and manner determined by the 9 Secretary. 10 (B) REPORT TO CONGRESS.—Not later 11 than 2 years after the date of enactment of this 12 Act, and every 2 years thereafter, the Secretary 13 shall submit a report to Congress concerning 14 the implementation of this subsection. 15 (6) DEFINITIONS.—In this subsection: 16 (A) ELIGIBLE COSTS.—The term ‘‘eligible 17 costs’’ means, with respect to an eligible entity 18 that provides language assistance services to 19 limited English proficient individuals, the prod- 20 uct of— 21 (i) the average per person cost of lan- 22 guage assistance services, determined ac- 23 cording to the methodology devised under 24 paragraph (2); and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 150 •HR 7585 IH (ii) the number individuals with lim- 1 ited English proficiency who are provided 2 language assistance services by the entity 3 and for whom no reimbursement is avail- 4 able for such services under the amend- 5 ments made by subsection (a), (b), (c), or 6 (d) or by private health insurance. 7 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 8 entity’’ means an entity that— 9 (i) is a Medicaid provider that is— 10 (I) a physician; 11 (II) a hospital with a low-income 12 utilization rate (as defined in section 13 1923(b)(3) of the Social Security Act 14 (42 U.S.C. 1396r–4(b)(3))) of greater 15 than 25 percent; 16 (III) a federally qualified health 17 center (as defined in section 18 1905(l)(2)(B) of the Social Security 19 Act (42 U.S.C. 1396d(l)(2)(B))); 20 (IV) a hospice provider; or 21 (V) a palliative care provider; 22 (ii) not later than 6 months after the 23 date of the enactment of this Act, provides 24 language assistance services to not less 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 151 •HR 7585 IH than 8 percent of the entity’s total number 1 of patients; and 2 (iii) prepares and submits an applica- 3 tion to the Secretary, at such time, in such 4 manner, and accompanied by such infor- 5 mation as the Secretary may require, to 6 ascertain the entity’s eligibility for funding 7 under this subsection. 8 (C) LANGUAGE ASSISTANCE SERVICES.— 9 The term ‘‘language assistance services’’ has 10 the meaning given such term in section 11 1861(kkk)(1) of the Social Security Act, as 12 added by subsection (b). 13 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 14 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 15 OTHER LAWS.—Nothing in this section shall be construed 16 to limit otherwise existing obligations of recipients of Fed- 17 eral financial assistance under title VI of the Civil Rights 18 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 19 the Affordable Care Act, or other laws that protect the 20 civil rights of individuals. 21 (g) EFFECTIVE DATE.— 22 (1) IN GENERAL.—Except as otherwise pro- 23 vided and subject to paragraph (2), the amendments 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 152 •HR 7585 IH made by this section shall take effect on January 1, 1 2023. 2 (2) EXCEPTION IF STATE LEGISLATION RE- 3 QUIRED.—In the case of a State plan for medical as- 4 sistance under title XIX of the Social Security Act 5 (42 U.S.C. 1396 et seq.) or a State plan for child 6 health assistance under title XXI of such Act (42 7 U.S.C. 1397aa et seq.) which the Secretary of 8 Health and Human Services determines requires 9 State legislation (other than legislation appro- 10 priating funds) in order for the plan to meet the ad- 11 ditional requirement imposed by the amendments 12 made by this section, such State plan shall not be 13 regarded as failing to comply with the requirements 14 of such title solely on the basis of its failure to meet 15 this additional requirement before the first day of 16 the first calendar quarter beginning after the close 17 of the first regular session of the State legislature 18 that begins after the date of the enactment of this 19 Act. For purposes of the previous sentence, in the 20 case of a State that has a 2-year legislative session, 21 each year of such session shall be deemed to be a 22 separate regular session of the State legislature. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 153 •HR 7585 IH SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV- 1 ING HEALTH LITERACY. 2 (a) IN GENERAL.—The Secretary, in consultation 3 with the Director of the National Institute on Minority 4 Health and Health Disparities and the Deputy Assistant 5 Secretary for Minority Health, shall award grants to eligi- 6 ble entities to improve health care for patient populations 7 that have low health literacy. 8 (b) ELIGIBILITY.—To be eligible to receive a grant 9 under subsection (a), an entity shall— 10 (1) be a hospital, health center or clinic, health 11 plan, or other health entity (including a nonprofit 12 minority health organization or association); and 13 (2) prepare and submit to the Secretary an ap- 14 plication at such time, in such manner, and con- 15 taining such information as the Secretary may rea- 16 sonably require. 17 (c) USE OF FUNDS.— 18 (1) AGENCY FOR HEALTHCARE RESEARCH AND 19 QUALITY.—A grant under subsection (a) that is 20 awarded through the Director of the Agency for 21 Healthcare Research and Quality shall be used— 22 (A) to define and increase the under- 23 standing of health literacy across all areas of 24 health care, including end of life care; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 154 •HR 7585 IH (B) to investigate the correlation between 1 low health literacy and health and health care; 2 (C) to clarify which aspects of health lit- 3 eracy have an effect on health outcomes; and 4 (D) for any other activity determined ap- 5 propriate by the Director. 6 (2) HEALTH RESOURCES AND SERVICES ADMIN- 7 ISTRATION.—A grant under subsection (a) that is 8 awarded through the Administrator of the Health 9 Resources and Services Administration shall be used 10 to conduct demonstration projects for interventions 11 for patients with low health literacy that may in- 12 clude— 13 (A) the development of new disease man- 14 agement and end of life care programs for pa- 15 tients with low health literacy; 16 (B) the tailoring of disease management 17 programs and end of life care addressing men- 18 tal, physical, oral, and behavioral health condi- 19 tions for patients with low health literacy; 20 (C) the translation of written health mate- 21 rials for patients with low health literacy; 22 (D) the identification, implementation, and 23 testing of low health literacy screening tools; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 155 •HR 7585 IH (E) the conduct of educational campaigns 1 for patients and providers about low health lit- 2 eracy; 3 (F) the conduct of educational campaigns 4 concerning health directed specifically at pa- 5 tients with mental disabilities, including those 6 with cognitive and intellectual disabilities, de- 7 signed to reduce the incidence of low health lit- 8 eracy among these populations, which shall 9 have instructional materials in the plain lan- 10 guage standards promulgated under the Plain 11 Writing Act of 2010 (5 U.S.C. 301 note) for 12 Federal agencies; and 13 (G) other activities determined appropriate 14 by the Administrator. 15 (d) DEFINITIONS.—In this section: 16 (1) LOW HEALTH LITERACY.—The term ‘‘low 17 health literacy’’ means the inability of an individual 18 to obtain, process, and understand basic health in- 19 formation and services needed to make appropriate 20 health decisions. 21 (2) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services— 23 (A) acting through the Director of the 24 Agency for Healthcare Research and Quality, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 156 •HR 7585 IH with respect to grants under subsection (c)(1); 1 and 2 (B) acting through the Administrator of 3 the Health Resources and Services Administra- 4 tion with respect to grants under subsection 5 (c)(2). 6 (e) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated to carry out this section 8 such sums as may be necessary for each of fiscal years 9 2023 through 2027. 10 SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 11 ACTIVITIES RECEIVING FEDERAL FUNDS. 12 (a) COVERED ENTITY; COVERED PROGRAM OR AC- 13 TIVITY.—In this section— 14 (1) the term ‘‘covered entity’’ has the meaning 15 given such term in section 92.4 of title 45, Code of 16 Federal Regulations, as in effect on May 18, 2016 17 (81 Fed. Reg. 31466); and 18 (2) the term ‘‘health program or activity’’ has 19 the meaning given such term in section 92.4 of title 20 45, Code of Federal Regulations, as in effect on May 21 18, 2016 (81 Fed. Reg. 31466). 22 (b) REQUIREMENTS.—A covered entity, in order to 23 ensure the right of individuals with limited English pro- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 157 •HR 7585 IH ficiency to receive access to high-quality health care 1 through the covered program or activity, shall— 2 (1) ensure that appropriate clinical and support 3 staff receive ongoing education and training in cul- 4 turally and linguistically appropriate service delivery 5 at least annually; 6 (2) offer and provide appropriate language as- 7 sistance services at no additional charge to each pa- 8 tient that is an individual with limited English pro- 9 ficiency at all points of contact, in a timely manner 10 during all hours of operation; 11 (3) notify patients of their right to receive lan- 12 guage services in their primary language; and 13 (4) utilize only qualified interpreters for an in- 14 dividual with limited English proficiency or qualified 15 translators, except as provided in subsection (c). 16 (c) EXEMPTIONS.—The requirements of subsection 17 (b)(4) shall not apply as follows: 18 (1) When a patient requests the use of family, 19 friends, or other persons untrained in interpretation 20 or translation if each of the following conditions are 21 met: 22 (A) The interpreter requested by the pa- 23 tient is over the age of 18. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 158 •HR 7585 IH (B) The covered entity informs the patient 1 in the primary language of the patient that he 2 or she has the option of having the entity pro- 3 vide to the patient an interpreter and trans- 4 lation services without charge. 5 (C) The covered entity informs the patient 6 that the entity may not require an individual 7 with a limited English proficiency to use a fam- 8 ily member or friend as an interpreter. 9 (D) The covered entity evaluates whether 10 the person the patient wishes to use as an in- 11 terpreter is competent. If the covered entity has 12 reason to believe that such person is not com- 13 petent as an interpreter, the entity provides its 14 own interpreter to protect the covered entity 15 from liability if the patient’s interpreter is later 16 found not competent. 17 (E) If the covered entity has reason to be- 18 lieve that there is a conflict of interest between 19 the interpreter and patient, the covered entity 20 may not use the patient’s interpreter. 21 (F) The covered entity has the patient sign 22 a waiver, witnessed by at least 1 individual not 23 related to the patient, that includes the infor- 24 mation stated in subparagraphs (A) through 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 159 •HR 7585 IH (E) and is translated into the patient’s primary 1 language. 2 (2) When a medical emergency exists and the 3 delay directly associated with obtaining competent 4 interpreter or translation services would jeopardize 5 the health of the patient, but only until a competent 6 interpreter or translation service is available. 7 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 8 shall not be construed to mean that emergency rooms or 9 similar entities that regularly provide health care services 10 in medical emergencies are exempt from legal or regu- 11 latory requirements related to competent interpreter serv- 12 ices. 13 SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 14 CULTURALLY AND LINGUISTICALLY APPRO- 15 PRIATE HEALTH CARE SERVICES. 16 (a) REPORT.—Not later than 1 year after the date 17 of enactment of this Act, and annually thereafter, the Sec- 18 retary of Health and Human Services shall enter into a 19 contract with the National Academy of Medicine for the 20 preparation and publication of a report that describes 21 Federal efforts to ensure that all individuals with limited 22 English proficiency have meaningful access to health care 23 services and health care-related services that are culturally 24 and linguistically appropriate. Such report shall include— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 160 •HR 7585 IH (1) a description and evaluation of the activities 1 carried out under this Act; 2 (2) a description and analysis of best practices, 3 model programs, guidelines, and other effective 4 strategies for providing access to culturally and lin- 5 guistically appropriate health care services; 6 (3) recommendations on the development and 7 implementation of policies and practices by providers 8 of health care services and health care-related serv- 9 ices for individuals with limited English proficiency, 10 including people with cognitive, hearing, vision, or 11 print impairments; 12 (4) recommend guidelines or standards for 13 health literacy and plain language, informed consent, 14 discharge instructions, and written communications, 15 and for improvement of health care access; 16 (5) a description of the effect of providing lan- 17 guage services on quality of health care and access 18 to care; and 19 (6) a description of the costs associated with or 20 savings related to the provision of language services. 21 (b) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2023 through 2027. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 161 •HR 7585 IH SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 1 LIMITED ENGLISH PROFICIENCY. 2 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 3 cation is authorized to provide grants to eligible entities 4 for the provision of English as a second language (in this 5 section referred to as ‘‘ESL’’) instruction to individuals 6 with limited English proficiency, including health care-re- 7 lated English instruction, and shall determine, after con- 8 sultation with appropriate stakeholders, the mechanism 9 for administering and distributing such grants. 10 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 11 igible entity’’ means— 12 (1) a State; or 13 (2) a community-based organization that pre- 14 dominantly employs and serves racial and ethnic mi- 15 nority groups (as defined in section 1707(g) of the 16 Public Health Service Act (42 U.S.C. 300u–6(g)). 17 (c) APPLICATION.—An eligible entity that desires to 18 receive a grant under this section shall apply by submit- 19 ting to the Secretary of Education an application at such 20 time, in such manner, and containing such information as 21 the Secretary may require. 22 (d) USE OF GRANT.—An eligible entity shall use 23 grant funds provided under this section to— 24 (1) develop and implement a plan for assuring 25 the availability of ESL instruction, free of charge, to 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 162 •HR 7585 IH the community served by the eligible entity, that ef- 1 fectively integrates information about the nature of 2 the United States health care system, how to access 3 care, and any special language skills that may be re- 4 quired for individuals with limited English pro- 5 ficiency to access and regularly negotiate the health 6 care system effectively; 7 (2) develop a plan for making ESL instruction 8 available free to charge to individuals with limited 9 English proficiency in the community served by the 10 eligible entity who are seeking instruction, including, 11 where appropriate, through the use of public-private 12 partnerships; and 13 (3) provide ESL instruction to individuals with 14 limited English proficiency in the community served 15 by the eligible entity. 16 (e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti- 17 ty awarded a grant under this section shall use funds 18 made available under this section to supplement, and not 19 supplant, other Federal, State, and local funds that would 20 otherwise be expended to carry out activities under this 21 section. 22 (f) DUTIES OF THE SECRETARY.—The Secretary of 23 Education shall— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 163 •HR 7585 IH (1) collect and make publicly available annual 1 data on how much Federal, State, and local govern- 2 ments spend annually on ESL instruction; 3 (2) collect data from eligible entities awarded a 4 grant under this section to identify the unmet needs 5 of individuals with limited English proficiency for 6 appropriate ESL instruction, including— 7 (A) the preferred written and spoken lan- 8 guage of such individuals; 9 (B) the availability of enrollment in ESL 10 instruction programs in the communities served 11 by each eligible entity awarded a grant under 12 this section, including the extent of waiting lists 13 for ESL instruction, how many programs main- 14 tain waiting lists, and, for programs that do not 15 have waiting lists, the reasons why such a list 16 is unnecessary or otherwise not maintained; 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 of individuals with limited 23 English proficiency and the number of individ- 24 uals enrolled in ESL instruction programs in 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 164 •HR 7585 IH the communities served by each eligible entity 1 awarded a grant under this section; 2 (F) the effectiveness of the ESL instruc- 3 tion provided through grants awarded under 4 this section in meeting the needs of individuals 5 receiving such instruction; and 6 (G) an assessment of the need for pro- 7 grams that integrate job training and ESL in- 8 struction, to assist individuals with limited 9 English proficiency in obtaining better jobs; 10 (3) determine the cost and most appropriate 11 methods of making ESL instruction available to all 12 individuals with limited English proficiency in the 13 United States who are seeking instruction; and 14 (4) not later than 1 year after the date of en- 15 actment of this Act, issue a report to Congress 16 that— 17 (A) assesses the information collected in 18 paragraphs (1), (2), and (3) and makes rec- 19 ommendations on steps that should be taken to 20 realize the goal of making ESL instruction 21 available to all individuals with limited English 22 proficiency in the United States who are seek- 23 ing instruction; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 165 •HR 7585 IH (B) evaluates the impact of the grant pro- 1 gram authorized under this section on the ac- 2 cessibility of, and ability to effectively negotiate, 3 the health care system for individuals with lim- 4 ited English proficiency who have received ESL 5 instruction funded by a grant under this sec- 6 tion. 7 (g) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to the Secretary of Edu- 9 cation $250,000,000 for each of fiscal years 2023 through 10 2027 to carry out this section. 11 SEC. 2012. IMPLEMENTATION. 12 (a) GENERAL PROVISIONS.— 13 (1) IMMUNITY.—A person injured by a violation 14 of this title (including an amendment made by this 15 title) by a State may bring a civil action in the ap- 16 propriate Federal court for such injury in accord- 17 ance with this section. 18 (2) REMEDIES.—In a civil action under this 19 section for a violation of this title, such remedies 20 shall be available as would be available in a civil ac- 21 tion for such violation against any party other than 22 a State. 23 (b) RULE OF CONSTRUCTION.—Nothing in this title 24 may be construed to limit otherwise existing obligations 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 166 •HR 7585 IH of recipients of Federal financial assistance under title VI 1 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 2 or any other Federal statute. 3 SEC. 2013. LANGUAGE ACCESS SERVICES. 4 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 5 the Patient Protection and Affordable Care Act (42 6 U.S.C. 18022(b)(1)) is amended by adding at the end the 7 following: 8 ‘‘(K) Language access services, including 9 oral interpretation and written translations.’’. 10 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 11 COVERAGE.— 12 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 13 Internal Revenue Code of 1986 is amended by redes- 14 ignating clauses (iii) and (iv) as clauses (iv) and (v), 15 respectively, and by inserting after clause (ii) the fol- 16 lowing new clause: 17 ‘‘(iii) COVERAGE MUST INCLUDE LAN- 18 GUAGE ACCESS AND SERVICES.—Except as 19 provided in clause (iv), an employee shall 20 not be treated as eligible for minimum es- 21 sential coverage if such coverage consists 22 of an eligible employer-sponsored plan (as 23 defined in section 5000A(f)(2)) and the 24 plan does not provide coverage for lan- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 167 •HR 7585 IH guage access services, including oral inter- 1 pretation and written translations.’’. 2 (2) CONFORMING AMENDMENTS.— 3 (A) Section 36B(c)(2)(C) of such Code is 4 amended by striking ‘‘clause (iii)’’ each place it 5 appears in clauses (i) and (ii) and inserting 6 ‘‘clause (iv)’’. 7 (B) Section 36B(c)(2)(C)(iv) of such Code, 8 as redesignated by this subsection, is amended 9 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 10 and (iii)’’. 11 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 12 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 13 amended— 14 (1) by striking ‘‘and’’ at the end of subpara- 15 graph (C); 16 (2) by striking the period at the end of sub- 17 paragraph (D) and inserting ‘‘; and’’; and 18 (3) by adding at the end the following new sub- 19 paragraph: 20 ‘‘(E) reduce health disparities through the 21 provision of language access services, including 22 oral interpretation and written translations.’’. 23 (d) REGULATIONS REGARDING INTERNAL CLAIMS 24 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 168 •HR 7585 IH HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 1 The Secretary of the Treasury, the Secretary of Labor, 2 and the Secretary of Health and Human Services shall 3 amend the regulations in section 54.9815–2719(e) of title 4 26, Code of Federal Regulations, section 2590.715– 5 2719(e) of title 29, Code of Federal Regulations, and sec- 6 tion 147.136(e) of title 45, Code of Federal Regulations 7 (or a successor regulation), respectively, to require group 8 health plans and health insurance issuers offering group 9 or individual health insurance coverage to which such sec- 10 tions apply— 11 (1) to provide oral interpretation services with- 12 out any threshold requirements; 13 (2) to provide in the English versions of all no- 14 tices a statement prominently displayed in not less 15 than 15 non-English languages clearly indicating 16 how to access the language services provided by the 17 plan or issuer; and 18 (3) with respect to the requirements for pro- 19 viding relevant notices in a culturally and linguis- 20 tically appropriate manner in the applicable non- 21 English languages, to apply a threshold that 5 per- 22 cent of the population, or not less than 500 individ- 23 uals, in the county is literate only in the same non- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 169 •HR 7585 IH English language in order for the language to be 1 considered an applicable non-English language. 2 (e) DATA COLLECTION AND REPORTING.—The Sec- 3 retary of Health and Human Services shall— 4 (1) amend the single streamlined application 5 form developed pursuant to section 1413 of the Pa- 6 tient Protection and Affordable Care Act (42 U.S.C. 7 18083) to collect the preferred spoken and written 8 language for each household member applying for 9 coverage under a qualified health plan through an 10 Exchange under title I of such Act (42 U.S.C. 11 18001 et seq.); 12 (2) require navigators, certified application 13 counselors, and other individuals assisting with en- 14 rollment to collect and report requests for language 15 assistance; and 16 (3) require the toll-free telephone hotlines es- 17 tablished pursuant to section 1311(d)(4)(B) of the 18 Patient Protection and Affordable Care Act (42 19 U.S.C. 18031(d)(4)(B)) to submit an annual report 20 documenting the number of language assistance re- 21 quests, the types of languages requested, the range 22 and average wait time for a consumer to speak with 23 an interpreter, the number of complaints and any 24 steps the hotline, and any entity contracting with 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 170 •HR 7585 IH the Secretary to provide language services, have 1 taken to actively address some of the consumer com- 2 plaints. 3 (f) EFFECTIVE DATE.—The amendments made by 4 this section shall not apply to plans beginning prior to the 5 date of the enactment of this Act. 6 SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS. 7 Section 330(b)(3) of the Public Health Service Act 8 (42 U.S.C. 254b(b)(3)) is amended to read as follows: 9 ‘‘(3) MEDICALLY UNDERSERVED.—The term 10 ‘medically underserved’, with respect to a popu- 11 lation, refers to— 12 ‘‘(A) the population of an urban or rural 13 area designated by the Secretary as— 14 ‘‘(i) an area with a shortage of per- 15 sonal health services; or 16 ‘‘(ii) a population group having a 17 shortage of such services; or 18 ‘‘(B) a population of individuals, not con- 19 fined to a particular urban or rural area, who 20 are designated by the Secretary as having a 21 shortage of personal health services due to a 22 specific demographic trait.’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 171 •HR 7585 IH TITLE III—HEALTH WORKFORCE 1 DIVERSITY 2 SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE 3 ACT. 4 Title XXXIV of the Public Health Service Act, as 5 added by section 2004, is amended by adding at the end 6 the following: 7 ‘‘Subtitle B—Diversifying the 8 Health Care Workplace 9 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 10 DIVERSITY. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Bureau of Health Workforce of the Health Resources 13 and Services Administration, shall award a grant to an 14 entity determined appropriate by the Secretary for the es- 15 tablishment of a national working group on workforce di- 16 versity. 17 ‘‘(b) REPRESENTATION.—In establishing the national 18 working group under subsection (a): 19 ‘‘(1) The grantee shall ensure that the group 20 has representatives of each of the following: 21 ‘‘(A) The Health Resources and Services 22 Administration. 23 ‘‘(B) The Department of Health and 24 Human Services Data Council. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 172 •HR 7585 IH ‘‘(C) The Office of Minority Health of the 1 Department of Health and Human Services. 2 ‘‘(D) The Substance Abuse and Mental 3 Health Services Administration. 4 ‘‘(E) The Bureau of Labor Statistics of 5 the Department of Labor. 6 ‘‘(F) The National Institute on Minority 7 Health and Health Disparities. 8 ‘‘(G) The Agency for Healthcare Research 9 and Quality. 10 ‘‘(H) The Institute of Medicine Study 11 Committee for the 2004 workforce diversity re- 12 port. 13 ‘‘(I) The Indian Health Service. 14 ‘‘(J) The Department of Education. 15 ‘‘(K) Minority-serving academic institu- 16 tions. 17 ‘‘(L) Consumer organizations. 18 ‘‘(M) Health professional associations, in- 19 cluding those that represent underrepresented 20 minority populations. 21 ‘‘(N) Researchers in the area of health 22 workforce. 23 ‘‘(O) Health workforce accreditation enti- 24 ties. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 173 •HR 7585 IH ‘‘(P) Private (including nonprofit) founda- 1 tions that have sponsored workforce diversity 2 initiatives. 3 ‘‘(Q) Local and State health departments. 4 ‘‘(R) Representatives of community mem- 5 bers to be included on admissions committees 6 for health profession schools pursuant to sub- 7 section (c)(9). 8 ‘‘(S) National community-based organiza- 9 tions that serve as a national intermediary to 10 their urban affiliate members and have dem- 11 onstrated capacity to train health care profes- 12 sionals. 13 ‘‘(T) The Veterans Health Administration. 14 ‘‘(U) Other entities determined appropriate 15 by the Secretary. 16 ‘‘(2) The grantee shall ensure that, in addition 17 to the representatives under paragraph (1), the 18 working group has not less than 5 health professions 19 students representing various health profession fields 20 and levels of training. 21 ‘‘(c) ACTIVITIES.—The working group established 22 under subsection (a) shall convene at least twice each year 23 to complete the following activities: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 174 •HR 7585 IH ‘‘(1) Review public and private health workforce 1 diversity initiatives. 2 ‘‘(2) Identify successful health workforce diver- 3 sity programs and practices. 4 ‘‘(3) Examine challenges relating to the devel- 5 opment and implementation of health workforce di- 6 versity initiatives. 7 ‘‘(4) Draft a national strategic work plan for 8 health workforce diversity, including recommenda- 9 tions for public and private sector initiatives. 10 ‘‘(5) Develop a framework and methods for the 11 evaluation of current and future health workforce di- 12 versity initiatives. 13 ‘‘(6) Develop recommended standards for work- 14 force diversity that could be applicable to all health 15 professions programs and programs funded under 16 this Act. 17 ‘‘(7) Develop guidelines to train health profes- 18 sionals to care for a diverse population. 19 ‘‘(8) Develop a workforce data collection or 20 tracking system to identify where racial and ethnic 21 minority health professionals practice. 22 ‘‘(9) Develop a strategy for the inclusion of 23 community members on admissions committees for 24 health profession schools. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 175 •HR 7585 IH ‘‘(10) Help with monitoring and implementation 1 of standards for diversity, equity, and inclusion. 2 ‘‘(11) Other activities determined appropriate 3 by the Secretary. 4 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 5 the establishment of the working group under subsection 6 (a), and annually thereafter, the working group shall pre- 7 pare and make available to the general public for com- 8 ment, an annual report on the activities of the working 9 group. Such report shall include the recommendations of 10 the working group for improving health workforce diver- 11 sity. 12 ‘‘(e) COORDINATION WITH OTHER EFFORTS.—In 13 providing for the establishment of the working group 14 under subsection (a), the Secretary shall take such steps 15 as may be necessary to ensure that the work of the work- 16 ing group does not overlap with, or otherwise duplicate, 17 other Federal Government efforts with respect to ensuring 18 health equity in data collection in public health emer- 19 gencies. 20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 176 •HR 7585 IH ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 1 WORKFORCE DIVERSITY. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Deputy Assistant Secretary for Minority Health, and 4 in collaboration with the Bureau of Health Workforce 5 within the Health Resources and Services Administration 6 and the National Institute on Minority Health and Health 7 Disparities, shall establish a technical clearinghouse on 8 health workforce diversity within the Office of Minority 9 Health and coordinate current and future clearinghouses 10 related to health workforce diversity. 11 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 12 house established under subsection (a) shall offer the fol- 13 lowing information and services: 14 ‘‘(1) Information on the importance of health 15 workforce diversity. 16 ‘‘(2) Statistical information relating to under- 17 represented minority representation in health and al- 18 lied health professions and occupations. 19 ‘‘(3) Model health workforce diversity practices 20 and programs, including integrated models of care. 21 ‘‘(4) Admissions policies that promote health 22 workforce diversity and are in compliance with Fed- 23 eral and State laws. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 177 •HR 7585 IH ‘‘(5) Retainment policies that promote comple- 1 tion of health profession degrees for underserved 2 populations. 3 ‘‘(6) Lists of scholarship, loan repayment, and 4 loan cancellation grants as well as fellowship infor- 5 mation for underserved populations for health pro- 6 fessions schools. 7 ‘‘(7) Foundation and other large organizational 8 initiatives relating to health workforce diversity. 9 ‘‘(c) CONSULTATION.—In carrying out this section, 10 the Secretary shall consult with non-Federal entities which 11 may include minority health professional associations and 12 minority sections of major health professional associations 13 to ensure the adequacy and accuracy of information. 14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of fiscal years 17 2023 through 2027. 18 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 19 WORKFORCE DIVERSITY, EQUITY, AND IN- 20 CLUSION. 21 ‘‘(a) IN GENERAL.—The Secretary, acting through 22 the Administrator of the Health Resources and Services 23 Administration and the Director of the Centers for Dis- 24 ease Control and Prevention, shall award grants to eligible 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 178 •HR 7585 IH entities that demonstrate a commitment to health work- 1 force diversity. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 3 under subsection (a), an entity shall— 4 ‘‘(1) be an educational institution or entity that 5 historically produces or trains meaningful numbers 6 of underrepresented minority health professionals, 7 including— 8 ‘‘(A) part B institutions, as defined in sec- 9 tion 322 of the Higher Education Act of 1965; 10 ‘‘(B) historically Black professional or 11 graduate institutions eligible for grants under 12 section 326 of the Higher Education Act of 13 1965; 14 ‘‘(C) Hispanic-serving health professions 15 schools; 16 ‘‘(D) Hispanic-serving institutions, as de- 17 fined in section 502 of such Act; 18 ‘‘(E) Tribal Colleges or Universities, as de- 19 fined in section 316 of such Act; 20 ‘‘(F) Asian American and Native American 21 Pacific Islander-serving institutions, as defined 22 in section 371(c) of such Act; 23 ‘‘(G) institutions that have programs to re- 24 cruit and retain underrepresented minority 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 179 •HR 7585 IH health professionals, in which a significant 1 number of the enrolled participants are under- 2 represented minorities; 3 ‘‘(H) health professional associations, 4 which may include underrepresented minority 5 health professional associations; and 6 ‘‘(I) institutions, including national and re- 7 gional community-based organizations with 8 demonstrated commitment to a diversified 9 workforce— 10 ‘‘(i) located in communities with pre- 11 dominantly underrepresented minority pop- 12 ulations; 13 ‘‘(ii) with whom partnerships have 14 been formed for the purpose of increasing 15 workforce diversity; and 16 ‘‘(iii) in which at least 20 percent of 17 the enrolled participants are underrep- 18 resented minorities; and 19 ‘‘(2) submit to the Secretary an application at 20 such time, in such manner, and containing such in- 21 formation as the Secretary may require. 22 ‘‘(c) USE OF FUNDS.—Amounts received under a 23 grant under subsection (a) shall be used to expand existing 24 workforce diversity programs, implement new workforce 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 180 •HR 7585 IH diversity programs, or evaluate existing or new workforce 1 diversity programs, including with respect to mental 2 health care professions. Such programs shall enhance di- 3 versity by considering minority status as part of an indi- 4 vidualized consideration of qualifications. Possible activi- 5 ties may include— 6 ‘‘(1) educational outreach programs relating to 7 opportunities in the health professions; 8 ‘‘(2) scholarship, fellowship, grant, loan repay- 9 ment, and loan cancellation programs; 10 ‘‘(3) postbaccalaureate programs; 11 ‘‘(4) academic enrichment programs, particu- 12 larly targeting those who would not be competitive 13 for health professions schools; 14 ‘‘(5) supporting workforce diversity in kinder- 15 garten through 12th grade and other health pipeline 16 programs; 17 ‘‘(6) mentoring programs; 18 ‘‘(7) internship or rotation programs involving 19 hospitals, health systems, health plans, and other 20 health entities; 21 ‘‘(8) community partnership development for 22 purposes relating to workforce diversity; or 23 ‘‘(9) leadership training. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 181 •HR 7585 IH ‘‘(d) REPORTS.—Not later than 1 year after receiving 1 a grant under this section, and annually for the term of 2 the grant, a grantee shall submit to the Secretary a report 3 that summarizes and evaluates all activities conducted 4 under the grant. 5 ‘‘(e) 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 2023 through 2027. 9 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 10 RESEARCHERS. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Director of the National Institutes of Health, the Di- 13 rector of the Centers for Disease Control and Prevention, 14 the Commissioner of Food and Drugs, the Director of the 15 Agency for Healthcare Research and Quality, and the Ad- 16 ministrator of the Health Resources and Services Admin- 17 istration, shall award grants that expand existing opportu- 18 nities for scientists and researchers and promote the inclu- 19 sion of underrepresented minorities in the health profes- 20 sions. 21 ‘‘(b) RESEARCH FUNDING.—The head of each agency 22 listed in subsection (a) shall establish or expand existing 23 programs to provide research funding to scientists and re- 24 searchers in training. Under such programs, the head of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 182 •HR 7585 IH each such entity shall give priority in allocating research 1 funding to support health research in traditionally under- 2 served communities, including underrepresented minority 3 communities, and research classified as community or 4 participatory. 5 ‘‘(c) DATA COLLECTION.—The head of each agency 6 listed in subsection (a) shall collect data on the number 7 (expressed as an absolute number and a percentage) of 8 underrepresented minority and nonminority applicants 9 who receive and are denied agency funding at every stage 10 of review. Such data shall be reported annually to the Sec- 11 retary and the appropriate committees of Congress. 12 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 13 retary shall establish a student loan reimbursement pro- 14 gram to provide student loan reimbursement assistance to 15 researchers who focus on racial and ethnic disparities in 16 health. The Secretary shall promulgate regulations to de- 17 fine the scope and procedures for the program under this 18 subsection. 19 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 20 retary shall establish a student loan cancellation program 21 to provide student loan cancellation assistance to research- 22 ers who focus on racial and ethnic disparities in health. 23 Students participating in the program shall make a min- 24 imum 5-year commitment to work at an accredited health 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 183 •HR 7585 IH profession school. The Secretary shall promulgate addi- 1 tional regulations to define the scope and procedures for 2 the program under this subsection. 3 ‘‘(f) 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 2023 through 2027. 7 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 8 PROFESSIONALS. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Director of the Centers for Disease Control and Pre- 11 vention, the Assistant Secretary for Mental Health and 12 Substance Use, the Administrator of the Health Resources 13 and Services Administration, and the Administrator of the 14 Centers for Medicare & Medicaid Services, shall establish 15 a program to award grants to universities and other insti- 16 tutions to enter into agreements with eligible individuals 17 under which— 18 ‘‘(1) the university or institution supports the 19 eligible individual’s career in a nonresearch-related 20 health and wellness profession; and 21 ‘‘(2) the eligible individual commits to per- 22 forming a period of obligated service in such a ca- 23 reer to serve, or to work on health issues affecting, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 184 •HR 7585 IH underserved communities, such as racial and ethnic 1 minority communities. 2 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi- 3 vidual for purposes of subsection (a), an individual shall 4 be a student in a health professions school, a graduate 5 of such a school who is working in a health profession, 6 an individual working in a health or wellness profession 7 (including mental and behavioral health), or a faculty 8 member of such a school. 9 ‘‘(c) APPLICATION.—To seek a grant under this sec- 10 tion, a university or other institution shall submit to the 11 Secretary an application at such time, in such manner, 12 and containing such information as the Secretary may re- 13 quire. 14 ‘‘(d) USE OF FUNDS.—A university or other institu- 15 tion receiving a grant under this section shall use the 16 grant for agreements described in subsection (a). Such 17 agreements may— 18 ‘‘(1) support an eligible individual’s health ac- 19 tivities or projects that involve underserved commu- 20 nities, including racial and ethnic minority commu- 21 nities; 22 ‘‘(2) support an eligible individual’s health-re- 23 lated career advancement activities; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 185 •HR 7585 IH ‘‘(3) pay, or reimburse for payment of, student 1 loans or training or credentialing costs for eligible 2 individuals who are health professionals and are fo- 3 cused on health issues affecting underserved commu- 4 nities, including racial and ethnic minority commu- 5 nities; and 6 ‘‘(4) establish and promote leadership training 7 programs for eligible individuals to decrease health 8 disparities and to increase cultural competence with 9 the goal of increasing diversity in leadership posi- 10 tions. 11 ‘‘(e) DEFINITION.—In this section, the term ‘career 12 in a nonresearch-related health and wellness profession’ 13 means employment or intended employment in the field 14 of public health, health policy, health management, health 15 administration, medicine, nursing, pharmacy, psychology, 16 social work, psychiatry, other mental and behavioral 17 health, allied health, community health, social work, or 18 other fields determined appropriate by the Secretary, 19 other than in a position that involves research. 20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 186 •HR 7585 IH ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 1 VERSITY ON QUALITY. 2 ‘‘(a) IN GENERAL.—The Director of the Agency for 3 Healthcare Research and Quality (in this section referred 4 to as the ‘Director’), in collaboration with the Deputy As- 5 sistant Secretary for Minority Health and the Director of 6 the National Institute on Minority Health and Health Dis- 7 parities, shall award grants to eligible entities to expand 8 research on the link between health workforce diversity 9 and quality health care. 10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 11 under subsection (a), an entity shall— 12 ‘‘(1) be a clinical, public health, or health serv- 13 ices research entity or other entity determined ap- 14 propriate by the Director; and 15 ‘‘(2) submit to the Secretary an application at 16 such time, in such manner, and containing such in- 17 formation as the Secretary may require. 18 ‘‘(c) USE OF FUNDS.—Amounts received under a 19 grant awarded under subsection (a) shall be used to sup- 20 port research that investigates the effect of health work- 21 force diversity on— 22 ‘‘(1) language access; 23 ‘‘(2) cultural competence; 24 ‘‘(3) patient satisfaction; 25 ‘‘(4) timeliness of care; 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 187 •HR 7585 IH ‘‘(5) safety of care; 1 ‘‘(6) effectiveness of care; 2 ‘‘(7) efficiency of care; 3 ‘‘(8) patient outcomes; 4 ‘‘(9) community engagement; 5 ‘‘(10) resource allocation; 6 ‘‘(11) organizational structure; 7 ‘‘(12) compliance of care; or 8 ‘‘(13) other topics determined appropriate by 9 the Director. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Director shall give individualized consider- 12 ation to all relevant aspects of the applicant’s background. 13 Consideration of prior research experience involving the 14 health of underserved communities shall be such a factor. 15 ‘‘(e) 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 2023 through 2027. 19 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 20 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 21 through the Office of Minority Health, in collaboration 22 with the National Institute on Minority Health and Health 23 Disparities, the Office for Civil Rights, the Centers for 24 Disease Control and Prevention, the Centers for Medicare 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 188 •HR 7585 IH & Medicaid Services, the Health Resources and Services 1 Administration, and other appropriate public and private 2 entities, shall establish and coordinate a health and health 3 care disparities education program to support, develop, 4 and implement educational initiatives and outreach strate- 5 gies that inform health care professionals and the public 6 about the existence of and methods to reduce racial and 7 ethnic disparities in health and health care. 8 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 9 cation program established under subsection (a), shall, 10 through the use of public awareness and outreach cam- 11 paigns targeting the general public and the medical com- 12 munity at large— 13 ‘‘(1) disseminate scientific evidence for the ex- 14 istence and extent of racial and ethnic disparities in 15 health care, including disparities that are not other- 16 wise attributable to known factors such as access to 17 care, patient preferences, or appropriateness of 18 intervention, as described in the 2002 Institute of 19 Medicine Report entitled ‘Unequal Treatment: Con- 20 fronting Racial and Ethnic Disparities in Health 21 Care’, as well as the impact of disparities related to 22 age, disability status, socioeconomic status, sex, gen- 23 der identity, and sexual orientation on racial and 24 ethnic minorities; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 189 •HR 7585 IH ‘‘(2) disseminate new research findings to 1 health care providers and patients to assist them in 2 understanding, reducing, and eliminating health and 3 health care disparities; 4 ‘‘(3) disseminate information about the impact 5 of linguistic and cultural barriers on health care 6 quality and the obligation of health providers who 7 receive Federal financial assistance to ensure that 8 individuals with limited English proficiency have ac- 9 cess to language access services; 10 ‘‘(4) disseminate information about the impor- 11 tance and legality of racial, ethnic, disability status, 12 socioeconomic status, sex, gender identity, and sex- 13 ual orientation, and primary language data collec- 14 tion, analysis, and reporting; 15 ‘‘(5) design and implement specific educational 16 initiatives to health care providers relating to health 17 and health care disparities; 18 ‘‘(6) assess the impact of the programs estab- 19 lished under this section in raising awareness of 20 health and health care disparities and providing in- 21 formation on available resources; and 22 ‘‘(7) design and implement specific educational 23 initiatives to educate the health care workforce relat- 24 ing to unconscious bias. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 190 •HR 7585 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2023 through 2027.’’. 4 SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI- 5 CALLY BLACK COLLEGES AND UNIVERSITIES, 6 HISTORICALLY BLACK PROFESSIONAL OR 7 GRADUATE INSTITUTIONS, ASIAN AMERICAN 8 AND NATIVE AMERICAN PACIFIC ISLANDER- 9 SERVING INSTITUTIONS, TRIBAL COLLEGES, 10 REGIONAL COMMUNITY-BASED ORGANIZA- 11 TIONS, AND NATIONAL MINORITY MEDICAL 12 ASSOCIATIONS. 13 Part B of title VII of the Public Health Service Act 14 (42 U.S.C. 293 et seq.) is amended by adding at the end 15 the following: 16 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 17 CALLY BLACK COLLEGES AND UNIVERSITIES, 18 HISTORICALLY BLACK PROFESSIONAL OR 19 GRADUATE INSTITUTIONS, ASIAN AMERICAN 20 AND NATIVE AMERICAN PACIFIC ISLANDER- 21 SERVING INSTITUTIONS, AND TRIBAL COL- 22 LEGES. 23 ‘‘(a) IN GENERAL.—The Secretary, acting through 24 the Administrator of the Health Resources and Services 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 191 •HR 7585 IH Administration and in consultation with the Secretary of 1 Education, shall award grants to Hispanic-serving institu- 2 tions, historically Black colleges and universities, histori- 3 cally Black professional or graduate institutions eligible 4 for grants under section 326 of the Higher Education Act 5 of 1965, Asian American and Native American Pacific Is- 6 lander-serving institutions, Tribal Colleges or Universities, 7 regional community-based organizations, and national mi- 8 nority medical associations, for counseling, mentoring, and 9 providing information on financial assistance to prepare 10 underrepresented minority individuals to enroll in and 11 graduate from health professional schools and to increase 12 services for underrepresented minority students includ- 13 ing— 14 ‘‘(1) mentoring with underrepresented health 15 professionals; 16 ‘‘(2) providing financial assistance information 17 for continued education and applications to health 18 professional schools; and 19 ‘‘(3) retaining existing enrolled underrep- 20 resented minority students in a health professions 21 school. 22 ‘‘(b) DEFINITIONS.—In this section: 23 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 24 PACIFIC ISLANDER-SERVING INSTITUTION.—The 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 192 •HR 7585 IH term ‘Asian American and Native American Pacific 1 Islander-serving institution’ has the meaning given 2 such term in section 320(b) of the Higher Education 3 Act of 1965. 4 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 5 term ‘Hispanic-serving institution’ means an entity 6 that— 7 ‘‘(A) is a school or program for which 8 there is a definition under section 799B; 9 ‘‘(B) has an enrollment of full-time equiva- 10 lent students that is made up of at least 9 per- 11 cent Hispanic students; 12 ‘‘(C) has been effective in carrying out pro- 13 grams to recruit Hispanic individuals to enroll 14 in and graduate from the school; 15 ‘‘(D) has been effective in recruiting and 16 retaining Hispanic faculty members; 17 ‘‘(E) has a significant number of graduates 18 who are providing health services to medically 19 underserved populations or to individuals in 20 health professional shortage areas; and 21 ‘‘(F) is a Hispanic Center of Excellence in 22 Health Professions Education designated under 23 section 736(d)(2) of the Public Health Service 24 Act (42 U.S.C. 293(d)(2)). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 193 •HR 7585 IH ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI- 1 VERSITY.—The term ‘historically Black college and 2 university’ has the meaning given the term ‘part B 3 institution’ as defined in section 322 of the Higher 4 Education Act of 1965. 5 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 6 term ‘Tribal College or University’ has the meaning 7 given such term in section 316(b) of the Higher 8 Education Act of 1965. 9 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 10 carrying out the National Health Service Corps Loan Re- 11 payment Program established under subpart III of part 12 D of title III and the loan repayment program under sec- 13 tion 317F, the Secretary shall ensure, notwithstanding 14 such subpart or section, that loan repayments of not less 15 than $50,000 per year per person are awarded for repay- 16 ment of loans incurred for enrollment or participation of 17 underrepresented minority individuals in health profes- 18 sional schools and other health programs described in this 19 section. 20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2023 through 2027.’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 194 •HR 7585 IH SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR 1 DISEASE CONTROL AND PREVENTION. 2 Section 317F(c)(1) of the Public Health Service Act 3 (42 U.S.C. 247b–7(c)(1)) is amended by striking 4 ‘‘$500,000 for fiscal year 1994, and such sums as may 5 be necessary for each of the fiscal years 1995 through 6 2002’’ and inserting ‘‘such sums as may be necessary for 7 each of fiscal years 2023 through 2027’’. 8 SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY. 9 (a) INCREASING WORKFORCE DIVERSITY IN THE 10 PROFESSIONS OF PHYSICAL THERAPY, OCCUPATIONAL 11 THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND 12 SPEECH-LANGUAGE PATHOLOGY.—Title VII of the Public 13 Health Service Act is amended— 14 (1) by redesignating part G (42 U.S.C. 295j et 15 seq.) as part H; and 16 (2) by inserting after part F (42 U.S.C. 295h) 17 the following new part: 18 ‘‘PART G—INCREASING WORKFORCE DIVERSITY 19 IN THE PROFESSIONS OF PHYSICAL THER- 20 APY, OCCUPATIONAL THERAPY, RES- 21 PIRATORY THERAPY, AUDIOLOGY, AND 22 SPEECH-LANGUAGE PATHOLOGY 23 ‘‘SEC. 783. SCHOLARSHIPS AND STIPENDS. 24 ‘‘(a) IN GENERAL.—The Secretary may award grants 25 and contracts to eligible entities to increase educational 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 195 •HR 7585 IH opportunities in the professions of physical therapy, occu- 1 pational therapy, respiratory therapy, audiology, and 2 speech-language pathology for eligible individuals by— 3 ‘‘(1) providing student scholarships or stipends, 4 including for— 5 ‘‘(A) completion of an accelerated degree 6 program; 7 ‘‘(B) completion of an associate’s, bach- 8 elor’s, master’s, or doctoral degree program; 9 and 10 ‘‘(C) entry by a diploma or associate’s de- 11 gree practitioner into a bridge or degree com- 12 pletion program; 13 ‘‘(2) providing assistance for completion of pre- 14 requisite courses or other preparation necessary for 15 acceptance for enrollment in the eligible entity; and 16 ‘‘(3) carrying out activities to increase the re- 17 tention of students in one or more programs in the 18 professions of physical therapy, occupational ther- 19 apy, respiratory therapy, audiology, and speech-lan- 20 guage pathology. 21 ‘‘(b) CONSIDERATION OF RECOMMENDATIONS.—In 22 carrying out subsection (a), the Secretary shall take into 23 consideration the recommendations of national organiza- 24 tions representing the professions of physical therapy, oc- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 196 •HR 7585 IH cupational therapy, respiratory therapy, audiology, and 1 speech-language pathology, including the American Phys- 2 ical Therapy Association, the American Occupational 3 Therapy Association, the American Speech-Language- 4 Hearing Association, the American Association for Res- 5 piratory Care, the American Academy of Audiology, and 6 the Academy of Doctors of Audiology. 7 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR 8 AWARD RECIPIENTS.— 9 ‘‘(1) IN GENERAL.—The Secretary may require 10 recipients of awards under this section to report to 11 the Secretary concerning the annual admission, re- 12 tention, and graduation rates for eligible individuals 13 in programs of the recipient leading to a degree in 14 any of the professions of physical therapy, occupa- 15 tional therapy, respiratory therapy, audiology, and 16 speech-language pathology. 17 ‘‘(2) FALLING RATES.—If any of the rates re- 18 ported by a recipient under paragraph (1) fall below 19 the average for such recipient over the two years 20 preceding the year covered by the report, the recipi- 21 ent shall provide the Secretary with plans for imme- 22 diately improving such rates. 23 ‘‘(3) INELIGIBILITY.—A recipient described in 24 paragraph (2) shall be ineligible for continued fund- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 197 •HR 7585 IH ing under this section if the plan of the recipient 1 fails to improve the rates within the 1-year period 2 beginning on the date such plan is implemented. 3 ‘‘(d) DEFINITIONS.—In this section: 4 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 5 entity’ means an accredited education program that 6 is carrying out a program for recruiting and retain- 7 ing students underrepresented in the professions of 8 physical therapy, occupational therapy, respiratory 9 therapy, audiology, and speech-language pathology 10 (including racial or ethnic minorities, or students 11 from disadvantaged backgrounds). 12 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 13 individual’ means an individual who— 14 ‘‘(A) is a member of a class of persons who 15 are underrepresented in the professions of phys- 16 ical therapy, occupational therapy, respiratory 17 therapy, audiology, and speech-language pathol- 18 ogy, including individuals who are— 19 ‘‘(i) racial or ethnic minorities; 20 ‘‘(ii) from disadvantaged backgrounds; 21 or 22 ‘‘(iii) individuals with a disability (as 23 defined in section 3(1) of the Americans 24 with Disabilities Act of 1990), or who have 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 198 •HR 7585 IH an individualized education program (as 1 defined in section 602 of the Individuals 2 with Disabilities Education Act), are cov- 3 ered under section 504 of the Rehabilita- 4 tion Act of 1973, or have other documenta- 5 tion establishing the student’s disability 6 (as such term is defined in section 3(1) of 7 the Americans with Disabilities Act of 8 1990); 9 ‘‘(B) has a financial need for a scholarship 10 or stipend; and 11 ‘‘(C) is enrolled (or accepted for enroll- 12 ment) at an audiology, speech-language pathol- 13 ogy, respiratory therapy, physical therapy, or 14 occupational therapy program as a full-time 15 student at an eligible entity. 16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 17 is authorized to be appropriated to carry out this section 18 $8,000,000 for the first fiscal year commencing after the 19 date of enactment of the Health Equity and Accountability 20 Act of 2022 and each of the 4 succeeding fiscal years.’’. 21 (b) ELIGIBILITY CLARIFICATION REGARDING STU- 22 DENTS SUPPORTED THROUGH MENTAL AND BEHAV- 23 IORAL HEALTH EDUCATION AND TRAINING GRANTS.— 24 Section 756(a)(1) of the Public Health Service Act (42 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 199 •HR 7585 IH U.S.C. 294e–1(a)(1)) is amended by inserting after ‘‘occu- 1 pational therapy’’ the following: ‘‘(which may include mas- 2 ter’s and doctoral level programs)’’. 3 SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DE- 4 GREE PROGRAMS AT SCHOOLS OF PUBLIC 5 HEALTH AND SCHOOLS OF ALLIED HEALTH. 6 Part B of title VII of the Public Health Service Act 7 (42 U.S.C. 293 et seq.) is amended by inserting after sec- 8 tion 755 of such Act (42 U.S.C. 294e) the following: 9 ‘‘SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DE- 10 GREE PROGRAMS. 11 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 12 acting through the Administrator of the Health Resources 13 and Services Administration, in consultation with the Di- 14 rector of the Centers for Disease Control and Prevention, 15 the Director of the Agency for Healthcare Research and 16 Quality, and the Deputy Assistant Secretary for Minority 17 Health, shall enter into cooperative agreements with 18 schools of public health and schools of allied health to de- 19 sign and implement online degree programs. 20 ‘‘(b) PRIORITY.—In entering into cooperative agree- 21 ments under this section, the Secretary shall give priority 22 to any school of public health or school of allied health 23 that has an established track record of serving medically 24 underserved communities. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 200 •HR 7585 IH ‘‘(c) REQUIREMENTS.—As a condition of entering 1 into a cooperative agreement with the Secretary under this 2 section, a school of public health or school of allied health 3 shall agree to design and implement an online degree pro- 4 gram that meets the following restrictions: 5 ‘‘(1) Enrollment of individuals who have ob- 6 tained a secondary school diploma or its recognized 7 equivalent. 8 ‘‘(2) Maintaining a significant enrollment of 9 underrepresented minority or disadvantaged stu- 10 dents. 11 ‘‘(3) Achieving a high completion rate of en- 12 rolled underrepresented minority or disadvantaged 13 students. 14 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 15 period during which payments are made through a cooper- 16 ative agreement entered into under this section may not 17 exceed 3 years. 18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2023 through 2027.’’. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 201 •HR 7585 IH SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMIS- 1 SION. 2 (a) SENSE OF CONGRESS.—It is the sense of Con- 3 gress that the National Health Care Workforce Commis- 4 sion established by section 5101 of the Patient Protection 5 and Affordable Care Act (42 U.S.C. 294q) should, in car- 6 rying out its assigned duties under that section, give at- 7 tention to the needs of racial and ethnic minorities, indi- 8 viduals with lower socioeconomic status, individuals with 9 mental, developmental, and physical disabilities, lesbian, 10 gay, bisexual, transgender, queer, and questioning popu- 11 lations, and individuals who are members of multiple mi- 12 nority or special population groups. 13 (b) REAUTHORIZATION.—Section 5101(h)(2) of the 14 Patient Protection and Affordable Care Act (42 U.S.C. 15 294q(h)(2)) is amended by striking ‘‘such sums as may 16 be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal 17 years 2023 through 2025’’. 18 SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 19 Subtitle B of title XXXIV of the Public Health Serv- 20 ice Act, as added by section 3001, is further amended by 21 inserting after section 3417 the following: 22 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 23 SERVICES CORPS. 24 ‘‘(a) IN GENERAL.—The Director of the Centers for 25 Disease Control and Prevention, in collaboration with the 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 202 •HR 7585 IH Administrator of the Health Resources and Services Ad- 1 ministration and the Deputy Assistant Secretary for Mi- 2 nority Health, shall award grants to eligible entities to in- 3 crease awareness among secondary and postsecondary stu- 4 dents of career opportunities in the health professions. 5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 6 under subsection (a), an entity shall— 7 ‘‘(1) be a clinical, public health, or health serv- 8 ices organization, community-based or nonprofit en- 9 tity, or other entity determined appropriate by the 10 Director of the Centers for Disease Control and Pre- 11 vention; 12 ‘‘(2) serve a health professional shortage area, 13 as determined by the Secretary; 14 ‘‘(3) work with students, including those from 15 racial and ethnic minority backgrounds, that have 16 expressed an interest in the health professions; and 17 ‘‘(4) submit to the Secretary an application at 18 such time, in such manner, and containing such in- 19 formation as the Secretary may require. 20 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 21 section (a) shall be used to support internships that will 22 increase awareness among students of non-research-based, 23 career opportunities in the following health professions: 24 ‘‘(1) Medicine. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 203 •HR 7585 IH ‘‘(2) Nursing. 1 ‘‘(3) Public health. 2 ‘‘(4) Pharmacy. 3 ‘‘(5) Health administration and management. 4 ‘‘(6) Health policy. 5 ‘‘(7) Psychology. 6 ‘‘(8) Dentistry. 7 ‘‘(9) International health. 8 ‘‘(10) Social work. 9 ‘‘(11) Allied health. 10 ‘‘(12) Psychiatry. 11 ‘‘(13) Hospice care. 12 ‘‘(14) Community health, patient navigation, 13 and peer support. 14 ‘‘(15) Other professions determined appropriate 15 by the Director of the Centers for Disease Control 16 and Prevention. 17 ‘‘(d) PRIORITY.—In awarding grants under sub- 18 section (a), the Director of the Centers for Disease Con- 19 trol and Prevention shall give priority to those entities 20 that— 21 ‘‘(1) serve a high proportion of individuals from 22 disadvantaged backgrounds; 23 ‘‘(2) have experience in health disparity elimi- 24 nation programs; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 204 •HR 7585 IH ‘‘(3) facilitate the entry of disadvantaged indi- 1 viduals into institutions of higher education; and 2 ‘‘(4) provide counseling or other services de- 3 signed to assist disadvantaged individuals in success- 4 fully completing their education at the postsecondary 5 level. 6 ‘‘(e) STIPENDS.— 7 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 8 an entity receiving a grant under this section may 9 use the funds made available through such grant to 10 award stipends for educational and living expenses 11 to students participating in the internship supported 12 by the grant. 13 ‘‘(2) LIMITATIONS.—A stipend awarded under 14 paragraph (1) to an individual— 15 ‘‘(A) may not be provided for a period that 16 exceeds 6 months; and 17 ‘‘(B) may not exceed $20 per day for an 18 individual (notwithstanding any other provision 19 of law regarding the amount of a stipend). 20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 205 •HR 7585 IH ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 1 PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Centers for 3 Disease Control and Prevention, in collaboration with the 4 Deputy Assistant Secretary for Minority Health, shall 5 award scholarships to eligible individuals under subsection 6 (b) who seek a career in public health. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 8 arship under subsection (a), an individual shall— 9 ‘‘(1) have interest, knowledge, or skill in public 10 health research or public health practice, or other 11 health professions as determined appropriate by the 12 Director of the Centers for Disease Control and Pre- 13 vention; 14 ‘‘(2) reside in a health professional shortage 15 area as determined by the Secretary; 16 ‘‘(3) demonstrate promise for becoming a leader 17 in public health; 18 ‘‘(4) secure admission to a 4-year institution of 19 higher education; and 20 ‘‘(5) submit to the Secretary an application at 21 such time, in such manner, and containing such in- 22 formation as the Secretary may require. 23 ‘‘(c) USE OF FUNDS.—Amounts received under an 24 award under subsection (a) shall be used to support oppor- 25 tunities for students to become public health professionals. 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 206 •HR 7585 IH ‘‘(d) PRIORITY.—In awarding grants under sub- 1 section (a), the Director shall give priority to those stu- 2 dents that— 3 ‘‘(1) are from disadvantaged backgrounds; 4 ‘‘(2) have secured admissions to a minority- 5 serving institution; and 6 ‘‘(3) have identified a health professional as a 7 mentor at their school or institution and an aca- 8 demic advisor to assist in the completion of their 9 baccalaureate degree. 10 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 11 payment of scholarships under this section for such indi- 12 viduals for any period of education in student under- 13 graduate tenure, except that such a scholarship may not 14 be provided to an individual for more than 4 years, and 15 such a scholarship may not exceed $10,000 per academic 16 year for an individual (notwithstanding any other provi- 17 sion of law regarding the amount of a scholarship). 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2023 through 2027. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 207 •HR 7585 IH ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 1 FELLOWSHIP PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Centers for 3 Disease Control and Prevention, in collaboration with the 4 Deputy Assistant Secretary for Minority Health, the As- 5 sistant Secretary for Mental Health and Substance Use, 6 and the Director of the Indian Health Service, shall award 7 research fellowships to eligible individuals under sub- 8 section (b) to conduct research that will examine gender 9 and health disparities and to pursue a career in the health 10 professions. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 12 ship under subsection (a), an individual shall— 13 ‘‘(1) have experience in health research or pub- 14 lic health practice; 15 ‘‘(2) reside in a health professional shortage 16 area designated by the Secretary under section 332; 17 ‘‘(3) have expressed an interest in the health 18 professions; 19 ‘‘(4) demonstrate promise for becoming a leader 20 in the field of women’s sexual and reproductive 21 health, including family planning; 22 ‘‘(5) secure admission to a health professions 23 school or graduate program with an emphasis in 24 gender studies; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 208 •HR 7585 IH ‘‘(6) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 4 subsection (a) to an eligible individual shall be used to 5 support an opportunity for the individual to become a re- 6 searcher and advance the research base on the intersection 7 between gender and health. 8 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 9 section (a), the Director of the Centers for Disease Con- 10 trol and Prevention shall give priority to those applicants 11 that— 12 ‘‘(1) are from disadvantaged backgrounds; and 13 ‘‘(2) have identified a mentor and academic ad- 14 visor who will assist in the completion of their grad- 15 uate or professional degree and have secured a re- 16 search assistant position with a researcher working 17 in the area of gender and health. 18 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 19 Disease Control and Prevention may approve fellowships 20 for individuals under this section for any period of edu- 21 cation in the student’s graduate or health profession ten- 22 ure, except that such a fellowship may not be provided 23 to an individual for more than 3 years, and such a fellow- 24 ship may not exceed $18,000 per academic year for an 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 209 •HR 7585 IH individual (notwithstanding any other provision of law re- 1 garding the amount of a fellowship). 2 ‘‘(f) 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 2023 through 2027. 6 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 7 HEALTH FELLOWSHIP PROGRAM. 8 ‘‘(a) IN GENERAL.—The Director of the Agency for 9 Healthcare Research and Quality, in collaboration with 10 the Deputy Assistant Secretary for Minority Health, shall 11 award research fellowships to eligible individuals under 12 subsection (b) to advance their understanding of inter- 13 national health. 14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 15 ship under subsection (a), an individual shall— 16 ‘‘(1) have educational experience in the field of 17 international health; 18 ‘‘(2) reside in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) demonstrate promise for becoming a leader 21 in the field of international health; 22 ‘‘(4) be a college senior or recent graduate of 23 a 4-year institution of higher education; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 210 •HR 7585 IH ‘‘(5) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 4 subsection (a) to an eligible individual shall be used to 5 support an opportunity for the individual to become a 6 health professional and to advance the knowledge of the 7 individual about international issues relating to health 8 care access and quality. 9 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 10 section (a), the Director shall give priority to eligible indi- 11 viduals that— 12 ‘‘(1) are from a disadvantaged background; and 13 ‘‘(2) have identified a mentor at a health pro- 14 fessions school or institution, an academic advisor to 15 assist in the completion of their graduate or profes- 16 sional degree, and an advisor from an international 17 health non-governmental organization, private volun- 18 teer organization, or other international institution 19 or program that focuses on increasing health care 20 access and quality for residents in developing coun- 21 tries. 22 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 23 this section may not— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 211 •HR 7585 IH ‘‘(1) be provided to an eligible individual for 1 more than a period of 6 months; 2 ‘‘(2) be awarded to a graduate of a 4-year insti- 3 tution of higher education that has not been enrolled 4 in such institution for more than 1 year; or 5 ‘‘(3) exceed $4,000 per academic year (notwith- 6 standing any other provision of law regarding the 7 amount of a fellowship). 8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2023 through 2027. 12 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 13 GRAM. 14 ‘‘(a) IN GENERAL.—The Director of the Agency for 15 Healthcare Research and Quality, the Administrator of 16 the Centers for Medicare & Medicaid Services, and the Ad- 17 ministrator of the Health Resources and Services Admin- 18 istration, in collaboration with the Deputy Assistant Sec- 19 retary for Minority Health, shall award grants to eligible 20 entities to expose entering graduate students to the health 21 professions. 22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 23 under subsection (a), an entity shall— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 212 •HR 7585 IH ‘‘(1) be a clinical, public health, or health serv- 1 ices organization, community-based, academic, or 2 nonprofit entity, or other entity determined appro- 3 priate by the Director of the Agency for Healthcare 4 Research and Quality; 5 ‘‘(2) serve in a health professional shortage 6 area designated by the Secretary under section 332; 7 ‘‘(3) work with students obtaining a degree in 8 the health professions; and 9 ‘‘(4) submit to the Secretary an application at 10 such time, in such manner, and containing such in- 11 formation as the Secretary may require. 12 ‘‘(c) USE OF FUNDS.—Amounts received under a 13 grant awarded under subsection (a) shall be used to sup- 14 port opportunities that expose students to non-research- 15 based health professions, including— 16 ‘‘(1) public health policy; 17 ‘‘(2) health care and pharmaceutical policy; 18 ‘‘(3) health care administration and manage- 19 ment; 20 ‘‘(4) health economics; and 21 ‘‘(5) other professions determined appropriate 22 by the Director of the Agency for Healthcare Re- 23 search and Quality, the Administrator of the Centers 24 for Medicare & Medicaid Services, or the Adminis- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 213 •HR 7585 IH trator of the Health Resources and Services Admin- 1 istration. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Director of the Agency for Healthcare Re- 4 search and Quality, the Administrator of the Centers for 5 Medicare & Medicaid Services, and the Administrator of 6 the Health Resources and Services Administration, in col- 7 laboration with the Deputy Assistant Secretary for Minor- 8 ity Health, shall give priority to entities that— 9 ‘‘(1) have experience with health disparity elimi- 10 nation programs; 11 ‘‘(2) facilitate training in the fields described in 12 subsection (c); and 13 ‘‘(3) provide counseling or other services de- 14 signed to assist students in successfully completing 15 their education at the postsecondary level. 16 ‘‘(e) STIPENDS.— 17 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 18 an entity receiving a grant under this section may 19 use the funds made available through such grant to 20 award stipends for educational and living expenses 21 to students participating in the opportunities sup- 22 ported by the grant. 23 ‘‘(2) LIMITATIONS.—A stipend awarded under 24 paragraph (1) to an individual— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 214 •HR 7585 IH ‘‘(A) may not be provided for a period that 1 exceeds 2 months; and 2 ‘‘(B) may not exceed $100 per day (not- 3 withstanding any other provision of law regard- 4 ing the amount of a stipend). 5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2023 through 2027. 9 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 10 ‘‘(a) IN GENERAL.—The Secretary shall award 11 grants to national minority medical or health professional 12 associations to develop leadership fellowship programs for 13 underrepresented health professionals in order to— 14 ‘‘(1) assist such professionals in becoming fu- 15 ture leaders in public health and health care delivery 16 institutions; and 17 ‘‘(2) increase diversity in decision-making posi- 18 tions that can improve the health of underserved 19 communities. 20 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro- 21 gram supported under this section shall— 22 ‘‘(1) focus on training mid-career physicians 23 and health care executives who have documented 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 215 •HR 7585 IH leadership experience and a commitment to public 1 health services in underserved communities; and 2 ‘‘(2) support Federal public health policy and 3 budget programs, and priorities that impact health 4 equity, through activities such as didactic lectures 5 and leader site visits. 6 ‘‘(c) PERIOD OF GRANTS.—The period during which 7 payments are made under a grant awarded under sub- 8 section (a) may not exceed 3 years. 9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2023 through 2027.’’. 13 SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 14 PROGRAM. 15 Section 402E of the Higher Education Act of 1965 16 (20 U.S.C. 1070a–15) is amended by striking subsection 17 (g) and inserting the following: 18 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 19 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 20 ordinate with the Secretary of Health and Human Serv- 21 ices to ensure that there is collaboration between the goals 22 of the program under this section and programs of the 23 Health Resources and Services Administration that pro- 24 mote health workforce diversity. The Secretary of Edu- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 216 •HR 7585 IH cation shall take such measures as may be necessary to 1 encourage students participating in projects assisted 2 under this section to consider health profession careers. 3 ‘‘(h) FUNDING.—From amounts appropriated pursu- 4 ant to the authority of section 402A(g), the Secretary 5 shall, to the extent practicable, allocate funds for projects 6 authorized by this section in an amount that is not less 7 than $31,000,000 for each of the fiscal years 2023 8 through 2027.’’. 9 SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME 10 EQUIVALENT RESIDENTS FOR COST-REPORT- 11 ING PERIODS. 12 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 13 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 14 amended by section 2006(a), is amended— 15 (1) in subparagraph (E), by striking ‘‘Subject 16 to subparagraphs (J) and (K), such rules’’ and in- 17 serting ‘‘Subject to subparagraphs (J), (K), and 18 (M), such rules’’; 19 (2) in subparagraph (J), by striking ‘‘Such 20 rules’’ and inserting ‘‘Subject to subparagraph (M), 21 such rules’’; 22 (3) in subparagraph (K), by striking ‘‘In deter- 23 mining’’ and inserting ‘‘Subject to subparagraph 24 (M), in determining’’; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 217 •HR 7585 IH (4) by adding at the end the following new sub- 1 paragraph: 2 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 3 AND INTERNS.—For purposes of cost-reporting 4 periods beginning on or after October 1, 2021, 5 in determining the hospital’s number of full- 6 time equivalent residents for purposes of this 7 paragraph, all time spent by an intern or resi- 8 dent in an approved medical residency training 9 program shall be counted toward the determina- 10 tion of full-time equivalency if the hospital— 11 ‘‘(i) is recognized as a subsection (d) 12 hospital; 13 ‘‘(ii) is recognized as a subsection (d) 14 Puerto Rico hospital; 15 ‘‘(iii) is reimbursed under a reim- 16 bursement system authorized under section 17 1814(b)(3); or 18 ‘‘(iv) is a provider-based hospital out- 19 patient department.’’. 20 (b) IME DETERMINATIONS.—Section 21 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 22 1395ww(d)(5)(B)(xi)), as redesignated by section 23 2006(b), is amended— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 218 •HR 7585 IH (1) in subclause (II), by striking ‘‘In deter- 1 mining’’ and inserting ‘‘Subject to subclause (IV), in 2 determining’’; 3 (2) in subclause (III), by striking ‘‘In deter- 4 mining’’ and inserting ‘‘Subject to subclause (IV), in 5 determining’’; and 6 (3) by inserting after subclause (III) the fol- 7 lowing new subclause: 8 ‘‘(IV) For purposes of cost-reporting peri- 9 ods beginning on or after October 1, 2021, the 10 provisions of subparagraph (M) of subsection 11 (h)(4) shall apply under this subparagraph in 12 the same manner as they apply under such sub- 13 section.’’. 14 SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES 15 FOR LOCAL HEALTH EQUITY. 16 (a) GRANTS.—The Secretary of Health and Human 17 Services, acting jointly with the Secretary of Education 18 and the Secretary of Labor, shall make grants to an eligi- 19 ble institution of higher education for the purposes of— 20 (1) in accordance with subsection (b), devel- 21 oping capacity— 22 (A) to build an evidence base for successful 23 strategies for increasing local health equity; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 219 •HR 7585 IH (B) to serve as national models of driving 1 local health equity; and 2 (2) in accordance with subsection (c), devel- 3 oping a strategic partnership with the community in 4 which the institution is located. 5 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 6 HEALTH EQUITY.—As a condition on receipt of a grant 7 under subsection (a), an institution of higher education 8 shall agree to use such grant to build an evidence base 9 for successful strategies for increasing local health equity, 10 and to serve as a national model of driving local health 11 equity, by supporting— 12 (1) resources to strengthen institutional metrics 13 and capacity to execute institution-wide health work- 14 force goals that can serve as models for increasing 15 health equity in communities across the United 16 States; 17 (2) collaborations among a cohort of institu- 18 tions in implementing systemic change, partnership 19 development, and programmatic efforts supportive of 20 health equity goals across disciplines and popu- 21 lations; and 22 (3) enhanced or newly developed data systems 23 and research infrastructure capable of informing 24 current and future workforce efforts and building a 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 220 •HR 7585 IH foundation for a broader research agenda targeting 1 urban health disparities. 2 (c) STRATEGIC PARTNERSHIPS.—As a condition on 3 receipt of a grant under subsection (a), an institution of 4 higher education shall agree to use the grant to develop 5 a strategic partnership with the community in which such 6 institution is located for the purposes of— 7 (1) strengthening connections between such in- 8 stitution and the community— 9 (A) to improve evaluation of, and address, 10 the health and health workforce needs of such 11 community; and 12 (B) to engage such community in health 13 workforce development; 14 (2) developing, enhancing, or accelerating inno- 15 vative undergraduate and graduate programs in the 16 biomedical sciences and health professions; and 17 (3) strengthening pipeline programs in the bio- 18 medical sciences and health professions, including by 19 developing partnerships between institutions of high- 20 er education and elementary schools and secondary 21 schools to recruit the next generation of health pro- 22 fessionals earlier in the pipeline to a health care ca- 23 reer. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 221 •HR 7585 IH (d) ELIGIBLE INSTITUTION OF HIGHER EDUCATION 1 DEFINED.—For purposes of this section, an ‘‘eligible in- 2 stitution of higher education’’ includes— 3 (1) a program authorized under section 317(a) 4 of the Higher Education Act of 1965 (20 U.S.C. 5 1059d(a)); or 6 (2) a professional or graduate institution de- 7 scribed in section 326 of such Act. 8 (e) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2023 through 2027. 12 SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND. 13 (a) ESTABLISHMENT.—There is established in the 14 Health Resources and Services Administration of the De- 15 partment of Health and Human Services a Health Profes- 16 sions Workforce Fund to provide for expanded and sus- 17 tained national investment in the health professions and 18 nursing workforce development programs under title VII 19 and title VIII of the Public Health Service Act (42 U.S.C. 20 292 et seq.; 42 U.S.C. 296 et seq.). 21 (b) FUNDING.— 22 (1) IN GENERAL.—There is authorized to be 23 appropriated, and there is appropriated, out of any 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 222 •HR 7585 IH monies in the Treasury not otherwise appropriated, 1 to the Health Professions Workforce Fund— 2 (A) $392,000,000 for fiscal year 2023; 3 (B) $412,000,000 for fiscal year 2024; 4 (C) $432,000,000 for fiscal year 2025; 5 (D) $454,000,000 for fiscal year 2026; 6 (E) $476,000,000 for fiscal year 2027; 7 (F) $500,000,000 for fiscal year 2028; 8 (G) $525,000,000 for fiscal year 2029; and 9 (H) $552,000,000 for fiscal year 2030. 10 (2) HEALTH PROFESSIONS EDUCATION PRO- 11 GRAMS.—For the purpose of carrying out health 12 professions education programs authorized under 13 title VII of the Public Health Service Act (42 U.S.C. 14 292 et seq.), in addition to any other amounts au- 15 thorized to be appropriated for such purpose, there 16 is authorized to be appropriated out of any monies 17 in the Health Professions Workforce Fund, the fol- 18 lowing: 19 (A) $265,000,000 for fiscal year 2023. 20 (B) $278,000,000 for fiscal year 2024. 21 (C) $292,000,000 for fiscal year 2025. 22 (D) $307,000,000 for fiscal year 2026. 23 (E) $322,000,000 for fiscal year 2027. 24 (F) $338,000,000 for fiscal year 2028. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 223 •HR 7585 IH (G) $355,000,000 for fiscal year 2029. 1 (H) $373,000,000 for fiscal year 2030. 2 (3) NURSING WORKFORCE DEVELOPMENT PRO- 3 GRAMS.—For the purpose of carrying out nursing 4 workforce development programs authorized under 5 title VIII of the Public Health Service Act (42 6 U.S.C. 296 et seq.), in addition to any other 7 amounts authorized to be appropriated for such pur- 8 pose, there is authorized to be appropriated out of 9 any monies in the Health Professions Workforce 10 Fund, the following: 11 (A) $127,000,000 for fiscal year 2023. 12 (B) $134,000,000 for fiscal year 2024. 13 (C) $140,000,000 for fiscal year 2025. 14 (D) $147,000,000 for fiscal year 2026. 15 (E) $154,000,000 for fiscal year 2027. 16 (F) $162,000,000 for fiscal year 2028. 17 (G) $170,000,000 for fiscal year 2029. 18 (H) $179,000,000 for fiscal year 2030. 19 SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURS- 20 ING. 21 (a) SUPPORT FOR NURSING EDUCATION AND THE 22 FUTURE NURSING WORKFORCE.—Part D of title VIII of 23 the Public Health Service Act (42 U.S.C. 296p et seq.) 24 is amended by adding at the end the following: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 224 •HR 7585 IH ‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD- 1 ERNIZATION GRANTS IN UNDERSERVED 2 AREAS. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Administrator of the Health Resources and Services 5 Administration, may award grants to schools of nursing 6 (as defined in section 801) for— 7 ‘‘(1) increasing the number of faculty and stu- 8 dents at such schools in order to enhance the pre- 9 paredness of the United States for, and the ability 10 of the United States to address and quickly respond 11 to, public health emergencies declared under section 12 319 and pandemics; or 13 ‘‘(2) the enhancement and modernization of 14 nursing education programs. 15 ‘‘(b) PRIORITY.—In selecting grant recipients under 16 this section, the Secretary shall give priority to schools of 17 nursing that— 18 ‘‘(1) are located in a medically underserved 19 community; 20 ‘‘(2) are located in a health professional short- 21 age area as defined under section 332(a); or 22 ‘‘(3) are institutions of higher education listed 23 under section 371(a) of the Higher Education Act of 24 1965. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 225 •HR 7585 IH ‘‘(c) CONSIDERATION.—In awarding grants under 1 this section, the Secretary, to the extent practicable, may 2 ensure equitable distribution of awards among the geo- 3 graphic regions of the United States. 4 ‘‘(d) USE OF FUNDS.—A school of nursing that re- 5 ceives a grant under this section may use the funds award- 6 ed through such grant for activities that include— 7 ‘‘(1) enhancing enrollment and retention of stu- 8 dents at such school, with a priority for students 9 from disadvantaged backgrounds (including racial or 10 ethnic groups underrepresented in the nursing work- 11 force), individuals from rural and underserved areas, 12 low-income individuals, and first generation college 13 students (as defined in section 402A(h)(3) of the 14 Higher Education Act of 1965); 15 ‘‘(2) creating, supporting, or modernizing edu- 16 cational programs and curriculum at such school; 17 ‘‘(3) retaining current faculty, and hiring new 18 faculty, with an emphasis on faculty from racial or 19 ethnic groups who are underrepresented in the nurs- 20 ing workforce; 21 ‘‘(4) modernizing infrastructure at such school, 22 including audiovisual or other equipment, personal 23 protective equipment, simulation and augmented re- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 226 •HR 7585 IH ality resources, telehealth technologies, and virtual 1 and physical laboratories; 2 ‘‘(5) partnering with a health care facility, 3 nurse-managed health clinic, community health cen- 4 ter, or other facility that provides health care in 5 order to provide educational opportunities for the 6 purpose of establishing or expanding clinical edu- 7 cation; 8 ‘‘(6) enhancing and expanding nursing pro- 9 grams that prepare nurse researchers and scientists; 10 ‘‘(7) establishing nurse-led intradisciplinary and 11 interprofessional educational partnerships; and 12 ‘‘(8) other activities that the Secretary deter- 13 mines further the development, improvement, and 14 expansion of schools of nursing. 15 ‘‘(e) REPORTS FROM ENTITIES.—Each school of 16 nursing awarded a grant under this section shall submit 17 an annual report to the Secretary on the activities con- 18 ducted under such grant, and other information as the 19 Secretary may require. 20 ‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 21 after the date of the enactment of this section, the Sec- 22 retary shall submit to the Committee on Health, Edu- 23 cation, Labor, and Pensions of the Senate and the Com- 24 mittee on Energy and Commerce of the House of Rep- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 227 •HR 7585 IH resentatives a report that provides a summary of the ac- 1 tivities and outcomes associated with grants made under 2 this section. Such report shall include— 3 ‘‘(1) a list of schools of nursing receiving grants 4 under this section, including the primary geographic 5 location of any school of nursing that was improved 6 or expanded through such a grant; 7 ‘‘(2) the total number of students who are en- 8 rolled at or who have graduated from any school of 9 nursing that was improved or expanded through a 10 grant under this section, which such statistic shall— 11 ‘‘(A) to the extent such information is 12 available, be deidentified and disaggregated by 13 race, ethnicity, age, sex, geographic region, dis- 14 ability status, and other relevant factors; and 15 ‘‘(B) include an indication of the number 16 of such students who are from racial or ethnic 17 groups underrepresented in the nursing work- 18 force, such students who are from rural or un- 19 derserved areas, such students who are low-in- 20 come students, and such students who are first 21 generation college students (as defined in sec- 22 tion 402A(h)(3) of the Higher Education Act of 23 1965); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 228 •HR 7585 IH ‘‘(3) to the extent such information is available, 1 the effects of the grants awarded under this section 2 on retaining and hiring of faculty, including any in- 3 crease in diverse faculty, the number of clinical edu- 4 cation partnerships, the modernization of nursing 5 education infrastructure, and other ways this section 6 helps address and quickly respond to public health 7 emergencies and pandemics; 8 ‘‘(4) recommendations for improving the grants 9 awarded under this section; and 10 ‘‘(5) any other considerations as the Secretary 11 determines appropriate. 12 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this section, there is authorized to be appro- 14 priated $1,000,000,000, to remain available until ex- 15 pended.’’. 16 (b) STRENGTHENING NURSE EDUCATION.—The 17 heading of part D of title VIII of the Public Health Serv- 18 ice Act (42 U.S.C. 296p et seq.) is amended by striking 19 ‘‘BASIC’’. 20 SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO 21 GRADUATE MEDICAL EDUCATION. 22 (a) FINDINGS.—Congress finds the following: 23 (1) Projections by the Association of American 24 Medical Colleges and other expert entities, such as 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 229 •HR 7585 IH the Health Resources and Services Administration, 1 have indicated a nationwide shortage of up to 2 121,900 physicians, split evenly between primary 3 care and specialists, by 2032. 4 (2) Primarily due to the growing and aging 5 population, over the next decade, physician demand 6 is expected to grow up to 17 percent. 7 (3) The United States Census Bureau estimates 8 that the United States population will grow from 9 321,000,000 in 2015 to 347,000,000 in 2025. Fur- 10 ther, the number of Medicare beneficiaries is esti- 11 mated to increase from 47,800,000 in 2015 to ap- 12 proximately 66,000,000 in 2025. 13 (4) Approximately 36 percent of practicing phy- 14 sicians are over the age of 55 and are likely to retire 15 within the next decade. 16 (5) A nationwide physician shortage will result 17 in many individuals in the United States waiting 18 longer and traveling farther for health care; seeking 19 nonemergent care in emergency departments; and 20 delaying treatment until the health care needs of 21 such individuals become more serious, complex, and 22 costly. 23 (6) Changing demographics (such as an aging 24 population), new health care delivery models (such 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 230 •HR 7585 IH as medical homes), and other factors (such as dis- 1 aster preparedness) are contributing to a shortage of 2 both generalist and specialist physicians. 3 (7) These shortages will have the most severe 4 impact on vulnerable and underserved populations, 5 including racial and ethnic minorities and the ap- 6 proximately 20 percent of people in the United 7 States who live in rural or inner-city locations des- 8 ignated as health professional shortage areas. 9 (8) The health care utilization equity model of 10 the Association of American Medical Colleges esti- 11 mates that if racial and ethnic minorities and indi- 12 viduals from rural areas utilized health care in a 13 similar way to their Caucasian counterparts living in 14 metropolitan areas, the physician shortage would re- 15 quire an additional 96,000 physicians. 16 (9) To address the physician shortage in rural 17 and medically underserved areas, medical education 18 and training need to be accessible to underrep- 19 resented minorities (including individuals who are 20 African American, Hispanic, Native American, or 21 Native Hawaiian), and need to increase pathway 22 programs for such underrepresented minorities who 23 make up less than 12 percent of individuals enrolled 24 in graduate medical education and for international 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 231 •HR 7585 IH students who make up 25 percent of individuals en- 1 rolled in graduate medical education. Immigration 2 pathways like student, exchange-visitor, and employ- 3 ment visas, and programs like the National Interest 4 Waiver and Conrad 30 J–1 Visa Waiver, help im- 5 prove health access across the United States. 6 (10) United States medical school enrollment 7 was expected to grow by 30 percent from 2018 to 8 2019 to help reduce the shortage of quality physi- 9 cians in the United States. 10 (11) An increase in United States medical 11 school graduates must be accompanied by an in- 12 crease of 4,000 graduate medical education training 13 positions each year. 14 (12) Graduate medical education programs and 15 teaching hospitals provide venues in which the next 16 generation of physicians learns to work collabo- 17 ratively with other physicians and health profes- 18 sionals, adopt more efficient care delivery models 19 (such as care coordination and medical homes), in- 20 corporate health information technology and elec- 21 tronic health records in every aspect of their work, 22 apply new methods of assuring quality and safety, 23 and participate in groundbreaking clinical and public 24 health research. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 232 •HR 7585 IH (13) The Medicare program under title XVIII 1 of the Social Security Act (42 U.S.C. 1395 et seq.) 2 (having more beneficiaries than any other health 3 care program), supports its ‘‘fair share’’ of the costs 4 associated with graduate medical education. 5 (14) In general, the level of support of graduate 6 medical education by the Medicare program has 7 been capped since 1997 and has not been increased 8 to support the expansion of graduate medical edu- 9 cation programs needed to avert the projected physi- 10 cian shortage or to accommodate the increase in 11 United States medical school graduates. 12 (b) SENSE OF CONGRESS.—It is the sense of Con- 13 gress that eliminating the limit of the number of residency 14 positions that receive some level of Medicare support 15 under section 1886(h) of the Social Security Act (42 16 U.S.C. 1395ww(h)), also referred to as the Medical grad- 17 uate medical education cap, is critical to— 18 (1) ensuring an appropriate supply of physi- 19 cians to meet the health care needs in the United 20 States; 21 (2) facilitating equitable access for all who seek 22 health care; 23 (3) increasing the racial and ethnic diversity of 24 physicians in the United States; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 233 •HR 7585 IH (4) mitigating disparities in health and health 1 care. 2 SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATION- 3 ALLY EDUCATED HEALTH PROFESSIONALS. 4 (a) FINDINGS.—Congress finds the following: 5 (1) According to a 2018 study, the State and 6 local public health workforce has shrunk by more 7 than 50,000 individuals since the beginning of the 8 2008 Great Recession, and almost one quarter of in- 9 dividuals comprising the governmental public health 10 workforce plan to leave or retire in the coming years. 11 (2) Shortages are projected for other health 12 professions, including within the fields of nursing 13 (500,000 by 2025), dentistry (15,000 by 2025), 14 pharmacy (38,000 by 2030), mental and behavioral 15 health (236,880 by 2025), and primary care (46,000 16 by 2025). 17 (3) A nationwide health workforce shortage will 18 result in serious health threats and more severe and 19 costly health care needs, due to, in part, a delayed 20 response to food-borne outbreaks, emerging infec- 21 tious diseases, natural disasters, fewer cancer 22 screenings, and delayed treatment. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 234 •HR 7585 IH (4) Vulnerable and underserved populations and 1 health professional shortage areas will be most se- 2 verely impacted by the health workforce shortage. 3 (5) According to the Migration Policy Institute, 4 more than 2,000,000 college-educated immigrants in 5 the United States today are unemployed or under- 6 employed in low- or semi-skilled jobs that fail to 7 draw on their education and expertise. 8 (6) Approximately 2 out of every 5 internation- 9 ally educated immigrants are unemployed or under- 10 employed. 11 (7) According to the Drexel University Center 12 for Labor Markets and Policy, underemployment for 13 internationally educated immigrant women is 28 per- 14 cent higher than for their male counterparts. 15 (8) According to the Drexel University Center 16 for Labor Markets and Policy, the mean annual 17 earnings of underemployed immigrants were 18 $32,000, or 43 percent less than United States born 19 college graduates employed in the college labor mar- 20 ket. 21 (9) According to Upwardly Global and the Wel- 22 come Back Initiative, with proper guidance and sup- 23 port, underemployed skilled immigrants typically in- 24 crease their income by 215 percent to 900 percent. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 235 •HR 7585 IH (10) According to the Brookings Institution and 1 the Partnership for a New American Economy, im- 2 migrants working in the health workforce are, on av- 3 erage, better educated than United States-born 4 workers in the health workforce. 5 (b) GRANTS TO ELIGIBLE ENTITIES.— 6 (1) AUTHORITY TO PROVIDE GRANTS.—The 7 Secretary of Health and Human Services acting 8 through the Bureau of Health Workforce within the 9 Health Resources and Services Administration, the 10 National Institute on Minority Health and Health 11 Disparities, or the Office of Minority Health (in this 12 section referred to as the ‘‘Secretary’’) may award 13 grants to eligible entities to carry out activities de- 14 scribed in subsection (c). 15 (2) ELIGIBILITY.—To be eligible to receive a 16 grant under this section, an entity shall— 17 (A) be a clinical, public health, or health 18 services organization, a community-based or 19 nonprofit entity, an academic institution, a 20 faith-based organization, a State, county, or 21 local government, an area health education cen- 22 ter, or another entity determined appropriate by 23 the Secretary; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 236 •HR 7585 IH (B) submit to the Secretary an application 1 at such time, in such manner, and containing 2 such information as the Secretary may require. 3 (c) AUTHORIZED ACTIVITIES.—A grant awarded 4 under this section shall be used— 5 (1) to provide services to assist unemployed and 6 underemployed skilled immigrants, residing in the 7 United States, who have legal, permanent work au- 8 thorization and who are internationally educated 9 health professionals, enter into the health workforce 10 of the United States with employment matching 11 their health professional skills and education, and 12 advance in employment to positions that better 13 match their health professional education and exper- 14 tise; 15 (2) to provide training opportunities to reduce 16 barriers to entry and advancement in the health 17 workforce for skilled, internationally educated immi- 18 grants; 19 (3) to educate employers regarding the abilities 20 and capacities of internationally educated health 21 professionals; 22 (4) to assist in the evaluation of foreign creden- 23 tials; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 237 •HR 7585 IH (5) to support preceptorships for international 1 medical graduates in hospital primary care training; 2 and 3 (6) to facilitate access to contextualized and ac- 4 celerated courses on English as a second language. 5 SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR IN- 6 CREASING DIVERSITY. 7 (a) STUDY.—The Comptroller General of the United 8 States shall conduct a study on strategies for increasing 9 the diversity of the health professional workforce. Such 10 study shall include an analysis of strategies for increasing 11 the number of health professionals from rural, lower in- 12 come, and underrepresented minority communities, includ- 13 ing which strategies are most effective for achieving such 14 goal. 15 (b) REPORT.—Not later than 2 years after the date 16 of enactment of this Act, the Comptroller General shall 17 submit to Congress a report on the study conducted under 18 subsection (a), together with recommendations for such 19 legislation and administrative action as the Comptroller 20 General determines appropriate. 21 SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN- 22 TION. 23 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec- 24 tion 220(c) of the Immigration and Nationality Technical 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 238 •HR 7585 IH Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 1 1182 note) is amended by striking ‘‘September 30, 2015’’ 2 and inserting ‘‘September 30, 2022’’. 3 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED 4 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 5 201(b)(1) of the Immigration and Nationality Act (8 6 U.S.C. 1151(b)(1)) is amended by adding at the end the 7 following: 8 ‘‘(F)(i) Alien physicians who have com- 9 pleted service requirements for a national inter- 10 est waiver requested under section 11 203(b)(2)(B)(ii), including— 12 ‘‘(I) alien physicians who completed 13 such service before the date of the enact- 14 ment of the Health Equity and Account- 15 ability Act of 2022; and 16 ‘‘(II) the spouse or children of an 17 alien physician described in subclause (I). 18 ‘‘(ii) Nothing in this subparagraph may be 19 construed— 20 ‘‘(I) to prevent the filing of a petition 21 with the Secretary of Homeland Security 22 for classification under section 204(a) or 23 the filing of an application for adjustment 24 of status under section 245 by an alien 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 239 •HR 7585 IH physician described in clause (i) before the 1 date on which such alien physician com- 2 pletes the service described in section 3 214(l) or worked full-time as a physician 4 for an aggregate of 5 years at the location 5 identified in the waiver of the 2-year for- 6 eign residence requirement under section 7 214(l) or in an area or areas designated by 8 the Secretary of Health and Human Serv- 9 ices as having a shortage of health care 10 professionals; or 11 ‘‘(II) to permit the Secretary of 12 Homeland Security to grant a petition or 13 application described in subclause (I) until 14 the alien has satisfied all of the require- 15 ments of the waiver received under section 16 214(l).’’. 17 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 18 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI- 19 DENCY REQUIREMENT.—Section 214(l)(1) of the 20 Immigration and Nationality Act (8 U.S.C. 21 1184(l)(1)) is amended— 22 (A) in the matter preceding subparagraph 23 (A), by striking ‘‘Attorney General shall not’’ 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 240 •HR 7585 IH and inserting ‘‘Secretary of Homeland Security 1 may not’’; 2 (B) in subparagraph (A), by striking ‘‘Di- 3 rector of the United States Information Agen- 4 cy’’ and inserting ‘‘Secretary of State’’; 5 (C) in subparagraph (B), by inserting ‘‘, 6 except as provided in paragraphs (7) and (8)’’ 7 before the semicolon at the end; 8 (D) in subparagraph (C), by amending 9 clauses (i) and (ii) to read as follows: 10 ‘‘(i) the alien demonstrates a bona 11 fide offer of full-time employment at a 12 health facility or health care organization, 13 which employment has been determined by 14 the Secretary of Homeland Security to be 15 in the public interest; and 16 ‘‘(ii) the alien— 17 ‘‘(I) has accepted employment 18 with the health facility or health care 19 organization in a geographic area or 20 areas which are designated by the 21 Secretary of Health and Human Serv- 22 ices as having a shortage of health 23 care professionals; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 241 •HR 7585 IH ‘‘(II) begins employment by the 1 later of the date that is— 2 ‘‘(aa) 120 days after receiv- 3 ing such waiver; 4 ‘‘(bb) 120 days after com- 5 pleting graduate medical edu- 6 cation or training under a pro- 7 gram approved pursuant to sec- 8 tion 212(j)(1); or 9 ‘‘(cc) 120 days after receiv- 10 ing nonimmigrant status or em- 11 ployment authorization, if the 12 alien or the alien’s employer peti- 13 tions for such nonimmigrant sta- 14 tus or employment authorization 15 not later than 120 days after the 16 date on which the alien completes 17 his or her graduate medical edu- 18 cation or training under a pro- 19 gram approved pursuant to sec- 20 tion 212(j)(1); and 21 ‘‘(III) agrees to continue to work 22 for a total of not less than 3 years in 23 the status authorized for such employ- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 242 •HR 7585 IH ment under this subsection, except as 1 provided in paragraph (8); and’’; and 2 (E) in subparagraph (D), in the matter 3 preceding clause (i), by inserting ‘‘, subject to 4 paragraph (8),’’ before ‘‘in the case’’. 5 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS 6 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 7 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 8 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 9 read as follows: 10 ‘‘(A) Upon the request of an interested 11 Federal agency or an interested State agency 12 for recommendation of a waiver under this sec- 13 tion by a physician who is maintaining valid 14 nonimmigrant status under section 15 101(a)(15)(J) and received a favorable rec- 16 ommendation by the Secretary of State, the 17 Secretary of Homeland Security may change 18 the status of such physician to any status au- 19 thorized for employment under this Act. The 20 numerical limitations set forth in subsection 21 (g)(1)(A) shall not apply to any alien whose 22 status is changed under this subparagraph.’’. 23 (3) VIOLATION OF AGREEMENTS.—Section 24 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 243 •HR 7585 IH amended by inserting ‘‘substantial requirement of 1 an’’ before ‘‘agreement entered into’’. 2 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 3 AREAS.—Section 214(l) of such Act (8 U.S.C. 4 1184(l)), as amended by this section, is further 5 amended by adding at the end the following: 6 ‘‘(4)(A) If an interested State agency denies the 7 application for a waiver under paragraph (1)(B) 8 from a physician pursuing graduate medical edu- 9 cation or training pursuant to section 101(a)(15)(J) 10 because the State has requested the maximum num- 11 ber of waivers permitted for that fiscal year, the 12 physician’s nonimmigrant status shall be extended 13 for up to 6 months if the physician agrees to seek 14 a waiver under this subsection (except for paragraph 15 (1)(D)(ii)) to work for an employer described in 16 paragraph (1)(C) in a State that has not yet re- 17 quested the maximum number of waivers. 18 ‘‘(B) A physician described in subparagraph (A) 19 may only work for the employer referred to in sub- 20 paragraph (A) during the period beginning on the 21 date on which a new waiver application is filed with 22 such State and ending on the earlier of— 23 ‘‘(i) the date on which the Secretary of 24 Homeland Security denies such waiver; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 244 •HR 7585 IH ‘‘(ii) the date on which the Secretary ap- 1 proves an application for change of status 2 under paragraph (2)(A) pursuant to the ap- 3 proval of such waiver.’’. 4 (5) CONTRACT REQUIREMENTS.—Section 214(l) 5 of such Act, as amended by this section, is further 6 amended by adding at the end the following: 7 ‘‘(5) An alien granted a waiver under para- 8 graph (1)(C) shall enter into an employment agree- 9 ment with the contracting health facility or health 10 care organization that— 11 ‘‘(A) specifies the maximum number of on- 12 call hours per week (which may be a monthly 13 average) that the alien will be expected to be 14 available and the compensation the alien will re- 15 ceive for on-call time; 16 ‘‘(B) specifies— 17 ‘‘(i) whether the contracting facility or 18 organization will pay the alien’s mal- 19 practice insurance premiums; 20 ‘‘(ii) whether the employer will provide 21 malpractice insurance; and 22 ‘‘(iii) the amount of such insurance 23 that will be provided; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 245 •HR 7585 IH ‘‘(C) describes all of the work locations 1 that the alien will work including a statement 2 that the contracting facility or organization will 3 not add additional work locations without the 4 approval of the Federal agency or State agency 5 that requested the waiver; and 6 ‘‘(D) does not include a non-compete provi- 7 sion. 8 ‘‘(6) An alien granted a waiver under this sub- 9 section whose employment relationship with a health 10 facility or health care organization terminates under 11 paragraph (1)(C)(ii) during the 3-year service period 12 required under paragraph (1) shall be considered to 13 be maintaining lawful status in an authorized period 14 of stay during the 120-day period referred to in 15 items (aa) and (bb) of subclause (III) of paragraph 16 (1)(C)(ii) or the 45-day period referred to in sub- 17 clause (III)(cc) of such paragraph.’’. 18 (6) RECAPTURING WAIVER SLOTS LOST TO 19 OTHER STATES.—Section 214(l) of such Act, as 20 amended by this section, is further amended by add- 21 ing at the end the following: 22 ‘‘(7) If a recipient of a waiver under this sub- 23 section terminates the recipient’s employment with a 24 health facility or health care organization pursuant 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 246 •HR 7585 IH to paragraph (1)(C)(ii), including termination of em- 1 ployment because of circumstances described in 2 paragraph (1)(C)(ii)(III), and accepts new employ- 3 ment with such a facility or organization in a dif- 4 ferent State, the State from which the alien is de- 5 parting may be accorded an additional waiver by the 6 Secretary of State for use in the fiscal year in which 7 the alien’s employment was terminated.’’. 8 (7) EXCEPTION TO 3-YEAR WORK REQUIRE- 9 MENT.—Section 214(l) of such Act, as amended by 10 this section, is further amended by adding at the 11 end the following: 12 ‘‘(8) The 3-year work requirement set forth in 13 subparagraphs (C) and (D) of paragraph (1) shall 14 not apply if— 15 ‘‘(A)(i) the Secretary of Homeland Secu- 16 rity determines that extenuating circumstances, 17 including violations by the employer of the em- 18 ployment agreement with the alien or of labor 19 and employment laws, exist that justify a lesser 20 period of employment at such facility or organi- 21 zation; and 22 ‘‘(ii) not later than 120 days after the em- 23 ployment termination date (unless the Secretary 24 determines that extenuating circumstances 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 247 •HR 7585 IH would justify an extension), the alien dem- 1 onstrates another bona fide offer of employment 2 at a health facility or health care organization 3 in a geographic area or areas which are des- 4 ignated by the Secretary of Health and Human 5 Services as having a shortage of health care 6 professionals, for the remainder of such 3-year 7 period; 8 ‘‘(B)(i) the interested State agency that re- 9 quested the waiver attests that extenuating cir- 10 cumstances, including violations by the em- 11 ployer of the employment agreement with the 12 alien or of labor and employment laws, exist 13 that justify a lesser period of employment at 14 such facility or organization; and 15 ‘‘(ii) the alien demonstrates, not later than 16 120 days after the employment termination 17 date (unless the Secretary determines that ex- 18 tenuating circumstances would justify an exten- 19 sion), another bona fide offer of employment at 20 a health facility or health care organization in 21 a geographic area or areas which are designated 22 by the Secretary of Health and Human Services 23 as having a shortage of health care profes- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 248 •HR 7585 IH sionals, for the remainder of such 3-year period; 1 or 2 ‘‘(C) the alien— 3 ‘‘(i) elects not to pursue a determina- 4 tion of extenuating circumstances pursuant 5 to subparagraph (A) or (B); 6 ‘‘(ii) terminates the alien’s employ- 7 ment relationship with the health facility 8 or health care organization at which the 9 alien was employed; 10 ‘‘(iii) not later than 45 days after the 11 employment termination date, dem- 12 onstrates another bona fide offer of em- 13 ployment at a health facility or health care 14 organization in a geographic area or areas, 15 in the State that requested the alien’s 16 waiver, which are designated by the Sec- 17 retary of Health and Human Services as 18 having a shortage of health care profes- 19 sionals; and 20 ‘‘(iv) agrees to be employed for the re- 21 mainder of such 3-year period, and 1 addi- 22 tional year for each termination under 23 clause (ii).’’. 24 (d) ALLOTMENT OF CONRAD 30 WAIVERS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 249 •HR 7585 IH (1) IN GENERAL.—Section 214(l) of the Immi- 1 gration and Nationality Act (8 U.S.C. 1184(l)), as 2 amended by subsection (c), is further amended by 3 adding at the end the following: 4 ‘‘(9)(A)(i) All States shall be allotted 35 waivers 5 under paragraph (1)(B) for each fiscal year if 90 percent 6 of the waivers available to the States receiving at least 7 5 waivers were used in the previous fiscal year. 8 ‘‘(ii) When an allotment occurs under clause (i), all 9 States shall be allotted an additional 5 waivers under 10 paragraph (1)(B) for each subsequent fiscal year if 90 11 percent of the waivers available to the States receiving at 12 least 5 waivers were used in the previous fiscal year. If 13 the States are allotted 45 or more waivers for a fiscal year, 14 the States will only receive an additional increase of 5 15 waivers the following fiscal year if 95 percent of the waiv- 16 ers available to the States receiving at least 1 waiver were 17 used in the previous fiscal year. 18 ‘‘(B) Any increase in allotments under subparagraph 19 (A) shall be maintained indefinitely, unless in a fiscal year 20 the total number of such waivers granted is 5 percent 21 lower than in the last year in which there was an increase 22 in the number of waivers allotted pursuant to this para- 23 graph. In such case— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 250 •HR 7585 IH ‘‘(i) the number of waivers allotted beginning in 1 the next fiscal year shall be decreased by 5 for all 2 States; and 3 ‘‘(ii) each additional 5 percent decrease in such 4 waivers granted from the last year in which there 5 was an increase in the allotment, shall result in an 6 additional decrease of 5 waivers allotted for all 7 States, provided that the number of waivers allotted 8 for all States shall not drop below 30.’’. 9 (2) ACADEMIC MEDICAL CENTERS.—Section 10 214(l)(1)(D) of such Act, as amended by subsection 11 (c)(1)(E), is further amended— 12 (A) in clause (ii), by striking ‘‘and’’ at the 13 end; 14 (B) in clause (iii), by striking the period at 15 the end and inserting ‘‘; and’’; and 16 (C) by adding at the end the following: 17 ‘‘(iv) in the case of a request by an inter- 18 ested State agency— 19 ‘‘(I) the head of such agency deter- 20 mines that the alien is to practice medicine 21 in, or be on the faculty of a residency pro- 22 gram at, an academic medical center (as 23 defined in section 411.355(e)(2) of title 42, 24 Code of Federal Regulations), without re- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 251 •HR 7585 IH gard to whether such facility is located 1 within an area designated by the Secretary 2 of Health and Human Services as having 3 a shortage of health care professionals; and 4 ‘‘(II) the head of such agency deter- 5 mines that— 6 ‘‘(aa) the alien physician’s work 7 is in the public interest; and 8 ‘‘(bb) subject to paragraph (6), 9 the grant of such waiver would not 10 cause the number of the waivers 11 granted on behalf of aliens for such 12 State for a fiscal year to exceed 3, 13 within the limitation under subpara- 14 graph (B).’’. 15 (e) AMENDMENTS TO THE PROCEDURES, DEFINI- 16 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 17 IMMIGRATION.— 18 (1) DUAL INTENT FOR PHYSICIANS SEEKING 19 GRADUATE MEDICAL TRAINING.—Section 214(b) of 20 the Immigration and Nationality Act (8 U.S.C. 21 1184(b)) is amended by striking ‘‘and other than a 22 nonimmigrant described in any provision of section 23 101(a)(15)(H)(i) except subclause (b1) of such sec- 24 tion)’’ and inserting ‘‘a nonimmigrant described in 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 252 •HR 7585 IH any provision of section 101(a)(15)(H)(i) (except 1 subclause (b1) of such section), and an alien coming 2 to the United States to receive graduate medical 3 education or training as described in section 212(j) 4 or to take examinations required to receive graduate 5 medical education or training as described in section 6 212(j))’’. 7 (2) PHYSICIAN NATIONAL INTEREST WAIVER 8 CLARIFICATIONS.— 9 (A) PRACTICE AND GEOGRAPHIC AREA.— 10 Section 203(b)(2)(B)(ii)(I) of the Immigration 11 and Nationality Act (8 U.S.C. 12 1153(b)(2)(B)(ii)(I)) is amended by striking 13 items (aa) and (bb) and inserting the following: 14 ‘‘(aa) the alien physician agrees to 15 work on a full-time basis practicing pri- 16 mary care, specialty medicine, or a com- 17 bination thereof, in an area or areas des- 18 ignated by the Secretary of Health and 19 Human Services as having a shortage of 20 health care professionals, or at a health 21 care facility under the jurisdiction of the 22 Secretary of Veterans Affairs; or 23 ‘‘(bb) the alien physician is pursuing 24 such waiver based upon service at a facility 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 253 •HR 7585 IH or facilities that serve patients who reside 1 in a geographic area or areas designated 2 by the Secretary of Health and Human 3 Services as having a shortage of health 4 care professionals (without regard to 5 whether such facility or facilities are lo- 6 cated within such an area) and a Federal 7 agency, or a local, county, regional, or 8 State department of public health deter- 9 mines the alien physician’s work was or 10 will be in the public interest.’’. 11 (B) FIVE-YEAR SERVICE REQUIREMENT.— 12 Section 203(b)(2)(B)(ii) of such Act is amend- 13 ed— 14 (i) by moving subclauses (II), (III), 15 and (IV) 4 ems to the left; and 16 (ii) in subclause (II)— 17 (I) by inserting ‘‘(aa)’’ after 18 ‘‘(II)’’; and 19 (II) by adding at the end the fol- 20 lowing: 21 ‘‘(bb) The 5-year service requirement 22 described in item (aa) shall begin on the 23 date on which the alien physician begins 24 work in the shortage area in any legal sta- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 254 •HR 7585 IH tus and not on the date on which an immi- 1 grant visa petition is filed or approved. 2 Such service shall be aggregated without 3 regard to when such service began and 4 without regard to whether such service 5 began during or in conjunction with a 6 course of graduate medical education. 7 ‘‘(cc) An alien physician shall not be 8 required to submit an employment contract 9 with a term exceeding the balance of the 5- 10 year commitment yet to be served or an 11 employment contract dated within a min- 12 imum time period before filing a visa peti- 13 tion under this subsection. 14 ‘‘(dd) An alien physician shall not be 15 required to file additional immigrant visa 16 petitions upon a change of work location 17 from the location approved in the original 18 national interest immigrant petition.’’. 19 (3) TECHNICAL CLARIFICATION REGARDING AD- 20 VANCED DEGREE FOR PHYSICIANS.—Section 21 203(b)(2)(A) of such Act is amended by adding at 22 the end the following: ‘‘An alien physician holding a 23 foreign medical degree that has been deemed suffi- 24 cient for acceptance by an accredited United States 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 255 •HR 7585 IH medical residency or fellowship program shall be 1 considered a member of the professions holding an 2 advanced degree or its equivalent for purposes of 3 this paragraph.’’. 4 (4) SHORT-TERM WORK AUTHORIZATION FOR 5 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 6 (A) IN GENERAL.—A physician completing 7 graduate medical education or training de- 8 scribed in section 212(j) of the Immigration 9 and Nationality Act (8 U.S.C. 1182(j)) as a 10 nonimmigrant described in section 11 101(a)(15)(H)(i) of such Act (8 U.S.C. 12 1101(a)(15)(H)(i))— 13 (i) shall have such nonimmigrant sta- 14 tus automatically extended until October 1 15 of the fiscal year for which a petition for 16 a continuation of such nonimmigrant sta- 17 tus has been submitted in a timely manner 18 and the employment start date for the ben- 19 eficiary of such petition is October 1 of 20 that fiscal year; and 21 (ii) shall be authorized to be employed 22 incident to status during the period be- 23 tween the filing of such petition and Octo- 24 ber 1 of such fiscal year. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 256 •HR 7585 IH (B) TERMINATION.—The status and em- 1 ployment authorization of a physician described 2 in subparagraph (A) shall terminate on the date 3 that is 30 days after the date on which a peti- 4 tion described in clause (i)(I) is rejected, denied 5 or revoked. 6 (C) AUTOMATIC EXTENSION.—The status 7 and employment authorization of a physician 8 described in subparagraph (A) will automati- 9 cally extend to October 1 of the next fiscal year 10 if all of the visas described in section 11 101(a)(15)(H)(i) of the Immigration and Na- 12 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 13 were authorized to be issued for the fiscal year 14 have been issued. 15 (5) APPLICABILITY OF SECTION 212(e) TO 16 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI- 17 TORS.—A spouse or child of an exchange visitor de- 18 scribed in section 101(a)(15)(J) of the Immigration 19 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 20 not be subject to the requirements under section 21 212(e) of such Act (8 U.S.C. 1182(e)). 22 SEC. 3017. NATIONAL HISPANIC NURSES DAY. 23 (a) FINDINGS.—Congress finds the following: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 257 •HR 7585 IH (1) A special group of nurses in the Nation are 1 the Hispanic nurses. 2 (2) Hispanic nurses provide culturally and eth- 3 nically competent care and are educated to be sen- 4 sitive to regional and community customs of persons 5 needing care. 6 (3) Hispanic nurses are well-positioned to pro- 7 vide leadership to eliminate health care disparities 8 that exist in the Nation. 9 (4) Since 1975, the National Association of 10 Hispanic Nurses (NAHN) has represented Hispanic 11 nurses (RNs/LPNs) in the United States and is the 12 only nursing organization for Hispanic nurses whose 13 mission is to advance the health in Hispanic commu- 14 nities and to lead, promote, and advocate for edu- 15 cational, professional, and leadership opportunities 16 for Hispanic nurses. 17 (5) Since September is the month that has been 18 set aside to honor the contributions of Hispanics, it 19 is only fitting that Hispanic nurses be recognized 20 and honored during this time for their outstanding 21 contributions to their community and country. 22 (6) The designation of an observation day will 23 help to raise awareness of the accomplishments of 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 258 •HR 7585 IH Hispanic nurses and pave the way for the important 1 work that they must continue to carry out. 2 (7) Each February, the NAHN convenes nearly 3 100 nursing leaders from academia, research, edu- 4 cation, and practice in the District of Columbia for 5 a day on Capitol Hill promoting legislation that im- 6 proves the health of Hispanic communities. 7 (8) Hispanic nurses are strong allies to Con- 8 gress as they help inform, educate, and work closely 9 with legislators to improve the education, retention, 10 recruitment, and practice of all nurses and, more 11 importantly, the health and safety of the patients 12 they care for. 13 (9) Hispanic nurses add needed diversity to the 14 nursing profession, and these nurses have engaged 15 in numerous ways to support communities and the 16 needs of an overlooked, under resourced, and under- 17 served population being severely impacted by 18 COVID–19. 19 (b) SENSE OF CONGRESS.—The Congress— 20 (1) supports the goals and ideals, and the des- 21 ignation, of National Hispanic Nurses Day, as pro- 22 posed by the National Association of Hispanic 23 Nurses; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 259 •HR 7585 IH (2) recognizes the significant contributions of 1 Hispanic nurses to the health care system of the 2 United States; and 3 (3) encourages the people of the United States 4 to observe National Hispanic Nurses Day with ap- 5 propriate recognition, ceremonies, activities, and pro- 6 grams to demonstrate the importance of Hispanic 7 nurses to the everyday lives of patients and the com- 8 munities they serve. 9 SEC. 3018. EXPANDING MEDICAL EDUCATION. 10 Subpart II of part C of title VII of the Public Health 11 Service Act (42 U.S.C. 293m et seq.) is amended by add- 12 ing at the end the following: 13 ‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 14 SCHOOLS OF OSTEOPATHIC MEDICINE IN UN- 15 DERSERVED AREAS. 16 ‘‘(a) IN GENERAL.—The Secretary, acting through 17 the Administrator of the Health Resources and Services 18 Administration, may award grants to institutions of high- 19 er education (including consortiums of such institutions) 20 for the establishment, improvement, or expansion of a 21 school of medicine or osteopathic medicine, or a branch 22 campus of a school of medicine or osteopathic medicine. 23 ‘‘(b) PRIORITY.—In selecting grant recipients under 24 this section, the Secretary shall give priority to any insti- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 260 •HR 7585 IH tution of higher education (or consortium of such institu- 1 tions) that— 2 ‘‘(1) proposes to use the grant for the establish- 3 ment of a school of medicine or osteopathic medi- 4 cine, or a branch campus of a school of medicine or 5 osteopathic medicine, in an area— 6 ‘‘(A) in which no other such school is 7 based; and 8 ‘‘(B) that is a medically underserved com- 9 munity or a health professional shortage area; 10 or 11 ‘‘(2) is a minority-serving institution described 12 in section 371(a) of the Higher Education Act of 13 1965. 14 ‘‘(c) CONSIDERATIONS.—In awarding grants under 15 this section, the Secretary, to the extent practicable, may 16 ensure equitable distribution of awards among the geo- 17 graphical regions of the United States. 18 ‘‘(d) USE OF FUNDS.—An institution of higher edu- 19 cation (or a consortium of such institutions)— 20 ‘‘(1) shall use grant amounts received under 21 this section to— 22 ‘‘(A) recruit, enroll, and retain students, 23 including individuals who are from disadvan- 24 taged backgrounds (including racial and ethnic 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 261 •HR 7585 IH groups underrepresented among medical stu- 1 dents and health professions), individuals from 2 rural and underserved areas, low-income indi- 3 viduals, and first generation college students, at 4 a school of medicine or osteopathic medicine or 5 branch campus of a school of medicine or osteo- 6 pathic medicine; and 7 ‘‘(B) develop, implement, and expand cur- 8 riculum that emphasizes care for rural and un- 9 derserved populations, including accessible and 10 culturally and linguistically appropriate care 11 and services, at such school or branch campus; 12 and 13 ‘‘(2) may use grant amounts received under this 14 section to— 15 ‘‘(A) plan and construct— 16 ‘‘(i) a school of medicine or osteo- 17 pathic medicine in an area in which no 18 other such school is based; or 19 ‘‘(ii) a branch campus of a school of 20 medicine or osteopathic medicine in an 21 area in which no other such school is 22 based; 23 ‘‘(B) plan, develop, and meet criteria for 24 accreditation for a school of medicine or osteo- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 262 •HR 7585 IH pathic medicine or branch campus of a school 1 of medicine or osteopathic medicine; 2 ‘‘(C) hire faculty, including faculty from 3 racial and ethnic groups who are underrep- 4 resented among the medical and other health 5 professions, and other staff to serve at such a 6 school or branch campus; 7 ‘‘(D) support educational programs at such 8 a school or branch campus; 9 ‘‘(E) modernize and expand infrastructure 10 at such a school or branch campus; and 11 ‘‘(F) support other activities that the Sec- 12 retary determines further the establishment, 13 improvement, or expansion of a school of medi- 14 cine or osteopathic medicine or branch campus 15 of a school of medicine or osteopathic medicine. 16 ‘‘(e) APPLICATION.—To be eligible to receive a grant 17 under subsection (a), an institution of higher education 18 (or a consortium of such institutions), shall submit an ap- 19 plication to the Secretary at such time, in such manner, 20 and containing such information as the Secretary may re- 21 quire, including a description of the institution’s or con- 22 sortium’s planned activities described in subsection (d). 23 ‘‘(f) REPORTING.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 263 •HR 7585 IH ‘‘(1) REPORTS FROM ENTITIES.—Each institu- 1 tion of higher education, or consortium of such insti- 2 tutions, awarded a grant under this section shall 3 submit an annual report to the Secretary on the ac- 4 tivities conducted under such grant, and other infor- 5 mation as the Secretary may require. 6 ‘‘(2) REPORT TO CONGRESS.—Not later than 5 7 years after the date of enactment of this section and 8 every 5 years thereafter, the Secretary shall submit 9 to the Committee on Health, Education, Labor, and 10 Pensions of the Senate and the Committee on En- 11 ergy and Commerce of the House of Representatives 12 a report that provides a summary of the activities 13 and outcomes associated with grants made under 14 this section. Such reports shall include— 15 ‘‘(A) a list of awardees, including their pri- 16 mary geographic location, and location of any 17 school of medicine or osteopathic medicine, or a 18 branch campus of school of medicine or osteo- 19 pathic medicine that was established, improved, 20 or expanded under this program; 21 ‘‘(B) the total number of students (includ- 22 ing the number of students from racial and eth- 23 nic groups underrepresented among medical 24 students and health professions, low-income 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 264 •HR 7585 IH students, and first generation college students) 1 who— 2 ‘‘(i) are enrolled at or who have grad- 3 uated from any school of medicine or os- 4 teopathic medicine, or a branch campus of 5 school of medicine or osteopathic medicine, 6 that was established, improved, or ex- 7 panded under this program, deidentified 8 and disaggregated by race, ethnicity, age, 9 sex, geographic region, disability status, 10 and other relevant factors, to the extent 11 such information is available; and 12 ‘‘(ii) who subsequently participate in 13 an accredited internship or medical resi- 14 dency program upon graduation from any 15 school of medicine or osteopathic medicine, 16 or a branch campus of a school of medicine 17 or osteopathic medicine, that was estab- 18 lished, improved, or expanded under this 19 program, deidentified and disaggregated by 20 race, ethnicity, age, sex, geographic region, 21 disability status, medical specialty pursued, 22 and other relevant factors, to the extent 23 such information is available; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 265 •HR 7585 IH ‘‘(C) the effects of such program on the 1 health care provider workforce, including any 2 impact on demographic representation 3 disaggregated by race, ethnicity, and sex, and 4 the fields or specialties pursued by students 5 who have graduated from any school of medi- 6 cine or osteopathic medicine, or a branch cam- 7 pus of school of medicine or osteopathic medi- 8 cine, that was established, improved, or ex- 9 panded under this program; 10 ‘‘(D) the effects of such program on health 11 care access in underserved areas, including 12 medically underserved communities and health 13 professional shortage areas; and 14 ‘‘(E) recommendations for improving the 15 program described in this section, and any 16 other considerations as the Secretary deter- 17 mines appropriate. 18 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 19 shall make reports submitted under paragraph (2) 20 publicly available on the internet website of the De- 21 partment of Health and Human Services. 22 ‘‘(g) DEFINITIONS.—In this section: 23 ‘‘(1) BRANCH CAMPUS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 266 •HR 7585 IH ‘‘(A) IN GENERAL.—The term ‘branch 1 campus’, with respect to a school of medicine or 2 osteopathic medicine, means an additional loca- 3 tion of such school that is geographically apart 4 and independent of the main campus, at which 5 the school offers at least 50 percent of the pro- 6 gram leading to a degree of doctor of medicine 7 or doctor of osteopathy that is offered at the 8 main campus. 9 ‘‘(B) INDEPENDENCE FROM MAIN CAM- 10 PUS.—For purposes of subparagraph (A), the 11 location of a school described in such subpara- 12 graph shall be considered to be independent of 13 the main campus described in such subpara- 14 graph if the location— 15 ‘‘(i) is permanent in nature; 16 ‘‘(ii) offers courses in educational pro- 17 grams leading to a degree, certificate, or 18 other recognized educational credential; 19 ‘‘(iii) has its own faculty and adminis- 20 trative or supervisory organization; and 21 ‘‘(iv) has its own budgetary and hiring 22 authority. 23 ‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 24 The term ‘first generation college student’ has the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 267 •HR 7585 IH meaning given such term in section 402A(h)(3) of 1 the Higher Education Act of 1965. 2 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE 3 AREA.—The term ‘health professional shortage area’ 4 has the meaning given such term in section 332(a). 5 ‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 6 The term ‘institution of higher education’ has the 7 meaning given such term in section 101 of the High- 8 er Education Act of 1965. 9 ‘‘(5) MEDICALLY UNDERSERVED COMMUNITY.— 10 The term ‘medically underserved community’ has the 11 meaning given such term in section 799B(6). 12 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this section, there is authorized to be appro- 14 priated $1,000,000,000, to remain available until ex- 15 pended.’’. 16 TITLE IV—IMPROVING HEALTH 17 CARE ACCESS AND QUALITY 18 SEC. 4000. DEFINITION. 19 In this title and the amendments made by this title, 20 the term ‘‘health care’’ includes all health care needed 21 throughout the life cycle and the end of life. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 268 •HR 7585 IH Subtitle A—Reducing Barriers to 1 Accessing Care 2 SEC. 4001. PROTECTING PROTECTED AREAS. 3 Section 287 of the Immigration and Nationality Act 4 (8 U.S.C. 1357) is amended— 5 (1) by striking ‘‘Service’’ each place such term 6 appears and inserting ‘‘Department of Homeland 7 Security’’; 8 (2) by striking ‘‘Attorney General’’ each place 9 such term appears and inserting ‘‘Secretary of 10 Homeland Security’’; 11 (3) in subsection (f)(1), by striking ‘‘Commis- 12 sioner’’ and inserting ‘‘Director of U.S. Citizenship 13 and Immigration Services’’; 14 (4) in subsection (h)— 15 (A) by striking ‘‘of the Immigration and 16 Nationality Act’’; and 17 (B) by striking ‘‘of such Act’’; and 18 (5) by adding at the end the following: 19 ‘‘(i)(1) In this subsection: 20 ‘‘(A) The term ‘appropriate congressional com- 21 mittees’ means— 22 ‘‘(i) the Committee on Homeland Security 23 and Governmental Affairs of the Senate; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 269 •HR 7585 IH ‘‘(ii) the Committee on the Judiciary of the 1 Senate; 2 ‘‘(iii) the Committee on Homeland Security 3 of the House of Representatives; and 4 ‘‘(iv) the Committee on the Judiciary of 5 the House of Representatives. 6 ‘‘(B) The term ‘enforcement action’— 7 ‘‘(i) means an apprehension, arrest, inspec- 8 tion interview, request for identification, search, 9 seizure, service of charging documents or sub- 10 poenas, or surveillance for the purposes of im- 11 migration enforcement; and 12 ‘‘(ii) includes an enforcement action at, or 13 focused on, a protected area that is part of a 14 joint case led by another law enforcement agen- 15 cy. 16 ‘‘(C) The term ‘exigent circumstances’ means a 17 situation involving— 18 ‘‘(i) the imminent risk of death, violence, 19 or physical harm to any person or property, in- 20 cluding a situation implicating terrorism or the 21 national security of the United States; 22 ‘‘(ii) the immediate arrest or pursuit of a 23 dangerous felon, terrorist suspect, or other indi- 24 vidual presenting an imminent danger; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 270 •HR 7585 IH ‘‘(iii) the imminent risk of destruction of 1 evidence that is material to an ongoing criminal 2 case. 3 ‘‘(D) The term ‘protected area’ includes all of 4 the physical space located within 1,000 feet of— 5 ‘‘(i) any medical treatment or mental 6 health care facility, including any hospital, doc- 7 tor’s office, health clinic, alcohol or drug pre- 8 vention, counseling, or treatment facilities, sy- 9 ringe exchange services, vaccination, treatment, 10 or testing sites, emergent or urgent care facil- 11 ity, sites that serve pregnant individuals, or 12 community health centers; 13 ‘‘(ii) any public or private school, including 14 any known and licensed day care facility, pre- 15 school, sites of early childhood programs, pri- 16 mary school, secondary school, postsecondary 17 school (including colleges and universities), or 18 other institution of learning (including voca- 19 tional or trade schools); 20 ‘‘(iii) any scholastic or education-related 21 activity or event or before or after school pro- 22 gram, including field trips and interscholastic 23 events; 24 ‘‘(iv) any school bus or school bus stop; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 271 •HR 7585 IH ‘‘(v) places where children gather such as 1 a playground, recreation center, library, foster 2 care facility, or group home for children; 3 ‘‘(vi) any physical structure of an organiza- 4 tion or subdivision of government that— 5 ‘‘(I) assists children, pregnant women, 6 victims of crime or abuse, or individuals 7 with significant mental or physical disabil- 8 ities; 9 ‘‘(II) provides social services and as- 10 sistance, including homeless shelters, com- 11 munity-based organizations, facilities that 12 serve disabled persons, drug or alcohol 13 counseling and treatment facilities, food 14 banks or food pantries, and other places 15 providing emergency and disaster services 16 or assistance with food and nutrition, 17 housing affordability and income or other 18 services funded by State or local govern- 19 ment, charitable giving, the Special Sup- 20 plemental Nutrition Program for Women, 21 Infants, and Children (WIC), Supple- 22 mental Nutrition Assistance Program 23 (SNAP), Temporary Assistance for Needy 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 272 •HR 7585 IH Families (TANF), Social Security, or the 1 United States Housing Act; or 2 ‘‘(III) provides hospice, palliative, or 3 other available end-of-life care services to 4 terminally ill persons; 5 ‘‘(vii) any church, synagogue, mosque, or 6 other place of worship or religious study, in- 7 cluding buildings rented for the purpose of reli- 8 gious services, retreats, counseling, workshops, 9 instruction, and education; 10 ‘‘(viii) any Federal, State, or local court- 11 house, including the office of an individual’s 12 legal counsel or representative, and a probation, 13 parole, or supervised release office; 14 ‘‘(ix) the site of a funeral, grave-side cere- 15 mony, rosary, wedding, or other religious cere- 16 mony or observance; 17 ‘‘(x) any public demonstration, such as a 18 march, rally, or parade; 19 ‘‘(xi) any domestic violence shelter, rape 20 crisis center, child advocacy center, supervised 21 visitation center, family justice center, or victim 22 services provider; 23 ‘‘(xii) congressional district offices; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 273 •HR 7585 IH ‘‘(xiii) indoor and outdoor premises of de- 1 partments of motor vehicles; 2 ‘‘(xiv) a place where disaster or emergency 3 response and relief is provided, including evacu- 4 ation routes, places where shelter or emergency 5 supplies, food, or water are distributed, or 6 places where registration for disaster-relief as- 7 sistance or family reunification is underway; or 8 ‘‘(xv) any other location specified by the 9 Secretary of Homeland Security for purposes of 10 this subsection. 11 ‘‘(E) The term ‘prior approval’ means— 12 ‘‘(i) in the case of officers and agents of 13 U.S. Immigration and Customs Enforcement, 14 prior written approval to carry out an enforce- 15 ment action involving a specific individual or in- 16 dividuals authorized by— 17 ‘‘(I) the Assistant Director of Oper- 18 ations, Homeland Security Investigations; 19 ‘‘(II) the Executive Associate Direc- 20 tor, Homeland Security Investigations; 21 ‘‘(III) the Assistant Director for Field 22 Operations, Enforcement and Removal Op- 23 erations; or 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 274 •HR 7585 IH ‘‘(IV) the Executive Associate Direc- 1 tor for Field Operations, Enforcement and 2 Removal Operations; 3 ‘‘(ii) in the case of officers and agents of 4 U.S. Customs and Border Protection, prior 5 written approval to carry out an enforcement 6 action involving a specific individual or individ- 7 uals authorized by— 8 ‘‘(I) a Chief Patrol Agent; 9 ‘‘(II) the Director of Field Operations; 10 ‘‘(III) the Director of Air and Marine 11 Operations; or 12 ‘‘(IV) the Internal Affairs Special 13 Agent in Charge; and 14 ‘‘(iii) in the case of other Federal, State, 15 or local law enforcement officers, to carry out 16 an enforcement action involving a specific indi- 17 vidual or individuals authorized by— 18 ‘‘(I) the head of the Federal agency 19 carrying out the enforcement action; or 20 ‘‘(II) the head of the State or local 21 law enforcement agency carrying out the 22 enforcement action. 23 ‘‘(2)(A) An enforcement action may not take place 24 at, or be focused on, a protected area unless— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 275 •HR 7585 IH ‘‘(i) the action involves exigent circumstances; 1 and 2 ‘‘(ii) prior approval for the enforcement action 3 was obtained. 4 ‘‘(B) If an enforcement action is initiated pursuant 5 to subparagraph (A) and the exigent circumstances per- 6 mitting the enforcement action cease, the enforcement ac- 7 tion shall be discontinued until such exigent circumstances 8 reemerge. 9 ‘‘(C) If an enforcement action is carried out in viola- 10 tion of this subsection— 11 ‘‘(i) no information resulting from the enforce- 12 ment action may be entered into the record or re- 13 ceived into evidence in a removal proceeding result- 14 ing from the enforcement action; and 15 ‘‘(ii) the noncitizen who is the subject of such 16 removal proceeding may file a motion for the imme- 17 diate termination of the removal proceeding. 18 ‘‘(3)(A) This subsection shall apply to any enforce- 19 ment action by officers or agents of the Department of 20 Homeland Security, including— 21 ‘‘(i) officers or agents of U.S. Immigration and 22 Customs Enforcement; 23 ‘‘(ii) officers or agents of U.S. Customs and 24 Border Protection; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 276 •HR 7585 IH ‘‘(iii) any individual designated to perform im- 1 migration enforcement functions pursuant to sub- 2 section (g). 3 ‘‘(B) While carrying out an enforcement action at a 4 protected area, officers and agents referred to in subpara- 5 graph (A) shall make every effort— 6 ‘‘(i) to limit the time spent at the protected 7 area; 8 ‘‘(ii) to limit the enforcement action at the pro- 9 tected area to the person or persons for whom prior 10 approval was obtained; and 11 ‘‘(iii) to conduct themselves discreetly. 12 ‘‘(C) If, while carrying out an enforcement action 13 that is not initiated at or focused on a protected area, 14 officers or agents are led to a protected area, and no exi- 15 gent circumstance and prior approval with respect to the 16 protected area, such officers or agents shall— 17 ‘‘(i) cease before taking any further enforce- 18 ment action; 19 ‘‘(ii) conduct themselves in a discreet manner; 20 ‘‘(iii) maintain surveillance on an individual; 21 and 22 ‘‘(iv) immediately consult their supervisor in 23 order to determine whether such enforcement action 24 should be discontinued. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 277 •HR 7585 IH ‘‘(D) The limitations under this paragraph shall not 1 apply to the transportation of an individual apprehended 2 at or near a land or sea border to a hospital or health 3 care provider for the purpose of providing medical care 4 to such individual. 5 ‘‘(4)(A) Each official specified in subparagraph (B) 6 shall ensure that the employees under his or her super- 7 vision receive annual training on compliance with— 8 ‘‘(i) the requirements under this subsection with 9 respect to enforcement actions at or focused on pro- 10 tected areas and enforcement actions that lead offi- 11 cers or agents to a protected area; and 12 ‘‘(ii) the requirements under section 239 of this 13 Act and section 384 of the Illegal Immigration Re- 14 form and Immigrant Responsibility Act of 1996 (8 15 U.S.C. 1367). 16 ‘‘(B) The officials specified in this subparagraph 17 are— 18 ‘‘(i) the Chief Counsel of each Field Office of 19 U.S. Immigration and Customs Enforcement; 20 ‘‘(ii) each Field Office Director of U.S. Immi- 21 gration and Customs Enforcement; 22 ‘‘(iii) each Special Agent in Charge of U.S. Im- 23 migration and Customs Enforcement; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 278 •HR 7585 IH ‘‘(iv) each Chief Patrol Agent of U.S. Customs 1 and Border Protection; 2 ‘‘(v) the Director of Field Operations of U.S. 3 Customs and Border Protection; 4 ‘‘(vi) the Director of Air and Marine Operations 5 of U.S. Customs and Border Protection; 6 ‘‘(vii) the Internal Affairs Special Agent in 7 Charge of U.S. Customs and Border Protection; and 8 ‘‘(viii) the chief law enforcement officer of each 9 State or local law enforcement agency that enters 10 into a written agreement with the Department of 11 Homeland Security pursuant to subsection (g). 12 ‘‘(5) Not later than 180 days after the date of the 13 Health Equity and Accountability Act, the Secretary of 14 Homeland Security shall modify the Notice to Appear 15 form (I–862)— 16 ‘‘(A) to provide the subject of an enforcement 17 action with information, written in plain language, 18 summarizing the restrictions against enforcement 19 actions at protected areas set forth in this sub- 20 section and the remedies available to the individual 21 if such action violates such restrictions; 22 ‘‘(B) to ensure that the information described 23 in subparagraph (A) is accessible to an individual 24 with limited English proficiency; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 279 •HR 7585 IH ‘‘(C) to ensure that a subject of an enforcement 1 action is not permitted to verify that the officers or 2 agents that carried out such action complied with 3 the restrictions set forth in this subsection. 4 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 5 toms Enforcement and the Commissioner of U.S. Customs 6 and Border Protection shall each submit an annual report 7 to the appropriate congressional committees that includes 8 the information set forth in subparagraph (B) with respect 9 to the respective agency. 10 ‘‘(B) Each report submitted under subparagraph (A) 11 shall include, with respect to the submitting agency during 12 the reporting period— 13 ‘‘(i) the number of enforcement actions that 14 were carried out at, or focused on, a protected area; 15 ‘‘(ii) the number of enforcement actions in 16 which officers or agents were subsequently led to a 17 protected area; and 18 ‘‘(iii) for each enforcement action described in 19 clause (i) or (ii)— 20 ‘‘(I) the date on which it occurred; 21 ‘‘(II) the specific site, city, county, and 22 State in which it occurred; 23 ‘‘(III) whether the site was a protected 24 area and, if so— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 280 •HR 7585 IH ‘‘(aa) identification of the protected 1 area; 2 ‘‘(bb) each reason why the enforce- 3 ment action was taken there; 4 ‘‘(cc) where the enforcement action 5 was taken without prior approval, certifi- 6 cation that notification to headquarters of 7 a submitting agency was provided after the 8 enforcement action took place; and 9 ‘‘(dd) a report of what occurred dur- 10 ing and immediately after the enforcement 11 action; 12 ‘‘(IV) the components of the agency in- 13 volved in the enforcement action; 14 ‘‘(V) a description of the enforcement ac- 15 tion, including the nature of the criminal activ- 16 ity of its intended target; 17 ‘‘(VI) the number of individuals, if any, ar- 18 rested or taken into custody; 19 ‘‘(VII) the number of collateral arrests, if 20 any, and the reasons for each such arrest; 21 ‘‘(VIII) a certification whether the location 22 administrator of a protected area was contacted 23 before, during, or after the enforcement action; 24 and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 281 •HR 7585 IH ‘‘(IX) the percentage of all of the staff 1 members and supervisors reporting to the offi- 2 cials listed in paragraph (4)(B) who completed 3 the training required under paragraph (4)(A). 4 ‘‘(7) Nothing in the subsection may be construed— 5 ‘‘(A) to affect the authority of Federal, State, 6 or local law enforcement agencies— 7 ‘‘(i) to enforce generally applicable Federal 8 or State criminal laws unrelated to immigra- 9 tion; or 10 ‘‘(ii) to protect residents from imminent 11 threats to public safety; or 12 ‘‘(B) to limit or override the protections pro- 13 vided in— 14 ‘‘(i) section 239; or 15 ‘‘(ii) section 384 of the Illegal Immigration 16 Reform and Immigrant Responsibility Act of 17 1996 (8 U.S.C. 1367).’’. 18 SEC. 4002. 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 282 •HR 7585 IH (1) STATE PAYMENTS FOR MEDICAL ASSIST- 1 ANCE.—Section 1902 of the Social Security Act (42 2 U.S.C. 1396a) is amended— 3 (A) by amending paragraph (46) of sub- 4 section (a) to read as follows: 5 ‘‘(46) provide that information is requested and 6 exchanged for purposes of income and eligibility 7 verification in accordance with a State system which 8 meets the requirements of section 1137 of this 9 Act;’’; 10 (B) in subsection (e)(13)(A)(i)— 11 (i) in the matter preceding subclause 12 (I), by striking ‘‘sections 1902(a)(46)(B) 13 and 1137(d)’’ and inserting ‘‘section 14 1137(d)’’; and 15 (ii) in subclause (IV), by striking 16 ‘‘1902(a)(46)(B) or’’; and 17 (C) by striking subsection (ee). 18 (2) PAYMENT TO STATES.—Section 1903 of the 19 Social Security Act (42 U.S.C. 1396b) is amended— 20 (A) in subsection (i), by redesignating 21 paragraphs (23) through (27) as paragraphs 22 (22) through (26), respectively; and 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 283 •HR 7585 IH (B) by redesignating subsections (y), (z), 1 and (aa) as subsections (x), (y), and (z), respec- 2 tively. 3 (3) REPEAL.—Subsection (c) of section 6036 of 4 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 5 note) is repealed. 6 (c) EFFECTIVE DATE.—The amendments made by 7 this section shall take effect on the date of enactment of 8 this Act. 9 SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAW- 10 FULLY PRESENT NONCITIZENS. 11 (a) ELIMINATION OF ARBITRARY ELIGIBILITY RE- 12 STRICTIONS.—Sections 402, 403, 411, 412, 421, and 422 13 of the Personal Responsibility and Work Opportunity Rec- 14 onciliation Act of 1996 (8 U.S.C. 1612, 1613, 1621, 1622, 15 1631, and 1632) are repealed. 16 (b) NOTIFICATION AND INFORMATION REPORTING.— 17 Section 404 of the Personal Responsibility and Work Op- 18 portunity Reconciliation Act of 1996 (8 U.S.C. 1614) is 19 amended by striking ‘‘, 402, or 403’’. 20 (c) QUALIFIED NONCITIZENS.—Title IV of the Per- 21 sonal Responsibility and Work Opportunity Reconciliation 22 Act of 1996 (8 U.S.C. 1601 et seq.) is amended— 23 (1) in the header, by striking ‘‘ALIENS’’ and 24 inserting ‘‘NONCITIZENS’’; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 284 •HR 7585 IH (2) by striking ‘‘alien’’ each place it appears 1 and inserting ‘‘noncitizen’’; 2 (3) by striking ‘‘aliens’’ each place it appears 3 and inserting ‘‘noncitizens’’; 4 (4) by striking ‘‘alien’s’’ each place it appears 5 and inserting ‘‘noncitizen’s’’; 6 (5) by striking ‘‘an alien’’ each place that it ap- 7 pears and inserting ‘‘a noncitizen’’; 8 (6) by striking ‘‘alien’’ each place that it ap- 9 pears and inserting ‘‘noncitizen’’; 10 (7) by striking ‘‘qualified alien’’ each place that 11 it appears and inserting ‘‘qualified noncitizen’’; 12 (8) by striking ‘‘qualified aliens’’ each place 13 that it appears and inserting ‘‘qualified noncitizens’’; 14 (9) by striking ‘‘qualified alien’s’’ each place 15 that it appears and inserting ‘‘qualified nonciti- 16 zen’s’’; and 17 (10) in section 402— 18 (A) in the header, by striking ‘‘QUALI- 19 FIED ALIENS’’ and inserting ‘‘QUALIFIED 20 NONCITIZENS’’; and 21 (B) in subsection (a)(2)(L), by striking 22 ‘‘QUALIFIED ALIENS’’ and inserting ‘‘QUALI- 23 FIED NONCITIZENS’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 285 •HR 7585 IH (d) ACCESS TO BASIC SERVICES FOR LAWFULLY RE- 1 SIDING NONCITIZENS.—Section 431 of the Personal Re- 2 sponsibility and Work Opportunity Reconciliation Act of 3 1996 (8 U.S.C. 1641) is amended— 4 (1) in subsection (b)— 5 (A) in the header, by striking ‘‘QUALIFIED 6 ALIEN’’ and inserting ‘‘QUALIFIED NONCIT- 7 IZEN’’; 8 (B) by striking ‘‘qualified alien’’ and in- 9 serting ‘‘qualified noncitizen’’; 10 (C) by striking ‘‘alien’’ and inserting ‘‘non- 11 citizen’’; 12 (D) by striking ‘‘an alien’’ and inserting ‘‘a 13 noncitizen’’; and 14 (E) by striking ‘‘benefit’’ and all that fol- 15 lows through the period at the end of the sub- 16 section and inserting ‘‘benefit, is lawfully 17 present in the United States.’’; 18 (2) in subsection (c)— 19 (A) in the header, by striking ‘‘QUALIFIED 20 ALIENS’’ and inserting ‘‘QUALIFIED NONCITI- 21 ZENS’’; 22 (B) by striking ‘‘; or’’ at the end of para- 23 graph (3) and inserting ‘‘;’’; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 286 •HR 7585 IH (C) by striking the period at the end of 1 paragraph (4) and inserting ‘‘; or’’; and 2 (D) by inserting after paragraph (4) the 3 following new paragraph: 4 ‘‘(5) a noncitizen— 5 ‘‘(A) in a category that was treated as law- 6 fully present for purposes of section 1101 of the 7 Patient Protection and Affordable Care Act of 8 2010 (42 U.S.C. 18001); 9 ‘‘(B) who met the requirements of section 10 402(a)(2)(D) of the Personal Responsibility and 11 Work Opportunity Reconciliation Act of 1996 12 (8 U.S.C. 1612(a)(2)(D)) on or before January 13 1, 2023; 14 ‘‘(C) who is granted special immigrant ju- 15 venile status as described by section 16 101(a)(27)(J) of the Immigration and Nation- 17 ality Act (8 U.S.C. 1101(a)(27)(J)); 18 ‘‘(D) who has a pending, bona fide applica- 19 tion for nonimmigrant status under section 20 101(a)(15)(U) of the Immigration and Nation- 21 ality Act (8 U.S.C. 1101(1)(15)(U)); 22 ‘‘(E) who was granted relief under the De- 23 ferred Action for Childhood Arrivals program; 24 or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 287 •HR 7585 IH ‘‘(F) any other person who is not a citizen 1 of the United States but who resides in a State 2 or territory of the United States and is Feder- 3 ally authorized to be present in the United 4 States.’’; and 5 (3) by adding at the end the following new sub- 6 section: 7 ‘‘(d) NONCITIZEN.—For the purposes of this title, the 8 term ‘noncitizen’ means any individual who is not a citizen 9 of the United States.’’. 10 (e) CHILD NUTRITION PROGRAMS.—Section 742 of 11 the Personal Responsibility and Work Opportunity Rec- 12 onciliation Act of 1996 (8 U.S.C. 1615) is amended— 13 (1) in subsection (a)— 14 (A) in the header by striking ‘‘SCHOOL 15 LUNCH AND BREAKFAST PROGRAMS’’ and in- 16 serting ‘‘CHILD NUTRITION PROGRAMS’’; 17 (B) by striking ‘‘the school lunch pro- 18 gram’’ and inserting ‘‘any program’’; and 19 (C) by striking ‘‘the school breakfast pro- 20 gram under section 4 of the’’ and inserting 21 ‘‘any program under the’’; and 22 (2) in subsection (b)(1)— 23 (A) by striking ‘‘Nothing in this Act shall 24 prohibit or require a State to provide to an in- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 288 •HR 7585 IH dividual who is not a citizen or a qualified alien, 1 as defined in section 431(b),’’ and inserting ‘‘A 2 State shall not deny’’; and 3 (B) by striking ‘‘paragraph (2)’’ and in- 4 serting ‘‘paragraph (2) on the basis of an indi- 5 vidual’s citizenship or citizenship, alienage, or 6 immigration status’’. 7 (f) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI- 8 TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 9 Section 1108(h) of the Social Security Act (42 U.S.C. 10 1308(h)) is amended— 11 (1) by striking ‘‘Expenditures’’ and inserting: 12 ‘‘(1) Expenditures’’; and 13 (2) by adding at the end the following new 14 paragraph: 15 ‘‘(2) With respect to eligibility for benefits for 16 the designated Federal program defined in para- 17 graph (3)(C) of section 402(b)(3)(c) (relating to the 18 Medicaid program), paragraph (1) shall not apply to 19 any individual who lawfully resides in 1 of the 50 20 States or the District of Columbia in accordance 21 with the Compacts of Free Association between the 22 Government of the United States and the Govern- 23 ments of the Federated States of Micronesia, the 24 Republic of the Marshall Islands, and the Republic 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 289 •HR 7585 IH of Palau and shall not apply, at the option of the 1 Governor of Puerto Rico, the Virgin Islands, Guam, 2 the Northern Mariana Islands, or American Samoa 3 as communicated to the Secretary of Health and 4 Human Services in writing, to any individual who 5 lawfully resides in the respective territory in accord- 6 ance with such Compacts.’’. 7 (g) CHILD HEALTH INSURANCE PROGRAM.—Section 8 2107(e)(1) of the Social Security Act (42 U.S.C. 9 1397gg(e)(1)) is amended— 10 (1) by striking subparagraph (O); and 11 (2) by redesignating subparagraphs (P), (Q), 12 (R), (S), (T), and (U) as subparagraphs (O), (P), 13 (Q), (R), (S), and (T). 14 (h) CONFORMING AMENDMENTS.— 15 (1) SUPPLEMENTAL FOOD ASSISTANCE PRO- 16 GRAM.—The Food and Nutrition Act of 2008 (7 17 U.S.C. 2011 et seq.) is amended— 18 (A) in section 5— 19 (i) by striking subsection (i); and 20 (ii) by redesignating subsections (j) 21 through (n) as subsection (i) through (m), 22 respectively; 23 (B) in section 6— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 290 •HR 7585 IH (i) in subsection (f), by striking ‘‘an 1 alien lawfully admitted for permanent’’ and 2 all that follows through the end of the sub- 3 section and inserting‘‘a noncitizen lawfully 4 present in the United States.’’; and 5 (ii) in subsection (s)(2), by striking 6 ‘‘(m), and (n)’’ and inserting ‘‘and (m)’’; 7 and 8 (C) in section 11(e)(2)(B)(v)(II) by strik- 9 ing ‘‘aliens’’ each place it appears and inserting 10 ‘‘noncitizens’’. 11 (2) MEDICAID.—Section 1903(v) of the Social 12 Security Act (42 U.S.C. 1396b(v)) is amended— 13 (A) in paragraph (1), by striking ‘‘admit- 14 ted for’’ and all that follows through the end of 15 the paragraph and inserting ‘‘present in the 16 United States.’’; and 17 (B) by striking paragraph (4). 18 (3) HOUSING ASSISTANCE.—Section 214(a) of 19 the Housing and Community Development Act of 20 1980 (42 U.S.C. 1436a(a)) is amended— 21 (A) by redesignating paragraphs (6) and 22 (7) as paragraphs (7) and (8), respectively; and 23 (B) by inserting after paragraph (5): 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 291 •HR 7585 IH ‘‘(6) a qualified noncitizen as defined in section 1 431 of the Personal Responsibility and Work Oppor- 2 tunity Reconciliation Act of 1996 (8 U.S.C. 1641);’’. 3 (4) GENERAL RULE ON NONCITIZENS’ ELIGI- 4 BILITY.—Section 401 of Personal Responsibility and 5 Work Opportunity Reconciliation Act of 1996 (8 6 U.S.C. 1611) is amended— 7 (A) in section 401, in the header— 8 (i) by striking ‘‘QUALIFIED ALIENS’’ 9 and inserting ‘‘QUALIFIED NONCITI- 10 ZENS’’; and 11 (ii) by striking ‘‘ALIENS’’ and insert- 12 ing ‘‘NONCITIZENS’’; 13 (B) by striking ‘‘qualified alien’’ wherever 14 it occurs and inserting ‘‘qualified noncitizen’’; 15 and 16 (C) by striking ‘‘alien’’ wherever it occurs 17 and inserting ‘‘noncitizen’’. 18 (5) ASSISTANCE NOT TREATED AS DEBT AB- 19 SENT FRAUD.—Section 213A(b)(1)(A) of the Immi- 20 gration and Nationality Act is amended by striking 21 ‘‘benefit,’’ and inserting ‘‘benefit by fraud,’’. 22 (i) PRESERVING ACCESS TO HEALTH CARE.—Sec- 23 tion 36B(c)(1)(B) of the Internal Revenue Code of 1986 24 is amended to read as follows: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 292 •HR 7585 IH ‘‘(B) SPECIAL RULE FOR CERTAIN INDI- 1 VIDUALS LAWFULLY PRESENT IN THE UNITED 2 STATES.—If— 3 ‘‘(i) a taxpayer has a household in- 4 come which is not greater than 100 per- 5 cent of an amount equal to the poverty line 6 for a family of the size involved, 7 ‘‘(ii) the taxpayer is a non-citizen law- 8 fully present in the United States, 9 ‘‘(iii) the taxpayer is ineligible for 10 minimum essential coverage under section 11 5000A(f)(1)(A)(ii), and 12 ‘‘(iv) under the Medicaid eligibility 13 criteria for non-citizens in effect on De- 14 cember 26, 2020, the taxpayer would be 15 ineligible for such minimum essential cov- 16 erage by reason of the taxpayer’s immigra- 17 tion status, 18 the taxpayer shall, for purposes of the credit 19 under this section, be treated as an applicable 20 taxpayer with a household income which is 21 equal to 100 percent of the poverty line for a 22 family of the size involved.’’. 23 (j) FEDERAL AGENCY GUIDANCE.—Not later than 24 180 days after the date of the enactment of this Act, each 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 293 •HR 7585 IH Federal agency, as applicable, shall issue guidance with 1 respect to implementing the amendments made by this 2 section. 3 (k) EFFECTIVE DATE.—The amendments made by 4 this section shall take effect on the date of enactment of 5 this Act and shall apply to services furnished on or after 6 the date that is 180 days after the date on which any guid- 7 ance is issued pursuant to subsection (i). 8 SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PRE- 9 MIUM COSTS OF HEALTH INSURANCE FOR 10 CONSUMERS. 11 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In- 12 ternal Revenue Code of 1986 is amended to read as fol- 13 lows: 14 ‘‘(A) APPLICABLE PERCENTAGE.—The ap- 15 plicable percentage for any taxable year shall be 16 the percentage such that the applicable percent- 17 age for any taxpayer whose household income is 18 within an income tier specified in the following 19 table shall increase, on a sliding scale in a lin- 20 ear manner, from the initial premium percent- 21 age to the final premium percentage specified in 22 such table for such income tier: 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 294 •HR 7585 IH ‘‘In the case of household income (expressed as a percent of poverty line) within the following in- come tier: The initial premium percentage is— The final premium percentage is— Up to 150 percent .................................................. 0.0 0.0 150 percent up to 200 percent ............................... 0.0 3.0 200 percent up to 250 percent ............................... 3.0 4.0 250 percent up to 300 percent ............................... 4.0 6.0 300 percent up to 400 percent ............................... 6.0 8.5 400 percent and higher .......................................... 8.5 8.5.’’. (b) CONFORMING AMENDMENT.—Section 1 36B(c)(1)(A) of the Internal Revenue Code of 1986 is 2 amended by striking ‘‘but does not exceed 400 percent’’. 3 (c) EFFECTIVE DATE.—The amendments made by 4 this section shall apply to taxable years beginning after 5 December 31, 2021. 6 SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION 7 BARRIERS TO ACCESS TO AFFORDABLE 8 HEALTH CARE UNDER THE ACA. 9 (a) IN GENERAL.— 10 (1) PREMIUM TAX CREDITS.—Section 36B of 11 the Internal Revenue Code of 1986 is amended— 12 (A) in subsection (c)(1)(B)— 13 (i) by amending the heading to read 14 as follows: ‘‘SPECIAL RULE FOR CERTAIN 15 INDIVIDUALS INELIGIBLE FOR MEDICAID 16 DUE TO STATUS’’; and 17 (ii) in clause (ii), to read as follows: 18 ‘‘(ii) the taxpayer is a noncitizen who 19 is not eligible for the Medicaid program 20 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 295 •HR 7585 IH under title XIX of the Social Security Act 1 by reason of the individual’s immigration 2 status,’’; and 3 (B) by striking subsection (e). 4 (2) COST-SHARING REDUCTIONS.—Section 1402 5 of the Patient Protection and Affordable Care Act 6 (42 U.S.C. 18071) is amended— 7 (A) by striking subsection (e); and 8 (B) by redesignating subsection (f) as sub- 9 section (e). 10 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 11 Section 1331(e)(1)(B) of the Patient Protection and 12 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 13 amended by striking ‘‘lawfully present in the United 14 States,’’. 15 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 16 Section 1412 of the Patient Protection and Afford- 17 able Care Act (42 U.S.C. 18082) is amended— 18 (A) by striking subsection (d); and 19 (B) by redesignating subsection (e) as sub- 20 section (d). 21 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 22 SENTIAL COVERAGE.—Section 5000A(d) of the In- 23 ternal Revenue Code of 1986 is amended— 24 (A) by striking paragraph (3); and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 296 •HR 7585 IH (B) by redesignating paragraph (4) as 1 paragraph (3). 2 (b) CONFORMING AMENDMENTS.— 3 (1) ESTABLISHMENT OF PROGRAM.—Section 4 1411(a) of the Patient Protection and Affordable 5 Care Act (42 U.S.C. 18081(a)) is amended— 6 (A) by striking paragraph (1); and 7 (B) by redesignating paragraphs (2), (3), 8 and (4) as paragraphs (1), (2), and (3), respec- 9 tively. 10 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 11 of the Patient Protection and Affordable Care Act 12 (42 U.S.C. 18032(f)) is amended— 13 (A) in the heading, by striking ‘‘; ACCESS 14 LIMITED TO CITIZENS AND LAWFUL RESI- 15 DENTS’’; and 16 (B) by striking paragraph (3). 17 (c) EFFECTIVE DATE.—The amendments made by 18 this section shall apply to years, plan years, and taxable 19 years, as applicable, beginning after December 31, 2022. 20 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 297 •HR 7585 IH SEC. 4006. REMOVING BARRIERS TO ACCESS TO AFFORD- 1 ABLE HEALTH CARE FOR LAWFULLY RESID- 2 ING IMMIGRANTS UNDER MEDICAID AND 3 CHIP. 4 (a) MEDICAID.—Section 1903(v)(4) of the Social Se- 5 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 6 (1) by amending subparagraph (A) to read as 7 follows: 8 ‘‘(A) Notwithstanding sections 401(a), 402(b), 9 403, and 421 of the Personal Responsibility and 10 Work Opportunity Reconciliation Act of 1996, a 11 State shall provide medical assistance under this 12 title to individuals who are lawfully residing in the 13 United States (including individuals described in 14 paragraph (1), battered individuals described in sec- 15 tion 431(c) of such Act, and individuals with an ap- 16 proved or pending application for deferred action or 17 other federally authorized presence), if they other- 18 wise meet the eligibility requirements for medical as- 19 sistance under the State plan approved under this 20 title (other than the requirement of the receipt of 21 aid or assistance under title IV, supplemental secu- 22 rity income benefits under title XVI, or a State sup- 23 plementary payment).’’; 24 (2) by amending subparagraph (B) to read as 25 follows: 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 298 •HR 7585 IH ‘‘(B) No debt shall accrue under an affidavit of 1 support against any sponsor of an individual pro- 2 vided medical assistance under subparagraph (A) on 3 the basis of provision of assistance to such individual 4 and the cost of such assistance shall not be consid- 5 ered as an unreimbursed cost.’’; and 6 (3) in subparagraph (C)— 7 (A) by striking ‘‘an election by the State 8 under subparagraph (A)’’ and inserting ‘‘the 9 application of subparagraph (A)’’; 10 (B) by inserting ‘‘or be lawfully present’’ 11 after ‘‘lawfully reside’’; and 12 (C) by inserting ‘‘or present’’ after ‘‘law- 13 fully residing’’ each place it appears. 14 (b) CHIP.—Subparagraph (O) of section 2107(e)(1) 15 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 16 amended to read as follows: 17 ‘‘(O) Paragraph (4) of section 1903(v) (re- 18 lating to lawfully residing individuals).’’. 19 (c) EFFECTIVE DATE.— 20 (1) IN GENERAL.—Except as provided in para- 21 graph (2), the amendments made by this section 22 shall take effect on the date of enactment of this Act 23 and shall apply to services furnished on or after the 24 date that is 90 days after such date of enactment. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 299 •HR 7585 IH (2) EXCEPTION IF STATE LEGISLATION RE- 1 QUIRED.—In the case of a State plan for medical as- 2 sistance under title XIX, or a State child health plan 3 under title XXI, of the Social Security Act which the 4 Secretary of Health and Human Services determines 5 requires State legislation (other than legislation ap- 6 propriating funds) in order for the plan to meet the 7 additional requirements imposed by the amendments 8 made by this section, the respective State plan shall 9 not be regarded as failing to comply with the re- 10 quirements of such title solely on the basis of its 11 failure to meet these additional requirements before 12 the first day of the first calendar quarter beginning 13 after the close of the first regular session of the 14 State legislature that begins after the date of enact- 15 ment of this Act. For purposes of the previous sen- 16 tence, in the case of a State that has a 2-year legis- 17 lative session, each year of such session shall be 18 deemed to be a separate regular session of the State 19 legislature. 20 (d) PRESERVING COVERAGE.— 21 (1) IN GENERAL.—Nothing in this section, in- 22 cluding the amendments made by this section, shall 23 prevent lawfully present noncitizens who are ineli- 24 gible for full benefits under the Medicaid program 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 300 •HR 7585 IH under title XIX of the Social Security Act from se- 1 curing a credit for which such lawfully present non- 2 citizens would be eligible under section 36B(c)(1)(B) 3 of the Internal Revenue Code of 1986 and under the 4 Medicaid provisions for lawfully present noncitizens, 5 as in effect on the date prior to the date of enact- 6 ment of this Act. 7 (2) DEFINITION.—For purposes of paragraph 8 (1), the term ‘‘full benefits’’ means, with respect to 9 an individual and State, medical assistance for all 10 services covered under the State plan under title 11 XIX of the Social Security Act that is not less in 12 amount, duration, or scope, or is determined by the 13 Secretary of Health and Human Services to be sub- 14 stantially equivalent to the medical assistance avail- 15 able for an individual described in section 16 1902(a)(10)(A)(i) of the Social Security Act (42 17 U.S.C. 1396a(a)(10)(A)(i)). 18 SEC. 4007. CONSISTENCY IN HEALTH INSURANCE COV- 19 ERAGE FOR INDIVIDUALS WITH FEDERALLY 20 AUTHORIZED PRESENCE, INCLUDING DE- 21 FERRED ACTION. 22 (a) IN GENERAL.—For purposes of eligibility under 23 any of the provisions described in subsection (b), all indi- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 301 •HR 7585 IH viduals granted lawful presence in the United States shall 1 be considered to be lawfully present in the United States. 2 (b) PROVISIONS DESCRIBED.—The provisions de- 3 scribed in this subsection are the following: 4 (1) EXCHANGE ELIGIBILITY.—Section 1411 of 5 the Patient Protection and Affordable Care Act (42 6 U.S.C. 18031). 7 (2) REDUCED COST-SHARING ELIGIBILITY.— 8 Section 1402 of the Patient Protection and Afford- 9 able Care Act (42 U.S.C. 18071). 10 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 11 36B of the Internal Revenue Code of 1986 (26 12 U.S.C. 36B). 13 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 14 XIX and XXI of the Social Security Act, including 15 under section 1903(v) of such Act (42 U.S.C. 16 1396b(v)). 17 (c) EFFECTIVE DATE.— 18 (1) IN GENERAL.—Subsection (a) shall take ef- 19 fect on the date of enactment of this Act. 20 (2) TRANSITION THROUGH SPECIAL ENROLL- 21 MENT PERIOD.—In the case of an individual de- 22 scribed in subsection (a) who, before the first day of 23 the first annual open enrollment period under sub- 24 paragraph (B) of section 1311(c)(6) of the Patient 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 302 •HR 7585 IH Protection and Affordable Care Act (42 U.S.C. 1 18031(c)(6)) beginning after the date of enactment 2 of this Act, is granted lawful presence in the United 3 States and who, as a result of such subsection, 4 qualifies for a subsidy under a provision described in 5 paragraph (2) or (3) of subsection (b), the Secretary 6 of Health and Human Services shall establish a spe- 7 cial enrollment period under subparagraph (C) of 8 such section 1311(c)(6) during which such individual 9 may enroll in qualified health plans through Ex- 10 changes under title I of the Patient Protection and 11 Affordable Care Act (42 U.S.C. 18001 note et seq.) 12 and qualify for such a subsidy. For such an indi- 13 vidual who has been granted federally authorized 14 presence in the United States as of the date of en- 15 actment of this Act, such special enrollment period 16 shall begin not later than 90 days after such date 17 of enactment. Nothing in this paragraph shall be 18 construed as affecting the authority of the Secretary 19 to establish additional special enrollment periods 20 under such subparagraph (C). 21 SEC. 4008. STUDY ON THE UNINSURED. 22 (a) IN GENERAL.—The Secretary of Health and 23 Human Services (in this section referred to as the ‘‘Sec- 24 retary’’) shall— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 303 •HR 7585 IH (1) conduct a study, in accordance with the 1 standards under section 3101 of the Public Health 2 Service Act (42 U.S.C. 300kk), on the demographic 3 characteristics of the population of individuals who 4 do not have health insurance coverage or oral health 5 coverage; and 6 (2) predict, based on such study, the demo- 7 graphic characteristics of the population of individ- 8 uals who would remain without health insurance cov- 9 erage after the end of any annual open enrollment 10 or any special enrollment period or upon enactment 11 and implementation of any legislative changes to the 12 Patient Protection and Affordable Care Act (Public 13 Law 111–148) that affect the number of persons eli- 14 gible for coverage. 15 (b) REPORTING REQUIREMENTS.— 16 (1) IN GENERAL.—Not later than 12 months 17 after the date of the enactment of this Act, the Sec- 18 retary shall submit to the Congress the results of 19 the study under subsection (a)(1) and the prediction 20 made under subsection (a)(2). 21 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 22 ISTICS.—The Secretary shall— 23 (A) report the demographic characteristics 24 under paragraphs (1) and (2) of subsection (a) 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 304 •HR 7585 IH on the basis of racial and ethnic group (as de- 1 fined in section 1707(g)(1) of the Public Health 2 Service Act, as amended by section 101 of this 3 Act), and stratify the reporting on each racial 4 and ethnic group by other demographic charac- 5 teristics that can impact access to health insur- 6 ance coverage, such as sexual orientation, gen- 7 der identity, primary language, disability status, 8 sex, socioeconomic status, age group, citizen- 9 ship, and immigration status, in a manner con- 10 sistent with title I of this Act, including the 11 amendments made by such title; and 12 (B) not use such report, or any informa- 13 tion gathered in preparing such report— 14 (i) to engage in or anticipate any de- 15 portation or immigration related enforce- 16 ment action by any entity, including the 17 Department of Homeland Security; or 18 (C) for the exploitation of, or discrimina- 19 tion against, communities of color or the 20 LGBTQ+ population. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 305 •HR 7585 IH SEC. 4009. MEDICAID FALLBACK COVERAGE PROGRAM FOR 1 LOW-INCOME ADULTS IN NON-EXPANSION 2 STATES. 3 (a) IN GENERAL.—As soon as possible after the date 4 of enactment of this Act the Secretary of Health and 5 Human Services (in this section referred to as the ‘‘Sec- 6 retary’’) shall— 7 (1) directly or by contract, establish a program 8 that offers eligible individuals the opportunity to en- 9 roll in health benefits coverage that meets the re- 10 quirements described in subsection (c) and any re- 11 quirements applicable to such coverage pursuant to 12 subsection (d); and 13 (2) ensure that such program is administered 14 consistent with the requirements of section 15 431.10(c)(2) of title 42, Code of Federal Regula- 16 tions. 17 (b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 18 section, the term ‘‘eligible individual’’ means an individual 19 who— 20 (1) is described in section 21 1902(a)(10)(A)(i)(VIII) of the Social Security Act 22 (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 23 (2) resides in a State that— 24 (A) does not expend amounts for medical 25 assistance under title XIX of the Social Secu- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 306 •HR 7585 IH rity Act (42 U.S.C. 1396 et seq.) for all individ- 1 uals described in such section; and 2 (B) did not expend amounts for medical 3 assistance under such title for all such individ- 4 uals as of the date of enactment of this Act; 5 and 6 (3) would not be eligible for medical assistance 7 under such State’s plan for medical assistance under 8 title XIX of the Social Security Act (42 U.S.C. 1396 9 et seq.), or a waiver of such plan, as such plan or 10 waiver was in effect on such date. 11 (c) HEALTH BENEFITS COVERAGE REQUIRE- 12 MENTS.—The requirements described in this subsection 13 with respect to health benefits coverage are the following: 14 (1) ESSENTIAL HEALTH BENEFITS.—At a min- 15 imum, the coverage meets the minimum standards 16 required under paragraph (5) of section 1937(b) of 17 the Social Security Act (42 U.S.C. 1396u–7(b)) for 18 benchmark coverage described in paragraph (1) of 19 such section or benchmark equivalent coverage de- 20 scribed in paragraph (2) of such section. 21 (2) PREMIUMS AND COST-SHARING.—No pre- 22 miums are imposed for the coverage, and deduct- 23 ibles, cost sharing, or similar charges may only be 24 imposed in accordance with the requirements im- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 307 •HR 7585 IH posed on State Medicaid plans under section 1916 of 1 the Social Security Act (42 U.S.C. 1396o). 2 (d) APPLICATION OF REQUIREMENTS AND PROVI- 3 SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 4 The Secretary shall specify that— 5 (1) any requirement applicable to the furnishing 6 of medical assistance under title XIX of the Social 7 Security Act (42 U.S.C. 1396 et seq.) by States that 8 have elected to make medical assistance available to 9 individuals described in section 10 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 11 1396a(a)(10)(A)(i)(VIII)) that does not conflict with 12 the requirements specified in subsection (c) applies 13 to the program established under this section; and 14 (2) other provisions of such title apply to such 15 program. 16 (e) NO STATE MANDATE.—Nothing in this section 17 shall be construed as requiring a State to make expendi- 18 tures related to the program established under this section 19 and the Secretary shall not impose any such requirement. 20 (f) FUNDING.—There are appropriated to the Sec- 21 retary for each fiscal year beginning with fiscal year 2022 22 from any funds in the Treasury not otherwise appro- 23 priated, such sums as are necessary to carry out this sec- 24 tion. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 308 •HR 7585 IH SEC. 4010. INCREASE AND EXTENSION OF TEMPORARY EN- 1 HANCED FMAP FOR STATES WHICH BEGIN TO 2 EXPEND AMOUNTS FOR CERTAIN MANDA- 3 TORY INDIVIDUALS. 4 (a) IN GENERAL.—Section 1905(ii)(1) of the Social 5 Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 6 (1) by striking ‘‘8-quarter period’’ and inserting 7 ‘‘40-quarter period’’; and 8 (2) by striking ‘‘5 percentage points’’ and in- 9 serting ‘‘10 percentage points’’. 10 (b) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect as if included in the enact- 12 ment of section 9814 of the American Rescue Plan Act 13 of 2021 (Public Law 117–2). 14 Subtitle B—Improvement of 15 Coverage 16 SEC. 4101. MEDICAID IN THE TERRITORIES. 17 (a) ELIMINATION OF GENERAL MEDICAID FUNDING 18 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 19 (1) IN GENERAL.—Section 1108 of the Social 20 Security Act (42 U.S.C. 1308) is amended— 21 (A) in subsection (f), in the matter pre- 22 ceding paragraph (1), by striking ‘‘subsections 23 (g) and (h)’’ and inserting ‘‘subsections (g), 24 (h), and (i)’’; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 309 •HR 7585 IH (B) in subsection (g)(2), in the matter pre- 1 ceding subparagraph (A), by inserting ‘‘sub- 2 section (i) and’’ after ‘‘subject to’’; and 3 (C) by adding at the end the following new 4 subsection: 5 ‘‘(i) SUNSET OF MEDICAID FUNDING LIMITATIONS 6 FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE 7 NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 8 Subsections (f) and (g) shall not apply to Puerto Rico, 9 the Virgin Islands, Guam, the Northern Mariana Islands, 10 and American Samoa beginning with fiscal year 2024.’’. 11 (2) CONFORMING AMENDMENTS.— 12 (A) Section 1902(j) of the Social Security 13 Act (42 U.S.C. 1396a(j)) is amended by strik- 14 ing ‘‘, the limitation in section 1108(f),,’’. 15 (B) Section 1903(u) of the Social Security 16 Act (42 U.S.C. 1396b(u)) is amended by strik- 17 ing paragraph (4). 18 (3) EFFECTIVE DATE.—The amendments made 19 by this section shall apply beginning with fiscal year 20 2024. 21 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 22 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR 23 TERRITORIES.—Section 1905(b) of the Social Security 24 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 310 •HR 7585 IH inserting ‘‘for fiscal years before fiscal year 2024’’ after 1 ‘‘American Samoa’’. 2 (c) PERMITTING MEDICAID DSH ALLOTMENTS FOR 3 TERRITORIES.—Section 1923(f) of the Social Security Act 4 (42 U.S.C. 1396r–4(f)) is amended— 5 (1) in paragraph (6), by adding at the end the 6 following new subparagraph: 7 ‘‘(C) TERRITORIES.— 8 ‘‘(i) FISCAL YEAR 2023.—For fiscal 9 year 2023, the DSH allotment for Puerto 10 Rico, the Virgin Islands, Guam, the North- 11 ern Mariana Islands, and American Samoa 12 shall bear the same ratio to $300,000,000 13 as the ratio of the number of individuals 14 who are low-income or uninsured and re- 15 siding in such respective territory (as esti- 16 mated from time to time by the Secretary) 17 bears to the sums of the number of such 18 individuals residing in all of the territories. 19 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 20 For each subsequent fiscal year, the DSH 21 allotment for each such territory is subject 22 to an increase in accordance with para- 23 graph (3).’’; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 311 •HR 7585 IH (2) in paragraph (9), by inserting before the pe- 1 riod at the end the following: ‘‘, and includes, begin- 2 ning with fiscal year 2023, Puerto Rico, the Virgin 3 Islands, Guam, the Northern Mariana Islands, and 4 American Samoa’’. 5 SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY 6 INCOME PROGRAM TO PUERTO RICO, THE 7 UNITED STATES VIRGIN ISLANDS, GUAM, AND 8 AMERICAN SAMOA. 9 (a) IN GENERAL.—Section 303 of the Social Security 10 Amendments of 1972 (86 Stat. 1484) is amended by strik- 11 ing subsection (b). 12 (b) CONFORMING AMENDMENTS.— 13 (1) DEFINITION OF STATE.—Section 14 1101(a)(1) of the Social Security Act (42 U.S.C. 15 1301(a)(1)) is amended by striking the 5th sentence 16 and inserting the following: ‘‘Such term when used 17 in title XVI includes Puerto Rico, the United States 18 Virgin Islands, Guam, and American Samoa.’’. 19 (2) ELIMINATION OF LIMIT ON TOTAL PAY- 20 MENTS TO THE TERRITORIES.—Section 1108 of 21 such Act (42 U.S.C. 1308) is amended— 22 (A) in the section heading, by striking ‘‘; 23 LIMITATION ON TOTAL PAYMENTS’’; 24 (B) by striking subsection (a); and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 312 •HR 7585 IH (C) in subsection (c), by striking para- 1 graphs (2) and (4) and redesignating para- 2 graphs (3) and (5) as paragraphs (2) and (4), 3 respectively. 4 (3) UNITED STATES NATIONALS TREATED THE 5 SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 6 Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 7 (A) in clause (i)(I), by inserting ‘‘or na- 8 tional,’’ after ‘‘citizen’’; 9 (B) in clause (i)(II), by adding ‘‘; or’’ at 10 the end; and 11 (C) in clause (ii), by inserting ‘‘or na- 12 tional’’ after ‘‘citizen’’. 13 (4) TERRITORIES INCLUDED IN GEOGRAPHIC 14 MEANING OF UNITED STATES.—Section 1614(e) of 15 such Act (42 U.S.C. 1382c(e)) is amended by strik- 16 ing ‘‘and the District of Columbia’’ and inserting ‘‘, 17 the District of Columbia, Puerto Rico, the United 18 States Virgin Islands, Guam, and American 19 Samoa’’. 20 (c) WAIVER AUTHORITY.—The Commissioner of So- 21 cial Security may waive or modify any statutory require- 22 ment relating to the provision of benefits under the Sup- 23 plemental Security Income Program under title XVI of the 24 Social Security Act in Puerto Rico, the United States Vir- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 313 •HR 7585 IH gin Islands, Guam, or American Samoa, to the extent that 1 the Commissioner deems it necessary in order to adapt 2 the program to the needs of the territory involved. 3 (d) EFFECTIVE DATE.—This section and the amend- 4 ments made by this section shall take effect on the 1st 5 day of the 1st Federal fiscal year that begins 1 year or 6 more after the date of the enactment of this Act. 7 SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER. 8 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 9 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 10 ed— 11 (1) in the last sentence, by inserting ‘‘, and be- 12 fore January 1, 2023’’ after ‘‘prior to such date)’’; 13 and 14 (2) by adding at the end the following new sen- 15 tence: ‘‘Effective for items and services furnished on 16 or after January 1, 2023 (with respect to periods 17 beginning on or after the date that is 42 months 18 prior to such date), clauses (i) and (ii) shall be ap- 19 plied by substituting ‘42-month’ for ‘12-month’ each 20 place it appears.’’. 21 (b) EFFECTIVE DATE.—The amendments made by 22 this section shall take effect on the date of enactment of 23 this Act. For purposes of determining an individual’s sta- 24 tus under section 1862(b)(1)(C) of the Social Security Act 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 314 •HR 7585 IH (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 1 (a), an individual who is within the coordinating period 2 as of the date of enactment of this Act shall have that 3 period extended to the full 42 months described in the last 4 sentence of such section, as added by the amendment 5 made by subsection (a)(2). 6 SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT 7 PROTECTION AND AFFORDABLE CARE ACT. 8 (a) DEFINITION OF INDIAN.—Section 1304 of the 9 Patient Protection and Affordable Care Act (42 U.S.C. 10 18024) is amended by adding at the end the following: 11 ‘‘(f) INDIAN.—In this title: 12 ‘‘(1) IN GENERAL.—The term ‘Indian’ means— 13 ‘‘(A) an Indian, California Indian, or 14 Urban Indian, as such terms are defined in sec- 15 tion 4 of the Indian Health Care Improvement 16 Act (25 U.S.C. 1603); or 17 ‘‘(B) an individual who is— 18 ‘‘(i) of Indian descent and a member 19 of an Indian community served by a local 20 facility or program of the Indian Health 21 Service; or 22 ‘‘(ii) described in paragraph (2). 23 ‘‘(2) INCLUSIONS.—The term ‘Indian’ includes 24 the following individuals: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 315 •HR 7585 IH ‘‘(A) A member of a federally recognized 1 Indian Tribe. 2 ‘‘(B) A resident of an urban center who 3 meets one or more of the following criteria: 4 ‘‘(i) A member of a Tribe, band, or 5 other organized group of Indians, including 6 those Tribes, bands, or groups terminated 7 since 1940 and those recognized as of the 8 date of enactment of the Health Equity 9 and Accountability Act of 2022 or later by 10 the State in which they reside, or being a 11 descendant, in the first or second degree, 12 of any such member. 13 ‘‘(ii) An Eskimo or Aleut or other 14 Alaska Native. 15 ‘‘(iii) An individual who is determined 16 to be an Indian under regulations promul- 17 gated by the Secretary. 18 ‘‘(C) An individual who is considered by 19 the Secretary of the Interior to be an Indian for 20 any purpose. 21 ‘‘(D) An individual who is considered by 22 the Secretary to be an Indian for purposes of 23 eligibility for services provided by the Indian 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 316 •HR 7585 IH Health Service, including as a California In- 1 dian, Eskimo, Aleut, or other Alaska Native.’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) AFFORDABLE CHOICES HEALTH BENEFIT 4 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 5 tection and Affordable Care Act (42 U.S.C. 6 18031(c)(6)(D)) is amended by striking ‘‘(as defined 7 in section 4 of the Indian Health Care Improvement 8 Act)’’. 9 (2) REDUCED COST-SHARING FOR INDIVIDUALS 10 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 11 1402(d) of the Patient Protection and Affordable 12 Care Act (42 U.S.C. 18071(d)) is amended— 13 (A) in paragraph (1), in the matter pre- 14 ceding subparagraph (A), by striking ‘‘(as de- 15 fined in section 4(d) of the Indian Self-Deter- 16 mination and Education Assistance Act (25 17 U.S.C. 450b(d))’’; and 18 (B) in paragraph (2), in the matter pre- 19 ceding subparagraph (A), by striking ‘‘(as so 20 defined)’’. 21 (3) EXEMPTION FROM PENALTY FOR NOT 22 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 23 Section 5000A(e) of the Internal Revenue Code of 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 317 •HR 7585 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 (c) EFFECTIVE DATE OF IRC PROVISION.—The 6 amendment made by subsection (b)(3) shall apply to tax- 7 able years beginning after the date of the enactment of 8 this section. 9 SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 10 CARE. 11 (a) PART A.—Section 1818(a)(3) of the Social Secu- 12 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 13 ‘‘an alien’’ and all that follows through ‘‘under this sec- 14 tion’’ and inserting ‘‘an individual who is lawfully present 15 in the United States’’. 16 (b) PART B.—Section 1836(2) of the Social Security 17 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 18 alien’’ and all that follows through ‘‘under this part’’ and 19 inserting ‘‘an individual who is lawfully present in the 20 United States’’. 21 SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE- 22 SCRIPTION DRUG COSTS. 23 (a) MEDICARE COST ASSISTANCE PROGRAM.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 318 •HR 7585 IH (1) IN GENERAL.—Title XVIII of the Social Se- 1 curity Act (42 U.S.C. 1395 et seq.) is amended by 2 adding at the end the following new section: 3 ‘‘SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM. 4 ‘‘(a) IN GENERAL.—Effective beginning January 1, 5 2023, in the case of a Medicare Cost Assistance Program 6 eligible individual (as defined in subsection (b)(1)), the 7 Secretary shall provide Medicare cost assistance for the 8 following costs incurred with respect to the individual: 9 ‘‘(1)(A) premiums under section 1818; and 10 ‘‘(B) premiums under section 1839. 11 ‘‘(2) Coinsurance under this title (including co- 12 insurance described in section 1813). 13 ‘‘(3) Deductibles established under this title (in- 14 cluding those described in section 1813 and section 15 1833(b)). 16 ‘‘(4) The difference between the amount that is 17 paid under section 1833(a) and the amount that 18 would be paid under such section if any reference to 19 a percent less than 100 percent therein were deemed 20 a reference to ‘100 percent’. 21 ‘‘(b) DETERMINATION OF ELIGIBILITY.— 22 ‘‘(1) MEDICARE COST ASSISTANCE PROGRAM 23 ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 319 •HR 7585 IH care Cost Assistance Program eligible individual’ 1 means an individual who— 2 ‘‘(A) is eligible for and is receiving medical 3 assistance for the payment of medicare cost- 4 sharing under a State Medicaid program pursu- 5 ant to clause (i), (iii), or (iv) of section 6 1902(a)(10)(E) as of December 31, 2022; or 7 ‘‘(B)(i) is entitled to hospital insurance 8 benefits under part A (including an individual 9 entitled to such benefits pursuant to an enroll- 10 ment under section 1818); and 11 ‘‘(ii) has income at or below 200 percent of 12 the poverty line applicable to a family of the 13 size involved. 14 ‘‘(2) JOINT DETERMINATION BY COMMISSIONER 15 OF SOCIAL SECURITY FOR LIS AND MEDICARE COST 16 ASSISTANCE.— 17 ‘‘(A) IN GENERAL.—The determination of 18 whether an individual is a Medicare Cost As- 19 sistance Program eligible individual described in 20 paragraph (1) shall be determined by the Com- 21 missioner of Social Security jointly with the de- 22 termination of whether an individual is a sub- 23 sidy eligible individual described in section 24 1860D–14(a)(3). Such determination shall be 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 320 •HR 7585 IH made with respect to eligibility for Medicare 1 cost assistance under this section and premium 2 and cost-sharing subsidies under section 3 1860D–14 upon application of an individual for 4 a determination with respect to eligibility for ei- 5 ther such assistance or such subsidies. There 6 are authorized to be appropriated to the Social 7 Security Administration such sums as may be 8 necessary for the determination of eligibility 9 under this paragraph. 10 ‘‘(B) EFFECTIVE PERIOD.—Determina- 11 tions under this paragraph with respect to eligi- 12 bility for each of such assistance or such sub- 13 sidies shall be effective beginning with the 14 month in which the individual applies for a de- 15 termination described in subparagraph (A) and 16 shall remain in effect until such time as the 17 Secretary determines the individual is no longer 18 eligible as determined under subparagraph 19 (C)(ii). 20 ‘‘(C) REDETERMINATIONS.—With respect 21 to eligibility determinations under this para- 22 graph— 23 ‘‘(i) redeterminations shall be made at 24 the same time with respect to eligibility for 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 321 •HR 7585 IH Medicare cost assistance under this section 1 and cost-sharing subsidies under section 2 1860D–14, but not more frequently than 3 once every 12 months; 4 ‘‘(ii) a redetermination shall automati- 5 cally determine that an individual remains 6 eligible for such assistance or subsidies un- 7 less— 8 ‘‘(I) the Commissioner has infor- 9 mation indicating that the individual’s 10 circumstances have changed such that 11 the individual is no longer eligible for 12 such assistance or subsidies; 13 ‘‘(II) the Commissioner sends no- 14 tice to the individual regarding such 15 information that requests a response 16 either confirming or correcting such 17 information; and 18 ‘‘(III) the individual either con- 19 firms such information or fails to pro- 20 vide documentation indicating that 21 such circumstances have not changed 22 within 60 days of receiving the notice 23 described in subclause (II); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 322 •HR 7585 IH ‘‘(iii) the Commissioner shall establish 1 procedures for appeals of such determina- 2 tions that are similar to the procedures de- 3 scribed in the third sentence of section 4 1631(c)(1)(A); and 5 ‘‘(iv) judicial review of the final deci- 6 sion of the Commissioner made after a 7 hearing shall be available to the same ex- 8 tent, and with the same limitations, as pro- 9 vided in subsections (g) and (h) of section 10 205. 11 ‘‘(D) TREATMENT OF MEDICAID BENE- 12 FICIARIES.—The Secretary shall provide that 13 individuals who are full-benefit dual eligible in- 14 dividuals (as defined in section 1935(c)(6)) or 15 who are recipients of supplemental security in- 16 come benefits under title XVI shall be treated 17 as a Medicare Cost Assistance Program eligible 18 individual described in paragraph (1) and, in 19 the case of such individual who is a part D eli- 20 gible individual, a subsidy eligible individual de- 21 scribed in section 1860D–14(a)(3). 22 ‘‘(E) SIMPLIFIED APPLICATION FORM.— 23 ‘‘(i) IN GENERAL.—The Secretary 24 shall develop and distribute a simplified 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 323 •HR 7585 IH application form for use by individuals in 1 applying for Medicare cost assistance 2 under this section and premium and cost- 3 sharing subsidies under section 1860D–14. 4 Such form shall be easily readable based 5 on culturally fluid language for all demo- 6 graphics beyond just the various languages 7 offered. An audio version, digital version 8 and photo-voice option should also be pro- 9 vided for all learners. The Secretary shall 10 provide for the translation of such applica- 11 tion form into at least the 10 languages 12 (other than English) that are most often 13 used by individuals applying for hospital 14 insurance benefits under section 226 or 15 226A and shall make the translated forms 16 available to the Commissioner of Social Se- 17 curity. 18 ‘‘(ii) CONSULTATION.—In developing 19 such form, the Secretary shall consult with 20 beneficiary groups. 21 ‘‘(3) INCOME DETERMINATIONS.—For purposes 22 of applying this section— 23 ‘‘(A) in the case of an individual who is 24 not treated as a Medicare Cost Assistance Pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 324 •HR 7585 IH gram eligible individual or a subsidy eligible in- 1 dividual under paragraph (2)(D), income shall 2 be determined in the manner described under 3 section 1612 for purposes of the supplemental 4 security income program, except that support 5 and maintenance furnished in kind shall not be 6 counted as income; and 7 ‘‘(B) the term ‘poverty line’ has the mean- 8 ing given such term in section 673(2) of the 9 Community Services Block Grant Act (42 10 U.S.C. 9902(2)), including any revision re- 11 quired by such section. 12 ‘‘(c) BENEFICIARY PROTECTIONS.— 13 ‘‘(1) IN GENERAL.—In the case in which the 14 payment for Medicare cost assistance for a Medicare 15 Cost Assistance Program eligible individual with re- 16 spect to an item or service is reduced or eliminated 17 the individual shall not have any legal liability to 18 make payment to a provider of services or supplier 19 or to an organization described in section 20 1903(m)(1)(A) for the service, and any lawful sanc- 21 tion that may be imposed upon a provider of services 22 or supplier or such an organization for excess 23 charges under this title or title XIX shall apply to 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 325 •HR 7585 IH the imposition of any charge imposed upon the indi- 1 vidual in such case. 2 ‘‘(2) CLARIFICATION.—This paragraph shall 3 not be construed as preventing payment of any 4 medicare cost assistance by a medicare supplemental 5 policy or an employer retiree health plan on behalf 6 of an individual. 7 ‘‘(d) ADMINISTRATION.— 8 ‘‘(1) IN GENERAL.—The Secretary shall estab- 9 lish procedures for the administration of the pro- 10 gram under this section. 11 ‘‘(2) FUNDING.—For purposes of carrying out 12 this section, the Secretary shall make payments from 13 the Federal Hospital Insurance Trust Fund under 14 section 1817 and the Federal Supplementary Med- 15 ical Insurance Trust Fund under section 1841, in 16 such proportion as the Secretary determines appro- 17 priate, of such amounts as the Secretary determines 18 necessary to provide Medicare cost assistance under 19 this section. 20 ‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 21 Effective beginning January 1, 2023, any reference to 22 medicare cost-sharing described in section 1905(p) shall 23 be deemed a reference to Medicare cost assistance under 24 this section. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 326 •HR 7585 IH ‘‘(f) OUTREACH EFFORTS.—For provisions relating 1 to outreach efforts to increase awareness of the availability 2 of Medicare cost assistance, see section 1144.’’. 3 (2) SPECIAL ENROLLMENT PERIOD.— 4 (A) NO PREMIUM PENALTY.—Section 5 1839(b) of the Social Security Act (42 U.S.C. 6 1395r(b)) is amended, in the last sentence, by 7 inserting the following before the period: ‘‘or, 8 effective beginning January 1, 2023, for indi- 9 viduals who are Medicare Cost Assistance Pro- 10 gram eligible individuals (as defined in section 11 1899B(b)(1)).’’. 12 (B) SPECIAL ENROLLMENT PERIOD.—Sec- 13 tion 1837 of the Social Security Act (42 U.S.C. 14 1395p) is amended by adding at the end the 15 following new subsection: 16 ‘‘(o) SPECIAL ENROLLMENT PERIOD FOR MEDICARE 17 COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 18 ‘‘(1) IN GENERAL.—Effective beginning Janu- 19 ary 1, 2023, the Secretary shall establish special en- 20 rollment periods for Medicare Cost Assistance Pro- 21 gram eligible individuals (as defined in section 22 1899B(b)(1)). 23 ‘‘(2) COVERAGE PERIOD.—In the case of an in- 24 dividual who enrolls during the special enrollment 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 327 •HR 7585 IH period provided under paragraph (1), the coverage 1 period under this part shall— 2 ‘‘(A) begin on the first day of the first 3 month in which the individual applies for a de- 4 termination under section 1899B(b)(2)(A); and 5 ‘‘(B) remain in effect until such time as 6 the Secretary determines the individual no 7 longer eligible as determined under section 8 1899B(b)(2)(C)(ii).’’. 9 (C) CONFORMING SUNSET OF STATE 10 AGREEMENTS RELATING TO ENROLLMENT OF 11 QUALIFIED MEDICARE BENEFICIARIES.— 12 (i) PART A.—Section 1818(g) of the 13 Social Security Act (42 U.S.C. 1395i–2(g)) 14 is amended by adding at the end the fol- 15 lowing new paragraph: 16 ‘‘(3) SUNSET.—This subsection shall not apply on or 17 after January 1, 2023.’’. 18 (ii) PART B.—Section 1843(h) of the 19 Social Security Act (42 U.S.C. 1395v(h)) 20 is amended by adding at the end the fol- 21 lowing new paragraph: 22 ‘‘(3) SUNSET WITH RESPECT TO QUALIFIED MEDI- 23 CARE BENEFICIARIES.—This subsection shall not apply 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 328 •HR 7585 IH with respect to qualified medicare beneficiaries on or after 1 January 1, 2023.’’. 2 (3) PUBLIC AWARENESS CAMPAIGN.—Section 3 1144 of the Social Security Act (42 U.S.C. 1320b– 4 14) is amended by adding at the end the following 5 new subsection: 6 ‘‘(d) PUBLIC AWARENESS CAMPAIGN.— 7 ‘‘(1) IN GENERAL.—The Commissioner shall 8 conduct a public awareness campaign to educate 9 Medicare beneficiaries on the availability of Medicare 10 cost assistance for low-income individuals under sec- 11 tion 1899B. 12 ‘‘(2) COORDINATION.—In carrying out such 13 public awareness campaign, the Commissioner shall 14 coordinate with State health insurance assistance 15 programs described in subsection (a)(1)(A) of sec- 16 tion 119 of the Medicare Improvements for Patients 17 and Providers Act of 2008 (42 U.S.C. 1395b–3 18 note)), the Administrator of the Administration for 19 Community Living, and the Administrator of the 20 Centers for Medicare & Medicaid Services. 21 ‘‘(3) FUNDING.—There are hereby appropriated 22 to the Commissioner, out of any funds in the Treas- 23 ury not otherwise appropriated, $10,000,000 for 24 each of fiscal years 2023 through 2025, to provide 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 329 •HR 7585 IH grants to State health insurance assistance pro- 1 grams to carry out outreach and education activities 2 under the public awareness campaign pursuant to 3 this subsection.’’. 4 (b) MOVING MEDICARE COST-SHARING BENEFITS 5 FROM MEDICAID TO MEDICARE.— 6 (1) ENDING MOST MEDICARE COST-SHARING 7 BENEFITS UNDER MEDICAID.—Section 1902(a)(10) 8 of the Social Security Act (42 U.S.C. 1396a(a)(10)) 9 is amended— 10 (A) by inserting ‘‘for calendar quarters be- 11 ginning before January 1, 2023,’’ before ‘‘for 12 making’’ each place it appears in clauses (i), 13 (iii), and (iv) of subparagraph (E); and 14 (B) in the matter following subparagraph 15 (G)— 16 (i) by inserting ‘‘furnished during cal- 17 endar quarters beginning before January 18 1, 2023’’ after ‘‘(described in section 19 1905(p)(3))’’; 20 (ii) by striking ‘‘(XV)’’ and inserting 21 ‘‘, (XV)’’; 22 (iii) by striking ‘‘and (XVIII)’’ and in- 23 serting ‘‘, (XVIII)’’; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 330 •HR 7585 IH (iv) by inserting ‘‘, and (XIX) no 1 medical assistance for medicare cost-shar- 2 ing, other than medical assistance for 3 medicare cost-sharing for qualified disabled 4 and working individuals described in sec- 5 tion 1905(s), shall be made available after 6 January 1, 2023’’ before the semicolon at 7 the end. 8 (2) CONFORMING AMENDMENTS.— 9 (A) TITLE XIX.— 10 (i) Section 1903(i) of such Act (42 11 U.S.C. 1396b(i)) is amended— 12 (I) in paragraph (26), by striking 13 ‘‘; and’’ and inserting a semicolon; 14 (II) in paragraph (27), by strik- 15 ing the period at the end and insert- 16 ing ‘‘; and’’; and 17 (III) by inserting after paragraph 18 (27) the following new paragraph: 19 ‘‘(28) with respect to any amount expended for 20 medical assistance for medicare cost-sharing (other 21 than medical assistance for medicare cost-sharing 22 for qualified disabled and working individuals de- 23 scribed in section 1905(s)) furnished during cal- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 331 •HR 7585 IH endar quarters beginning on or after January 1, 1 2023.’’. 2 (ii) Section 1905(a) of such Act (42 3 U.S.C. 1396d(a)) is amended, in the first 4 sentence, by inserting ‘‘furnished during 5 calendar quarters beginning before Janu- 6 ary 1, 2023’’ after ‘‘medicare cost-shar- 7 ing’’. 8 (iii) Section 1933(g) of such Act (42 9 U.S.C. 1396u–3(g)) is amended— 10 (I) in paragraph (2)(Q), by strik- 11 ing ‘‘paragraph (4), for each subse- 12 quent year’’ and inserting ‘‘para- 13 graphs (4) and (5), for each subse- 14 quent year before 2023’’; and 15 (II) by adding at the end the fol- 16 lowing: 17 ‘‘(5) SUNSET.—No individual shall be selected 18 to be a qualifying individual for any calendar year 19 or period under this section beginning on or after 20 January 1, 2023, and no State allocation shall be 21 made for any fiscal year or period under this section 22 beginning on or after January 1, 2023.’’. 23 (iv) Section 1935(a) of such Act (42 24 U.S.C. 1396u–5(a)) is amended— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 332 •HR 7585 IH (I) in paragraph (2), by striking 1 ‘‘make determinations’’ and inserting 2 ‘‘prior to January 1, 2023, make de- 3 terminations’’; and 4 (II) in paragraph (3), by insert- 5 ing ‘‘prior to January 1, 2023,’’ be- 6 fore ‘‘the State shall’’. 7 (B) TITLE XI.—Section 1144 of the Social 8 Security Act (42 U.S.C. 1320b–14) is amend- 9 ed— 10 (i) in subsection (a)— 11 (I) in paragraph (1)(A)— 12 (aa) by striking ‘‘sections 13 1902(a)(10)(E) and 1933’’ and 14 inserting ‘‘section 15 1902(a)(10)(E) and (prior to 16 January 1, 2023) section 1933’’; 17 (bb) by striking ‘‘for the 18 transitional assistance under sec- 19 tion 1860D–31(f), or’’ and in- 20 serting a comma; and 21 (cc) by inserting ‘‘, or for 22 Medicare premium and cost-shar- 23 ing assistance under section 24 1899B (in the case of months be- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 333 •HR 7585 IH ginning on or after January 1, 1 2023)’’ before the semicolon; and 2 (II) by striking paragraph (2) 3 and inserting the following: 4 ‘‘(2) CONTENT OF NOTICE.—Any notice fur- 5 nished under paragraph (1) shall state that eligi- 6 bility for such medical assistance, subsidies, or pro- 7 gram is conditioned upon meeting the applicable eli- 8 gibility criteria.’’; 9 (ii) in subsection (b)(1)(A)— 10 (I) by striking ‘‘sections 11 1902(a)(10)(E) and 1933’’ and in- 12 serting ‘‘section 1902(a)(10)(E) and 13 (prior to January 1, 2023) section 14 1933’’; 15 (II) by striking ‘‘for transitional 16 assistance under section 1860D–31(f), 17 or’’; and 18 (III) by inserting ‘‘, or for Medi- 19 care premium and cost-sharing assist- 20 ance under section 1899B’’ before the 21 semicolon; and 22 (iii) in subsection (c)— 23 (I) in paragraph (1)(B), by in- 24 serting ‘‘, and (beginning January 1, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 334 •HR 7585 IH 2023), provide an application for en- 1 rollment under the Medicare Savings 2 Program’’ before the period; 3 (II) in paragraph (2), in the 4 paragraph header, by inserting 5 ‘‘MEDICARE SAVINGS PROGRAM APPLI- 6 CATION AND’’ before ‘‘LIS APPLICA- 7 TION’’; and 8 (III) in paragraph (7), by strik- 9 ing ‘‘means the program of medical 10 assistance’’ and all that follows 11 through the period and inserting 12 ‘‘means— 13 ‘‘(A) prior to January 1, 2023, the pro- 14 gram of medical assistance for payment of the 15 cost of medicare cost-sharing under the Med- 16 icaid program pursuant to sections 17 1902(a)(10)(E) and 1933; and 18 ‘‘(B) beginning January 1, 2023, the pro- 19 gram for medical assistance for payment of the 20 cost of medicare cost-sharing for qualified dis- 21 abled and working individuals described in sec- 22 tion 1905(s) pursuant to section 23 1902(a)(10)(E)(ii) and medicare premium and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 335 •HR 7585 IH cost-sharing assistance provided under section 1 1899B.’’. 2 (3) ENSURING THAT MEDICARE COST-SHARING 3 BENEFICIARIES UNDER MEDICAID RECEIVE MEDI- 4 CARE COST ASSISTANCE.—Not later than June 1, 5 2022, the Secretary of Health and Human Services 6 and the Commissioner of Social Security shall jointly 7 develop and implement a transition plan to ensure 8 that all individuals who are eligible for and are re- 9 ceiving medical assistance for the payment of medi- 10 care cost-sharing under a State Medicaid program 11 pursuant to clauses (i), (iii), and (iv) of section 12 1902(a)(10)(E) of the Social Security Act (42 13 U.S.C. 1396a(a)(10)(E)) as of December 31, 2022, 14 receive Medicare cost assistance under section 15 1899B of such Act, as added by subsection (a), as 16 of January 1, 2023. 17 (c) ENHANCING PRESCRIPTION DRUG AFFORD- 18 ABILITY BY EXPANDING ACCESS TO ASSISTANCE WITH 19 OUT-OF-POCKET COSTS UNDER MEDICARE PART D FOR 20 LOW-INCOME SENIORS AND INDIVIDUALS WITH DISABIL- 21 ITIES.— 22 (1) EXPANDING ACCESS.—Section 1860D–14 of 23 the Social Security Act (42 U.S.C. 1395w–114) is 24 amended— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 336 •HR 7585 IH (A) in subsection (a)— 1 (i) in the heading, by striking ‘‘150 2 PERCENT’’ and inserting ‘‘200 PERCENT’’; 3 (ii) in paragraph (1)— 4 (I) in the heading, by striking 5 ‘‘135 PERCENT’’ and inserting ‘‘200 6 PERCENT’’; and 7 (II) in the matter preceding sub- 8 paragraph (A)— 9 (aa) by striking ‘‘135 per- 10 cent’’ and inserting ‘‘200 per- 11 cent’’; and 12 (bb) by striking ‘‘and who 13 meets the resources requirement 14 described in paragraph (3)(D) or 15 who is covered under this para- 16 graph under paragraph 17 (3)(B)(i)’’ and inserting ‘‘or who 18 is covered under this paragraph 19 under paragraph (3)(B)(v)’’; 20 (iii) by striking paragraph (2); 21 (iv) in paragraph (3)— 22 (I) in subparagraph (A)— 23 (aa) in clause (i), by adding 24 ‘‘and’’ at the end; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 337 •HR 7585 IH (bb) in clause (ii)— 1 (AA) by striking ‘‘150 2 percent’’ and inserting ‘‘200 3 percent’’; and 4 (BB) by striking ‘‘; 5 and’’ at the end and insert- 6 ing a period; and 7 (cc) by striking clause (iii); 8 (II) by striking subparagraphs 9 (B) and (C) and inserting the fol- 10 lowing: 11 ‘‘(B) DETERMINATIONS.—For provisions 12 relating to joint determinations with respect to 13 eligibility for Medicare cost assistance under 14 section 1899B and premium and cost-sharing 15 subsidies under this section, see section 16 1899B(b)(2). 17 ‘‘(C) INCOME DETERMINATIONS.—For pur- 18 poses of applying this section— 19 ‘‘(i) in the case of an individual who 20 is not treated as a Medicare cost-sharing 21 assistance eligible individual and a subsidy 22 eligible individual under section 23 1899B(b)(2)(D), income shall be deter- 24 mined in the manner described under sec- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 338 •HR 7585 IH tion 1612 for purposes of the supplemental 1 security income program, except that sup- 2 port and maintenance furnished in kind 3 shall not be counted as income; and 4 ‘‘(ii) the term ‘poverty line’ has the 5 meaning given such term in section 673(2) 6 of the Community Services Block Grant 7 Act (42 U.S.C. 9902(2)), including any re- 8 vision required by such section.’’; and 9 (III) by striking subparagraphs 10 (D), (E), and (G); and 11 (v) in paragraph (4), by striking sub- 12 paragraph (B); and 13 (B) in subsection (c)(1), in the second sen- 14 tence, by striking ‘‘subsections (a)(1)(D) and 15 (a)(2)(E)’’ and inserting ‘‘subsection 16 (a)(1)(D)’’. 17 (2) TREATMENT OF REDUCTION OF COST-SHAR- 18 ING FOR INDIVIDUALS RECEIVING HOME AND COM- 19 MUNITY BASED SERVICES.—Section 1860D– 20 14(a)(1)(D) of the Social Security Act (42 U.S.C. 21 1395w–114(a)(1)(D)) is amended— 22 (A) by striking ‘‘who would be such an in- 23 stitutionalized individual or couple, if the full- 24 benefit dual eligible individual were not’’; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 339 •HR 7585 IH (B) by striking ‘‘or subsection (c) or (d) of 1 section 1915 or under a State plan amendment 2 under subsection (i) of such section’’ and in- 3 serting ‘‘, section 1115A, section 1915, or 4 under a State plan amendment’’. 5 (3) EFFECTIVE DATE.—The amendments made 6 by this subsection shall apply to plan year 2023 and 7 subsequent plan years. 8 SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME 9 AND RESOURCE ELIGIBILITY TESTS, SIMPLI- 10 FYING ENROLLMENT, AND OTHER PROGRAM 11 IMPROVEMENTS FOR LOW-INCOME BENE- 12 FICIARIES. 13 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER- 14 CENT OF FPL FOR QUALIFIED MEDICARE BENE- 15 FICIARIES.— 16 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 17 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 18 amended by striking ‘‘shall be at least the percent 19 provided under subparagraph (B) (but not more 20 than 100 percent) of the official poverty line’’ and 21 all that follows through the period at the end and 22 inserting the following: ‘‘shall be— 23 ‘‘(i) before January 1, 2023, at least 24 the percent provided under subparagraph 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 340 •HR 7585 IH (B) (but not more than 100 percent) of 1 the official poverty line (as defined by the 2 Office of Management and Budget, and re- 3 vised annually in accordance with section 4 673(2) of the Omnibus Budget Reconcili- 5 ation Act of 1981) applicable to a family 6 of the size involved; and 7 ‘‘(ii) on or after January 1, 2023, 8 equal to 135 percent of the official poverty 9 line (as so defined and revised) applicable 10 to a family of the size involved.’’. 11 (2) NOT COUNTING IN-KIND SUPPORT AND 12 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 13 of the Social Security Act (42 U.S.C. 14 1396d(p)(2)(D)) is amended by adding at the end 15 the following new clause: 16 ‘‘(iii) In determining income under this sub- 17 section, support and maintenance furnished in kind 18 shall not be counted as income.’’. 19 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER- 20 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE 21 BENEFICIARIES.— 22 (1) ELIGIBILITY OF INDIVIDUALS WITH IN- 23 COMES BELOW 150 PERCENT OF FPL.—Section 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 341 •HR 7585 IH 1902(a)(10)(E) of the Social Security Act (42 1 U.S.C. 1396a(a)(10)(E)) is amended— 2 (A) by adding ‘‘and’’ at the end of clause 3 (ii); 4 (B) in clause (iii)— 5 (i) by striking ‘‘and 120 percent in 6 1995 and years thereafter’’ and inserting 7 ‘‘120 percent in 1995 and years thereafter 8 before 2023, and 200 percent in 2023 and 9 years thereafter’’; and 10 (ii) by striking ‘‘and’’ at the end; and 11 (C) by striking clause (iv). 12 (2) REFERENCES.—Section 1905(p)(1) of the 13 Social Security Act (42 U.S.C. 1396d(p)(1)) is 14 amended by adding at and below subparagraph (C) 15 the following flush sentence: 16 ‘‘The term ‘specified low-income medicare beneficiary’ 17 means an individual described in section 18 1902(a)(10)(E)(iii).’’. 19 (3) CONFORMING AMENDMENTS.— 20 (A) The first sentence of section 1905(b) 21 of such Act (42 U.S.C. 1396d(b)) is amended 22 by striking ‘‘and section 1933(d)’’. 23 (B) Section 1933 of such Act (42 U.S.C. 24 1396u–3) is repealed. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 342 •HR 7585 IH (c) 100 PERCENT FMAP.—Section 1905 of the So- 1 cial Security Act (42 U.S.C. 1396d) is amended by adding 2 at the end the following new subsection: 3 ‘‘(jj) INCREASED FMAP FOR EXPANDED MEDICARE 4 COST-SHARING POPULATIONS.— 5 ‘‘(1) IN GENERAL.—Notwithstanding subsection 6 (b), with respect to expenditures described in para- 7 graph (2) the Federal medical assistance percentage 8 shall be equal to 100 percent. 9 ‘‘(2) EXPENDITURES DESCRIBED.—The expend- 10 itures described in this paragraph are expenditures 11 made on or after January 1, 2023, for medical as- 12 sistance for medicare cost-sharing provided to any 13 individual under clause (i), (ii), or (iii) of section 14 1902(a)(10)(E) who would not have been eligible for 15 medicare cost-sharing under any such clause under 16 the income or resource eligibility standards in effect 17 on October 1, 2018.’’. 18 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE- 19 SOURCE ELIGIBILITY TESTS.— 20 (1) IN GENERAL.—Section 1860D–14(a)(3) of 21 the Social Security Act (42 U.S.C. 1395w– 22 114(a)(3)) is amended— 23 (A) by striking subparagraph (D); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 343 •HR 7585 IH (B) by redesignating subparagraphs (E) 1 through (G) as subparagraphs (D) through (F), 2 respectively; and 3 (C) in the heading of subparagraph (D), as 4 so redesignated, by striking ‘‘ALTERNATIVE’’. 5 (2) CLARIFICATION OF CERTAIN RULES RELAT- 6 ING TO INCOME AND RESOURCE DETERMINA- 7 TIONS.—Section 1860D–14(a)(3) of the Social Secu- 8 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 9 by paragraph (1), is amended by striking subpara- 10 graph (F) and inserting the following new subpara- 11 graphs: 12 ‘‘(F) RESOURCE EXCLUSIONS.—In deter- 13 mining the resources of an individual (and the 14 eligible spouse of the individual, if any) under 15 section 1613 for purposes of subparagraph 16 (D)— 17 ‘‘(i) no part of the value of any life in- 18 surance policy shall be taken into account; 19 ‘‘(ii) no part of the value of any vehi- 20 cle shall be taken into account; 21 ‘‘(iii) there shall be excluded an 22 amount equal to $1,500 each with respect 23 to any individual or eligible spouse of an 24 individual who attests that some of the re- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 344 •HR 7585 IH sources of such individual or spouse will be 1 used to meet the burial and related ex- 2 penses of such individual or spouse; and 3 ‘‘(iv) no balance in, or benefits re- 4 ceived under, an employee pension benefit 5 plan (as defined in section 3 of the Em- 6 ployee Retirement Income Security Act of 7 1974) shall be taken into account. 8 ‘‘(G) FAMILY SIZE.—In determining the 9 size of the family of an individual for purposes 10 of determining the income eligibility of such in- 11 dividual under this section, an individual’s fam- 12 ily shall consist of— 13 ‘‘(i) the individual; 14 ‘‘(ii) the individual’s spouse who lives 15 in the same household as the individual (if 16 any); and 17 ‘‘(iii) any other individuals who— 18 ‘‘(I) are related to the individual 19 whose income eligibility is in question 20 or such individual’s spouse who lives 21 in the same household; 22 ‘‘(II) are living in the same 23 household as such individual; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 345 •HR 7585 IH ‘‘(III) are dependent on such in- 1 dividual or such individual’s spouse 2 who is living in the same household 3 for at least one-half of their financial 4 support.’’. 5 (3) CONFORMING AMENDMENTS.—Section 6 1860D–14(a) of the Social Security Act (42 U.S.C. 7 1395w–114(a)) is amended— 8 (A) in paragraph (1), in the matter pre- 9 ceding subparagraph (A), by inserting ‘‘(as de- 10 termined under paragraph (3)(G))’’ after ‘‘fam- 11 ily of the size involved’’; and 12 (B) in paragraph (3), as amended by para- 13 graphs (1) and (2)— 14 (i) in subparagraph (A), in the matter 15 preceding clause (i), by striking ‘‘subpara- 16 graph (F)’’ and inserting ‘‘subparagraph 17 (E)’’; 18 (ii) in subparagraph (A)(ii), by insert- 19 ing ‘‘(as determined under subparagraph 20 (G))’’ after ‘‘family of the size involved’’; 21 (iii) in subparagraph (A)(iii), by strik- 22 ing ‘‘or (E)’’; 23 (iv) in subparagraph (B)(v), in the 24 matter preceding subclause (I), by striking 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 346 •HR 7585 IH ‘‘subparagraph (F)’’ and inserting ‘‘sub- 1 paragraph (E)’’; and 2 (v) in subparagraph (D)(i), in the 3 matter preceding subclause (I), by striking 4 ‘‘subject to the life insurance policy exclu- 5 sion provided under subparagraph (G)’’ 6 and inserting ‘‘subject to the resource ex- 7 clusions provided under subparagraph 8 (F)’’. 9 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND 10 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE 11 ELIGIBILITY TESTS.— 12 (1) APPLICATION OF MEDICAID SPOUSAL IM- 13 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND 14 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 15 of the Social Security Act (42 U.S.C. 16 1396d(p)(1)(C)) is amended to read as follows: 17 ‘‘(C) whose resources (as determined under sec- 18 tion 1613 for purposes of the supplemental security 19 income program subject to the resource exclusions 20 under subparagraph (G) of section 1860D–14(a)(3)) 21 do not exceed— 22 ‘‘(i) in the case of an individual with a 23 spouse, an amount equal to the sum of the first 24 amount specified in subsection (f)(2)(A)(i) of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 347 •HR 7585 IH section 1924 (as adjusted under subsection (g) 1 of such section) and the amount specified in 2 subsection (f)(2)(A)(ii)(II) of such section (as 3 so adjusted); or 4 ‘‘(ii) in the case of an individual who does 5 not have a spouse, an amount equal to 1⁄2 of 6 the amount described in clause (i).’’. 7 (2) APPLICATION TO QDWIS.—Section 8 1905(s)(3) of the Social Security Act (42 U.S.C. 9 1396d(s)(3)) is amended to read as follows: 10 ‘‘(3) whose resources (as determined under sec- 11 tion 1613 for purposes of the supplemental security 12 income program subject to the resource exclusions 13 under subparagraph (G) of section 1860D–14(a)(3)) 14 do not exceed— 15 ‘‘(A) in the case of an individual with a 16 spouse, the amount in effect for the year under 17 clause (i) of subsection (p)(1)(C); and 18 ‘‘(B) in the case of an individual who does 19 not have a spouse, the amount in effect for the 20 year under clause (ii) of subsection (p)(1)(C); 21 and’’. 22 (3) APPLICATION TO LIS.—Clause (i) of section 23 1860D–14(a)(3)(D) of the Social Security Act (42 24 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 348 •HR 7585 IH amended by subsection (d)(1), is amended to read as 1 follows: 2 ‘‘(i) IN GENERAL.—The resources re- 3 quirement of this subparagraph is that an 4 individual’s resources (as determined under 5 section 1613 for purposes of the supple- 6 mental security income program subject to 7 the resource exclusions provided under 8 subparagraph (G)) do not exceed the 9 amount in effect for the year under section 10 1905(p)(1)(C)(ii).’’. 11 (f) ENROLLMENT SIMPLIFICATIONS.— 12 (1) APPLICATION OF 3-MONTH RETROACTIVE 13 ELIGIBILITY TO QMBS.— 14 (A) IN GENERAL.—Section 1902(e)(8) of 15 the Social Security Act (42 U.S.C. 1396a(e)(8)) 16 is amended by striking ‘‘after the end of the 17 month in which the determination first occurs’’ 18 and inserting ‘‘in or after the third month be- 19 fore the month in which the individual makes 20 application for assistance’’. 21 (B) PROCESS FOR SUBMITTING CLAIMS 22 DURING RETROACTIVE ELIGIBILITY PERIOD.— 23 Section 1902(e)(8) of the Social Security Act 24 (42 U.S.C. 1396a(e)(8)) is further amended by 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 349 •HR 7585 IH adding at the end the following: ‘‘The Secretary 1 shall provide for a process under which claims 2 for medical assistance under the State plan may 3 be submitted for services furnished to such an 4 individual during such 3-month period before 5 the month in which the individual made appli- 6 cation for assistance.’’. 7 (C) CONFORMING AMENDMENT.—Section 8 1905(a) of the Social Security Act (42 U.S.C. 9 1396d(a)) is amended, in the matter preceding 10 paragraph (1), by striking ‘‘or, in the case of 11 medicare cost-sharing with respect to a quali- 12 fied medicare beneficiary described in sub- 13 section (p)(1), if provided after the month in 14 which the individual becomes such a bene- 15 ficiary’’. 16 (2) STATE OPTION FOR 12-MONTH CONTINUOUS 17 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 18 1902(e)(12) of the Social Security Act (42 U.S.C. 19 1396a(e)(12)) is amended— 20 (A) by redesignating subparagraphs (A) 21 and (B) as clauses (i) and (ii), respectively; 22 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 23 (C) by adding at the end the following: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 350 •HR 7585 IH ‘‘(B) At the option of the State, the plan may provide 1 that an individual who is determined to be eligible for ben- 2 efits under a State plan approved under this title under 3 any of the following eligibility categories, or who is rede- 4 termined to be eligible for such benefits under any of such 5 categories, shall be considered to meet the eligibility re- 6 quirements met on the date of application and shall re- 7 main eligible for those benefits until the end of the 12- 8 month period following the date of the determination or 9 redetermination of eligibility, except that a State may pro- 10 vide for such determinations more frequently, but not 11 more frequently than once every 6 months for an indi- 12 vidual: 13 ‘‘(i) A specified low-income medicare beneficiary 14 described in subsection (a)(10)(E)(iii) of this section 15 who is determined eligible for medicare cost sharing 16 described in section 1905(p)(3)(A)(ii). 17 ‘‘(ii) A qualified disabled and working indi- 18 vidual described in section 1905(s) who is deter- 19 mined eligible for medicare cost-sharing described in 20 section 1905(p)(3)(A)(i).’’. 21 (3) STATE OPTION TO USE EXPRESS LANE ELI- 22 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 23 Section 1902(e)(13)(A) of the Social Security Act 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 351 •HR 7585 IH (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 1 at the end the following new clause: 2 ‘‘(iii) STATE OPTION TO EXTEND EXPRESS 3 LANE ELIGIBILITY TO OTHER POPULATIONS.— 4 ‘‘(I) IN GENERAL.—At the option of 5 the State, the State may apply the provi- 6 sions of this paragraph with respect to de- 7 termining eligibility under this title for an 8 eligible individual (as defined in subclause 9 (II)). In applying this paragraph in the 10 case of a State making such an option, any 11 reference in this paragraph to a child with 12 respect to this title (other than a reference 13 to child health assistance) shall be deemed 14 to be a reference to an eligible individual. 15 ‘‘(II) ELIGIBLE INDIVIDUAL DE- 16 FINED.—In this clause, the term ‘eligible 17 individual’ means any of the following: 18 ‘‘(aa) A qualified medicare bene- 19 ficiary described in section 1905(p)(1) 20 for purposes of determining eligibility 21 for medicare cost-sharing (as defined 22 in section 1905(p)(3)). 23 ‘‘(bb) A specified low-income 24 medicare beneficiary described in sub- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 352 •HR 7585 IH section (a)(10)(E)(iii) of this section 1 for purposes of determining eligibility 2 for medicare cost-sharing described in 3 section 1905(p)(3)(A)(ii). 4 ‘‘(cc) A qualified disabled and 5 working individual described in sec- 6 tion 1905(s) for purposes of deter- 7 mining eligibility for medicare cost- 8 sharing described in section 9 1905(p)(3)(A)(i).’’. 10 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE 11 PROVIDERS.—Section 1902(n) of the Social Security Act 12 (42 U.S.C. 1396a(n)) is amended by adding at the end 13 the following new paragraph: 14 ‘‘(4) A State plan shall not deny a claim from a pro- 15 vider or supplier with respect to medicare cost-sharing de- 16 scribed in subparagraph (B), (C), or (D) of section 17 1905(p)(3) for an item or service which is eligible for pay- 18 ment under title XVIII on the basis that the provider or 19 supplier does not have a provider agreement in effect 20 under this title or does not otherwise serve all individuals 21 entitled to medical assistance under this title. The State 22 shall create a mechanism through which provider or sup- 23 pliers that do not otherwise have provider agreements with 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 353 •HR 7585 IH the State can bill the State for medicare cost-sharing for 1 qualified medicare beneficiaries.’’. 2 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 3 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 4 is amended by adding at the end the following new para- 5 graph: 6 ‘‘(7) Notwithstanding any other provision of law, any 7 medical assistance for some or all medicare cost-sharing 8 under this title shall not be considered income or resources 9 in determining eligibility for, or the amount of assistance 10 or benefits provided under, any other public benefit pro- 11 vided under Federal law or the law of any State or polit- 12 ical subdivision thereof.’’. 13 (i) TREATMENT OF QUALIFIED MEDICARE BENE- 14 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE- 15 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE 16 BENEFICIARIES.—Section 1862 of the Social Security Act 17 (42 U.S.C. 1395y) is amended by adding at the end the 18 following new subsection: 19 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE- 20 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE 21 BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI- 22 BLES.—Nothing in this title shall be construed as author- 23 izing a provider of services or supplier to discriminate 24 (through a private contractual arrangement or otherwise) 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 354 •HR 7585 IH against an individual who is otherwise entitled to services 1 under this title on the basis that the individual is a quali- 2 fied medicare beneficiary (as defined in section 3 1905(p)(1)), a specified low-income medicare beneficiary, 4 or is otherwise eligible for medical assistance for medicare 5 cost-sharing or other benefits under title XIX.’’. 6 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN- 7 SURANCE ASSISTANCE PROGRAMS.— 8 (1) GRANTS.— 9 (A) IN GENERAL.—The Secretary of 10 Health and Human Services (in this subsection 11 referred to as the ‘‘Secretary’’) shall use 12 amounts made available under subparagraph 13 (B) to make grants to States for State health 14 insurance assistance programs receiving assist- 15 ance under section 4360 of the Omnibus Budg- 16 et Reconciliation Act of 1990. 17 (B) FUNDING.—For purposes of making 18 grants under this subsection, the Secretary 19 shall provide for the transfer, from the Federal 20 Hospital Insurance Trust Fund under section 21 1817 of the Social Security Act (42 U.S.C. 22 1395i) and the Federal Supplementary Medical 23 Insurance Trust Fund under section 1841 of 24 such Act (42 U.S.C. 1395t), in the same pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 355 •HR 7585 IH portion as the Secretary determines under sec- 1 tion 1853(f) of such Act (42 U.S.C. 1395w– 2 23(f)), of $50,000,000 to the Centers for Medi- 3 care & Medicaid Services Program Management 4 Account for each of the fiscal years 2024 5 through 2028, to remain available until ex- 6 pended. 7 (2) AMOUNT OF GRANTS.—The amount of a 8 grant to a State under this subsection from the total 9 amount made available under paragraph (1) shall be 10 equal to the sum of the amount allocated to the 11 State under paragraph (3)(A) and the amount allo- 12 cated to the State under subparagraph (3)(B). 13 (3) ALLOCATION TO STATES.— 14 (A) ALLOCATION BASED ON PERCENTAGE 15 OF LOW-INCOME BENEFICIARIES.—The amount 16 allocated to a State under this subparagraph 17 from 2⁄3 of the total amount made available 18 under paragraph (1) shall be based on the num- 19 ber of individuals who meet the requirement 20 under subsection (a)(3)(A)(ii) of section 21 1860D–14 of the Social Security Act (42 22 U.S.C. 1395w–114) but who have not enrolled 23 to receive a subsidy under such section 1860D– 24 14 relative to the total number of individuals 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 356 •HR 7585 IH who meet the requirement under such sub- 1 section (a)(3)(A)(ii) in each State, as estimated 2 by the Secretary. 3 (B) ALLOCATION BASED ON PERCENTAGE 4 OF RURAL BENEFICIARIES.—The amount allo- 5 cated to a State under this subparagraph from 6 1⁄3 of the total amount made available under 7 paragraph (1) shall be based on the number of 8 part D eligible individuals (as defined in section 9 1860D–1(a)(3)(A) of such Act (42 U.S.C. 10 1395w–101(a)(3)(A))) residing in a rural area 11 relative to the total number of such individuals 12 in each State, as estimated by the Secretary. 13 (4) PORTION OF GRANT BASED ON PERCENT- 14 AGE OF LOW-INCOME BENEFICIARIES TO BE USED 15 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY 16 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE 17 FOR THE MEDICARE SAVINGS PROGRAM.—Each 18 grant awarded under this subsection with respect to 19 amounts allocated under paragraph (3)(A) shall be 20 used to provide outreach to individuals who may be 21 subsidy eligible individuals (as defined in section 22 1860D–14(a)(3)(A) of the Social Security Act (42 23 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro- 24 gram of medical assistance for payment of the cost 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 357 •HR 7585 IH of medicare cost-sharing under the Medicaid pro- 1 gram pursuant to sections 1902(a)(10)(E) and 1933 2 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 3 (k) EFFECTIVE DATE.— 4 (1) IN GENERAL.—Except as provided in para- 5 graph (2), the amendments and repeal made by this 6 section take effect on January 1, 2023, and, with re- 7 spect to title XIX of the Social Security Act, apply 8 to calendar quarters beginning on or after January 9 1, 2023. 10 (2) EXCEPTION FOR STATE LEGISLATION.—In 11 the case of a State plan for medical assistance under 12 title XIX of the Social Security Act which the Sec- 13 retary of Health and Human Services determines re- 14 quires State legislation (other than legislation appro- 15 priating funds) in order for the plan to meet the ad- 16 ditional requirements imposed by the amendments 17 and repeal made by this section, the State plan shall 18 not be regarded as failing to comply with the re- 19 quirements 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 358 •HR 7585 IH sentence, in the case of a State that has a 2-year 1 legislative session, each year of such session shall be 2 deemed to be a separate regular session of the State 3 legislature. 4 SEC. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 5 PROVIDED BY URBAN INDIAN ORGANIZA- 6 TIONS. 7 (a) IN GENERAL.—The third sentence of section 8 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 9 is amended by inserting ‘‘or are received through a pro- 10 gram operated by an urban Indian organization through 11 a grant or contract under title V of the Indian Health 12 Care Improvement Act’’ after ‘‘(as defined in section 4 13 of the Indian Health Care Improvement Act)’’. 14 (b) EFFECTIVE DATE.—The amendment made by 15 this section shall apply to medical assistance provided on 16 or after the date of enactment of this Act. 17 SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 18 PROVIDED TO A NATIVE HAWAIIAN THROUGH 19 A FEDERALLY QUALIFIED HEALTH CENTER 20 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 21 TEM UNDER THE MEDICAID PROGRAM. 22 (a) IN GENERAL.—The third sentence of section 23 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 24 is amended by striking ‘‘, for such 8 fiscal year quarters’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 359 •HR 7585 IH (b) EFFECTIVE DATE.—The amendment made by 1 this section shall apply to medical assistance provided on 2 or after the date of enactment of this Act. 3 SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOV- 4 ERY UNDER THE MEDICAID PROGRAM. 5 Section 1917 of the Social Security Act (42 U.S.C. 6 1396p) is amended— 7 (1) in subsection (a)— 8 (A) by amending paragraph (1) to read as 9 follows: 10 ‘‘(1) No lien may be imposed against the prop- 11 erty of any individual prior to his death on account 12 of medical assistance paid or to be paid on his behalf 13 under the State plan, except pursuant to the judg- 14 ment of a court on account of benefits incorrectly 15 paid on behalf of such individual.’’; 16 (B) by striking paragraph (2); 17 (C) in paragraph (3), by striking ‘‘(1)(B)’’ 18 and inserting ‘‘(1)’’; and 19 (D) by redesignating paragraph (3) as 20 paragraph (2); and 21 (2) by amending subsection (b) to read as fol- 22 lows: 23 ‘‘(b) ADJUSTMENT OR RECOVERY OF MEDICAL AS- 24 SISTANCE CORRECTLY PAID UNDER A STATE PLAN.—No 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 360 •HR 7585 IH adjustment or recovery of any medical assistance correctly 1 paid on behalf of an individual under the State plan may 2 be made.’’. 3 SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENE- 4 FITS AND PREMIUM LIABILITY FOR INDIVID- 5 UALS WHO ARE INCARCERATED AND PRO- 6 VIDE A SPECIAL ENROLLMENT PERIOD 7 AROUND THE DATE OF RELEASE. 8 (a) SPECIAL ENROLLMENT PERIOD FOR INDIVID- 9 UALS INCARCERATED AT TIME OF MEDICARE ELIGI- 10 BILITY.—Section 1837(i) of the Social Security Act (42 11 U.S.C. 1395p(i)) is amended by adding at the end the fol- 12 lowing new paragraph: 13 ‘‘(5)(A) In the case of an individual who— 14 ‘‘(i) at the time the individual first satis- 15 fies paragraph (1) or (2) of section 1836(a), is 16 incarcerated; or 17 ‘‘(ii) has elected not to enroll (or to be 18 deemed enrolled) under this section during the 19 individual’s initial enrollment period; 20 there shall be a special enrollment period de- 21 scribed in subparagraph (B). 22 ‘‘(B) The special enrollment period re- 23 ferred to in subparagraph (A) is the 6-month 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 361 •HR 7585 IH period on the first day after which the indi- 1 vidual is no longer incarcerated.’’. 2 (b) PREMIUM AMOUNT.—Section 1839(b) of the So- 3 cial Security Act (42 U.S.C. 1395r(b)) is amended— 4 (1) by inserting ‘‘(1)’’ after ‘‘(b)’’; 5 (2) in paragraph (1), as so redesignated by 6 paragraph (1), by striking ‘‘or (l)’’ and inserting 7 ‘‘(l), or (m)’’; and 8 (3) by adding at the end the following new 9 paragraph: 10 ‘‘(2) In the case of an individual whose coverage pe- 11 riod includes months in which by reason of custody under 12 penal authority coverage is excluded pursuant to section 13 1862(a)(3), the premium amount for such months such 14 individual is in custody under penal authority shall be 15 zero.’’. 16 (c) CONFORMING AMENDMENT.—Section 1818(d)(5) 17 of the Social Security Act (42 U.S.C. 1395i–2(d)(5)) is 18 amended by adding at the end the following: 19 ‘‘(D) In the case of an individual who is a 20 person who is excluded from coverage pursuant 21 to section 1862(a)(3) by reason of custody 22 under penal authority, the amount of the 23 monthly premium for such individual shall be 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 362 •HR 7585 IH zero for any month in which such individual is 1 in custody under penal authority.’’. 2 SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 3 (a) COVERAGE OF PREGNANCY.—The Director of the 4 Office of Personnel Management shall issue such regula- 5 tions as are necessary to ensure that pregnancy is consid- 6 ered a change in family status and a qualifying life event 7 for an individual who is eligible to enroll, but is not en- 8 rolled, in a health benefit plan under chapter 89 of title 9 5, United States Code. 10 (b) EFFECTIVE DATE.—The requirement in para- 11 graph (1) shall apply with respect to any contract entered 12 into under section 8902 of such title beginning 12 months 13 after the date of enactment of this Act. 14 SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGI- 15 BILITY STANDARD FOR PREGNANT INDIVID- 16 UALS AND INFANTS. 17 Section 1902(l)(2)(A) of the Social Security Act (42 18 U.S.C. 1396a(l)(2)(A)) is amended— 19 (1) in clause (i), by striking ‘‘and not more 20 than 185 percent’’; 21 (2) in clause (ii)— 22 (A) in subclause (I), by striking ‘‘and’’ 23 after the comma; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 363 •HR 7585 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, 2023, 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, 2023, 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 364 •HR 7585 IH State’s appropriations as of that 1 date.’’. 2 Subtitle C—Expansion of Access 3 PART 1—GENERAL PROVISIONS 4 SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 5 ACT. 6 Title XXXIV of the Public Health Service Act, as 7 amended by titles I, II, and III of this Act, is further 8 amended by inserting after subtitle D the following: 9 ‘‘Subtitle D—Reconstruction and 10 Improvement Grants for Public 11 Health Care Facilities Serving 12 Pacific Islanders and the Insu- 13 lar Areas 14 ‘‘SEC. 3441. GRANT SUPPORT FOR QUALITY IMPROVEMENT 15 INITIATIVES. 16 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 17 with the Administrator of the Health Resources and Serv- 18 ices Administration, the Director of the Agency for 19 Healthcare Research and Quality, and the Administrator 20 of the Centers for Medicare & Medicaid Services, shall 21 award grants to eligible entities for the conduct of dem- 22 onstration projects to improve the quality of and access 23 to health care. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 365 •HR 7585 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, hospice or palliative 4 care provider, or other health entity determined ap- 5 propriate by the Secretary— 6 ‘‘(A) that, by legal mandate or explicitly 7 adopted mission, provides patients with access 8 to services regardless of their ability to pay; 9 ‘‘(B) that provides care or treatment for a 10 substantial number of patients who are unin- 11 sured, are receiving assistance under a State 12 plan under title XIX of the Social Security Act 13 (or under a waiver of such plan), or are mem- 14 bers of vulnerable populations, as determined 15 by the Secretary; and 16 ‘‘(C)(i) with respect to which, not less than 17 50 percent of the entity’s patient population is 18 made up of racial and ethnic minority groups 19 (as defined in section 1707(g)(1)); or 20 ‘‘(ii) that— 21 ‘‘(I) serves a disproportionate percent- 22 age of local patients who are from a racial 23 and ethnic minority group, or has a patient 24 population at least 50 percent of which is 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 366 •HR 7585 IH composed of individuals with limited 1 English proficiency; and 2 ‘‘(II) provides an assurance that 3 amounts received under the grant will be 4 used only to support quality improvement 5 activities in the racial and ethnic minority 6 population served; and 7 ‘‘(2) prepare and submit to the Secretary an 8 application at such time, in such manner, and con- 9 taining such information as the Secretary may re- 10 quire. 11 ‘‘(c) PRIORITY.—In awarding grants under sub- 12 section (a), the Secretary shall give priority to eligible enti- 13 ties that— 14 ‘‘(1) demonstrate an intent to operate as part 15 of a health care partnership, network, collaborative, 16 coalition, or alliance where each member entity con- 17 tributes to the design, implementation, and evalua- 18 tion of the proposed intervention; or 19 ‘‘(2) intend to use funds to carry out system- 20 wide changes with respect to health care quality im- 21 provement, including— 22 ‘‘(A) improved systems for data collection 23 and reporting; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 367 •HR 7585 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; 8 ‘‘(G) comprehensive and patient-centric 9 health care; 10 ‘‘(H) creation and distribution of education 11 materials on available health care options; or 12 ‘‘(I) other activities determined appropriate 13 by the Secretary. 14 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 15 received under a grant under subsection (a) to support 16 the implementation and evaluation of health care quality 17 improvement activities or minority health and health care 18 disparity reduction activities that include— 19 ‘‘(1) with respect to health care systems, activi- 20 ties relating to improving— 21 ‘‘(A) patient safety; 22 ‘‘(B) timeliness of care; 23 ‘‘(C) effectiveness of care; 24 ‘‘(D) efficiency of care; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 368 •HR 7585 IH ‘‘(E) patient centeredness; 1 ‘‘(F) health information technology; 2 ‘‘(G) accessibility and availability of infor- 3 mation on health care; 4 ‘‘(H) comprehensiveness of health care; 5 and 6 ‘‘(I) patient involvement and choice in 7 health care; and 8 ‘‘(2) with respect to patients, activities relating 9 to— 10 ‘‘(A) staying healthy; 11 ‘‘(B) getting well, mentally and physically; 12 ‘‘(C) living effectively with illness or dis- 13 ability; 14 ‘‘(D) preparing for end of life and ensuring 15 that end-of-life care is accessible and available, 16 as well as coping with end-of-life issues; and 17 ‘‘(E) shared decision making. 18 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 19 provide financial and other technical assistance to grant- 20 ees under this section for the development of common data 21 systems. 22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 369 •HR 7585 IH such sums as may be necessary for each of fiscal years 1 2023 through 2030. 2 ‘‘SEC. 3442. CENTERS OF EXCELLENCE. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Administrator of the Health Resources and Services 5 Administration, shall designate centers of excellence at 6 public hospitals, and other health systems serving large 7 numbers of minority patients, that— 8 ‘‘(1) meet the requirements of section 9 3441(b)(1); 10 ‘‘(2) demonstrate excellence in providing care to 11 minority populations; and 12 ‘‘(3) demonstrate excellence in reducing dispari- 13 ties in health and health care. 14 ‘‘(b) REQUIREMENTS.—A hospital or health system 15 that serves as a center of excellence under subsection (a) 16 shall— 17 ‘‘(1) design, implement, and evaluate programs 18 and policies relating to the delivery of care in ra- 19 cially, ethnically, and linguistically diverse popu- 20 lations; 21 ‘‘(2) provide training and technical assistance 22 to other hospitals and health systems relating to the 23 provision of high-quality health care to minority pop- 24 ulations; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 370 •HR 7585 IH ‘‘(3) develop activities for graduate or con- 1 tinuing medical education that institutionalize a 2 focus on cultural competence training for health care 3 providers. 4 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated to carry out this section, 6 such sums as may be necessary for each of fiscal years 7 2023 through 2030. 8 ‘‘SEC. 3443. RECONSTRUCTION AND IMPROVEMENT GRANTS 9 FOR PUBLIC HEALTH CARE FACILITIES SERV- 10 ING PACIFIC ISLANDERS AND THE INSULAR 11 AREAS. 12 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 13 rect financial assistance to designated health care pro- 14 viders and community health centers in American Samoa, 15 Guam, the Commonwealth of the Northern Mariana Is- 16 lands, the United States Virgin Islands, Puerto Rico, and 17 Hawaii for the purposes of reconstructing and improving 18 health care facilities and services in a culturally competent 19 and sustainable manner. 20 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 21 nancial assistance under subsection (a), an entity shall be 22 a public health facility or community health center located 23 in American Samoa, Guam, the Commonwealth of the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 371 •HR 7585 IH Northern Mariana Islands, the United States Virgin Is- 1 lands, Puerto Rico, or Hawaii that— 2 ‘‘(1) is owned or operated by— 3 ‘‘(A) the Government of American Samoa, 4 Guam, the Commonwealth of the Northern 5 Mariana Islands, the United States Virgin Is- 6 lands, Puerto Rico, or Hawaii or a unit of local 7 government; or 8 ‘‘(B) a nonprofit organization; and 9 ‘‘(2)(A) provides care or treatment for a sub- 10 stantial number of patients who are uninsured, are 11 receiving assistance under title XVIII of the Social 12 Security Act or under a State plan under title XIX 13 of such Act (or under a waiver of such plan), or are 14 members of a vulnerable population, as determined 15 by the Secretary; or 16 ‘‘(B) serves a disproportionate percentage of 17 local patients that are from a racial and ethnic mi- 18 nority group. 19 ‘‘(c) REPORT.—Not later than 180 days after the 20 date of enactment of this title and annually thereafter, the 21 Secretary shall submit to the Congress and the President 22 a report that includes an assessment of health resources 23 and facilities serving populations in American Samoa, 24 Guam, the Commonwealth of the Northern Mariana Is- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 372 •HR 7585 IH lands, the United States Virgin Islands, Puerto Rico, and 1 Hawaii. In preparing such report, the Secretary shall— 2 ‘‘(1) consult with and obtain information on all 3 health care facilities needs from the entities receiv- 4 ing direct financial assistance under subsection (a); 5 ‘‘(2) include all amounts of Federal assistance 6 received by each such entity in the preceding fiscal 7 year; 8 ‘‘(3) review the total unmet needs of health care 9 facilities serving American Samoa, Guam, the Com- 10 monwealth of the Northern Mariana Islands, the 11 United States Virgin Islands, Puerto Rico, and Ha- 12 waii, including needs for renovation and expansion 13 of existing facilities; 14 ‘‘(4) include a strategic plan for addressing the 15 needs of each such population identified in the re- 16 port; and 17 ‘‘(5) evaluate the effectiveness of the care pro- 18 vided by measuring patient outcomes and cost meas- 19 ures. 20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated such sums as necessary 22 to carry out this section.’’. 23 SEC. 4202. BORDER HEALTH GRANTS. 24 (a) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 373 •HR 7585 IH (1) BORDER AREA.—The term ‘‘border area’’ 1 means the United States-Mexico Border Area, as de- 2 fined in section 8 of the United States-Mexico Bor- 3 der Health Commission Act (22 U.S.C. 290n–6). 4 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 5 ty’’ means an entity that is located in the border 6 area and is any of the following: 7 (A) A State, local government, or Tribal 8 government. 9 (B) A public institution of higher edu- 10 cation. 11 (C) A nonprofit health organization. 12 (D) A community health center. 13 (E) A community clinic that is a health 14 center receiving assistance under section 330 of 15 the Public Health Service Act (42 U.S.C. 16 254b). 17 (F) A nonprofit organization serving immi- 18 grants. 19 (b) AUTHORIZATION.—From funds appropriated pur- 20 suant to subsection (f), the Secretary of Health and 21 Human Services (in this section referred to as the ‘‘Sec- 22 retary’’), acting through the United States members of the 23 United States-Mexico Border Health Commission, shall 24 award grants to eligible entities to address priorities and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 374 •HR 7585 IH recommendations to improve the health of border area 1 residents that are established by— 2 (1) the United States members of the United 3 States-Mexico Border Health Commission; 4 (2) the State border health offices; and 5 (3) the Secretary. 6 (c) APPLICATION.—An eligible entity that desires a 7 grant under subsection (b) shall submit an application to 8 the Secretary at such time, in such manner, and con- 9 taining such information as the Secretary may require and 10 demonstrating the entity’s capacity to provide culturally 11 and linguistically appropriate services to border area resi- 12 dents. 13 (d) USE OF FUNDS.—An eligible entity that receives 14 a grant under subsection (b) shall use the grant funds 15 for— 16 (1) programs relating to— 17 (A) maternal and child health; 18 (B) primary care and preventative health; 19 (C) public health and public health infra- 20 structure; 21 (D) musculoskeletal health and obesity; 22 (E) health education and promotion; 23 (F) oral health; 24 (G) mental and behavioral health; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 375 •HR 7585 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; 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.)); 17 (Q) end-of-life care; and 18 (R) addressing social determinants of 19 health; and 20 (2) other programs determined appropriate by 21 the Secretary. 22 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 23 vided to an eligible entity awarded a grant under sub- 24 section (b) shall be used to supplement and not supplant 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 376 •HR 7585 IH other funds available to the eligible entity to carry out the 1 activities described in subsection (d). 2 (f) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section, 4 $200,000,000 for fiscal year 2024, and such sums as may 5 be necessary for each succeeding fiscal year. 6 SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 7 (a) ELIMINATION OF ISOLATION TEST FOR COST- 8 BASED AMBULANCE REIMBURSEMENT.— 9 (1) IN GENERAL.—Section 1834(l)(8) of the 10 Social Security Act (42 U.S.C. 1395m(l)(8)) is 11 amended— 12 (A) in subparagraph (B)— 13 (i) by striking ‘‘owned and’’; and 14 (ii) by inserting ‘‘(including when 15 such services are provided by the entity 16 under an arrangement with the hospital)’’ 17 after ‘‘hospital’’; and 18 (B) by striking the comma at the end of 19 subparagraph (B) and all that follows and in- 20 serting a period. 21 (2) EFFECTIVE DATE.—The amendments made 22 by this subsection shall apply to services furnished 23 on or after January 1, 2021. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 377 •HR 7585 IH (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 1 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 2 REQUIREMENT.— 3 (1) IN GENERAL.—Section 1820(c)(2) of the 4 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 5 amended— 6 (A) in subparagraph (B)(iii), by striking 7 ‘‘provides not more than’’ and inserting ‘‘sub- 8 ject to subparagraph (F), provides not more 9 than’’; and 10 (B) by adding at the end the following new 11 subparagraph: 12 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 13 LIMIT REQUIREMENT.— 14 ‘‘(i) IN GENERAL.—A State may elect 15 to treat a facility, with respect to the des- 16 ignation of the facility for a cost-reporting 17 period, as satisfying the requirement of 18 subparagraph (B)(iii) relating to a max- 19 imum number of acute care inpatient beds 20 if the facility elects, in accordance with a 21 method specified by the Secretary and be- 22 fore the beginning of the cost reporting pe- 23 riod, to meet the requirement under clause 24 (ii). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 378 •HR 7585 IH ‘‘(ii) ALTERNATE REQUIREMENT.— 1 The requirement under this clause, with 2 respect to a facility and a cost-reporting 3 period, is that the total number of inpa- 4 tient bed days described in subparagraph 5 (B)(iii) during such period will not exceed 6 7,300. For purposes of this subparagraph, 7 an individual who is an inpatient in a bed 8 in the facility for a single day shall be 9 counted as one inpatient bed day. 10 ‘‘(iii) WITHDRAWAL OF ELECTION.— 11 The option described in clause (i) shall not 12 apply to a facility for a cost-reporting pe- 13 riod if the facility (for any two consecutive 14 cost-reporting periods during the previous 15 5 cost-reporting periods) was treated under 16 such option and had a total number of in- 17 patient bed days for each of such two cost- 18 reporting periods that exceeded the num- 19 ber specified in such clause.’’. 20 (2) EFFECTIVE DATE.—The amendments made 21 by paragraph (1) shall apply to cost-reporting peri- 22 ods beginning on or after the date of the enactment 23 of this Act. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 379 •HR 7585 IH (c) EXPANDING THE FUNDING AUTHORITY FOR 1 RENOVATING, CONSTRUCTING, AND EXPANDING CERTAIN 2 FACILITIES.—Section 509 of the Indian Health Care Im- 3 provement Act (25 U.S.C. 1659) is amended— 4 (1) by striking ‘‘minor’’ before ‘‘renovations’’; 5 and 6 (2) by striking ‘‘, to assist’’ and all that follows 7 through ‘‘standards’’. 8 SEC. 4204. MEDICARE REMOTE MONITORING PILOT 9 PROJECTS. 10 (a) PILOT PROJECTS.— 11 (1) IN GENERAL.—Not later than 9 months 12 after the date of enactment of this Act, the Sec- 13 retary of Health and Human Services (in this sec- 14 tion referred to as the ‘‘Secretary’’) shall conduct 15 pilot projects under title XVIII of the Social Secu- 16 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 17 providing incentives to home health agencies to uti- 18 lize home monitoring and communications tech- 19 nologies that— 20 (A) enhance health and health care out- 21 comes for Medicare beneficiaries; and 22 (B) reduce expenditures under such title. 23 (2) SITE REQUIREMENTS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 380 •HR 7585 IH (A) URBAN AND RURAL.—The Secretary 1 shall conduct the pilot projects under this sec- 2 tion in both urban and rural areas. 3 (B) SITE IN A SMALL STATE.—The Sec- 4 retary shall conduct at least 3 of the pilot 5 projects in a State with a population of less 6 than 1,000,000. 7 (3) DEFINITION OF HOME HEALTH AGENCY.— 8 In this section, the term ‘‘home health agency’’ has 9 the meaning given that term in section 1861(o) of 10 the Social Security Act (42 U.S.C. 1395x(o)). 11 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 12 OF PROJECTS.—The Secretary shall specify the criteria 13 for identifying those Medicare beneficiaries who shall be 14 considered within the scope of the pilot projects under this 15 section for purposes of the application of subsection (c) 16 and for the assessment of the effectiveness of the home 17 health agency in achieving the objectives of this section. 18 Such criteria may provide for the inclusion in the projects 19 of Medicare beneficiaries who begin receiving home health 20 services under title XVIII of the Social Security Act (42 21 U.S.C. 1395 et seq.) after the date of the implementation 22 of the projects. 23 (c) INCENTIVES.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 381 •HR 7585 IH (1) PERFORMANCE TARGETS.—The Secretary 1 shall establish for each home health agency partici- 2 pating in a pilot project under this section a per- 3 formance target using one of the following meth- 4 odologies, as determined appropriate by the Sec- 5 retary: 6 (A) ADJUSTED HISTORICAL PERFORMANCE 7 TARGET.—The Secretary shall establish for the 8 agency— 9 (i) a base expenditure amount equal 10 to the average total payments made to the 11 agency under parts A and B of title XVIII 12 of the Social Security Act (42 U.S.C. 1395 13 et seq.) for Medicare beneficiaries deter- 14 mined to be within the scope of the pilot 15 project in a base period determined by the 16 Secretary; and 17 (ii) an annual per capita expenditure 18 target for such beneficiaries, reflecting the 19 base expenditure amount adjusted for risk 20 and adjusted growth rates. 21 (B) COMPARATIVE PERFORMANCE TAR- 22 GET.—The Secretary shall establish for the 23 agency a comparative performance target equal 24 to the average total payments under such parts 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 382 •HR 7585 IH A and B during the pilot project for comparable 1 individuals in the same geographic area that 2 are not determined to be within the scope of the 3 pilot project. 4 (2) INCENTIVE.—Subject to paragraph (3), the 5 Secretary shall pay to each participating home care 6 agency an incentive payment for each year under the 7 pilot project equal to a portion of the Medicare sav- 8 ings realized for such year relative to the perform- 9 ance target under paragraph (1). 10 (3) LIMITATION ON EXPENDITURES.—The Sec- 11 retary shall limit incentive payments under this sec- 12 tion in order to ensure that the aggregate expendi- 13 tures under title XVIII of the Social Security Act 14 (42 U.S.C. 1395 et seq.) (including incentive pay- 15 ments under this subsection) do not exceed the 16 amount that the Secretary estimates would have 17 been expended if the pilot projects under this section 18 had not been implemented. 19 (d) WAIVER AUTHORITY.—The Secretary may waive 20 such provisions of titles XI and XVIII of the Social Secu- 21 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 22 as the Secretary determines to be appropriate for the con- 23 duct of the pilot projects under this section. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 383 •HR 7585 IH (e) REPORT TO CONGRESS.—Not later than 5 years 1 after the date that the first pilot project under this section 2 is implemented, the Secretary shall submit to Congress a 3 report on the pilot projects. Such report shall contain a 4 detailed description of issues related to the expansion of 5 the projects under subsection (f) and recommendations for 6 such legislation and administrative actions as the Sec- 7 retary considers appropriate. 8 (f) EXPANSION.—If the Secretary determines that 9 any of the pilot projects under this section enhance health 10 outcomes for Medicare beneficiaries and reduce expendi- 11 tures under title XVIII of the Social Security Act (42 12 U.S.C. 1395 et seq.), the Secretary may initiate com- 13 parable projects in additional areas. 14 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 15 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 16 tive payment under this section— 17 (1) shall be in addition to the payments that a 18 home health agency would otherwise receive under 19 title XVIII of the Social Security Act for the provi- 20 sion of home health services; and 21 (2) shall have no effect on the amount of such 22 payments. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 384 •HR 7585 IH SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE 1 ACCESS EXPANSION. 2 Section 330(r)(4) of the Public Health Service Act 3 (42 U.S.C. 254b(r)(4)) is amended— 4 (1) in subparagraph (A), by striking ‘‘primary 5 health care services’’ each place it appears and in- 6 serting ‘‘primary health care and other mental, den- 7 tal, and physical health services’’; and 8 (2) in subparagraph (B)— 9 (A) in clause (i), by striking ‘‘and’’ at the 10 end; 11 (B) in clause (ii), by striking the period at 12 the end and inserting ‘‘; and’’; and 13 (C) by adding at the end the following: 14 ‘‘(iii) in the case of a rural health 15 clinic described in such subparagraph— 16 ‘‘(I) that such clinic provides, to 17 the extent possible, enabling services, 18 such as transportation and language 19 assistance (including translation and 20 interpretation); and 21 ‘‘(II) that the primary health 22 care and other services described in 23 such subparagraph are subject to full 24 reimbursement according to the pro- 25 spective payment system for Federally 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 385 •HR 7585 IH qualified health center services under 1 section 1834(o) of the Social Security 2 Act.’’. 3 SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH 4 SERVICES ACROSS STATE LINES. 5 (a) IN GENERAL.—For purposes of expediting the 6 provision of telehealth services, for which payment is made 7 under the Medicare Program, across State lines, the Sec- 8 retary of Health and Human Services shall, in consulta- 9 tion with representatives of States, physicians, health care 10 practitioners, and patient advocates, encourage and facili- 11 tate the adoption of provisions allowing for multistate 12 practitioner practice across State lines. 13 (b) DEFINITIONS.—In subsection (a): 14 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 15 health service’’ has the meaning given that term in 16 subparagraph (F) of section 1834(m)(4) of the So- 17 cial Security Act (42 U.S.C. 1395m(m)(4)). 18 (2) PHYSICIAN, PRACTITIONER.—The terms 19 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 20 given those terms in subparagraphs (D) and (E), re- 21 spectively, of such section. 22 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 23 Program’’ means the program of health insurance 24 administered by the Secretary of Health and Human 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 386 •HR 7585 IH Services under title XVIII of the Social Security Act 1 (42 U.S.C. 1395 et seq.). 2 SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS. 3 Section 202 of the Congressional Budget and Im- 4 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 5 ed by adding at the end the following: 6 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 7 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 8 Upon a request by the chairman or ranking minority 9 member of the Committee on the Budget of the Sen- 10 ate, or by the chairman or ranking minority member 11 of the Committee on the Budget of the House of 12 Representatives, the Director shall determine if a 13 proposed measure would result in reductions in 14 budget outlays in budgetary outyears through the 15 use of preventive health and preventive health serv- 16 ices. 17 ‘‘(2) PROJECTIONS.—If the Director determines 18 that a measure would result in substantial reduc- 19 tions in budget outlays as described in paragraph 20 (1), the Director— 21 ‘‘(A) shall include, in any projection pre- 22 pared by the Director, a description and esti- 23 mate of the reductions in budget outlays in the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 387 •HR 7585 IH budgetary outyears and a description of the 1 basis for such conclusions; and 2 ‘‘(B) may prepare a budget projection that 3 includes some or all of the budgetary outyears, 4 notwithstanding the time periods for projections 5 described in subsection (e) and sections 308, 6 402, and 424. 7 ‘‘(3) DEFINITIONS.—As used in this sub- 8 section— 9 ‘‘(A) the term ‘budgetary outyears’ means 10 the 2 consecutive 10-year periods beginning 11 with the first fiscal year that is 10 years after 12 the budget year provided for in the most re- 13 cently agreed to concurrent resolution on the 14 budget; and 15 ‘‘(B) the term ‘preventive health’ means an 16 action that focuses on the health of the public, 17 individuals, and defined populations in order to 18 protect, promote, and maintain health, wellness, 19 and functional ability, and prevent disease, dis- 20 ability, and premature death that is dem- 21 onstrated by credible and publicly available epi- 22 demiological projection models, incorporating 23 clinical trials or observational studies in hu- 24 mans, to avoid future health care costs.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 388 •HR 7585 IH SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EF- 1 FORT PROVISIONS REGARDING CHILDREN’S 2 HEALTH. 3 It is the sense of the Congress that— 4 (1) the maintenance of effort provisions added 5 to sections 1902 and 2105(d) of the Social Security 6 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec- 7 tions 2001(b) and 2101(b) of the Patient Protection 8 and Affordable Care Act were intended to maintain 9 the eligibility standards for the Medicaid program 10 under title XIX of the Social Security Act (42 11 U.S.C. 1396 et seq.) and Children’s Health Insur- 12 ance Program under title XXI of such Act (42 13 U.S.C. 1397aa et seq.) to protect vulnerable and dis- 14 abled adults, children, and senior citizens, many of 15 whom are also members of communities of color; 16 (2) the maintenance of effort provisions for 17 children’s coverage have been extended by the Con- 18 gress through September 30, 2027; 19 (3) the maintenance of effort provisions ensure 20 the continued success of the Medicaid program and 21 Children’s Health Insurance Program and were in- 22 tended to specifically protect vulnerable and disabled 23 children, many of whom are also members of com- 24 munities of color; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 389 •HR 7585 IH (4) the maintenance of effort provisions must 1 be strictly enforced and proposals to weaken or 2 waive the maintenance of effort provisions must not 3 be considered. 4 SEC. 4209. PROTECTION OF THE HHS OFFICES OF MINOR- 5 ITY HEALTH. 6 (a) IN GENERAL.—Pursuant to section 1707A of the 7 Public Health Service Act (42 U.S.C. 300u–6a), the Of- 8 fices of Minority Health established within the Centers for 9 Disease Control and Prevention, the Health Resources 10 and Services Administration, the Substance Abuse and 11 Mental Health Services Administration, the Agency for 12 Healthcare Research and Quality, the Food and Drug Ad- 13 ministration, and the Centers for Medicare & Medicaid 14 Services, are offices that, regardless of change in the 15 structure of the Department of Health and Human Serv- 16 ices, shall report to the Secretary of Health and Human 17 Services. 18 (b) SENSE OF CONGRESS.—It is the sense of the 19 Congress that the Offices of Minority Health referred to 20 in subsection (a) play a critical role in addressing health 21 disparities and should be adequately funded and given a 22 prominent role in evaluating and establishing health poli- 23 cies and programs. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 390 •HR 7585 IH SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS 1 HEALTH ADMINISTRATION OF DEPARTMENT 2 OF VETERANS AFFAIRS. 3 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 4 I of chapter 73 of title 38, United States Code, is amended 5 by inserting after section 7308 the following new section: 6 ‘‘§ 7308A. Office of Minority Health 7 ‘‘(a) ESTABLISHMENT.—There is established in the 8 Department within the Office of the Under Secretary for 9 Health an office to be known as the ‘Office of Minority 10 Health’ (in this section referred to as the ‘Office’). 11 ‘‘(b) HEAD.—The Director of the Office of Minority 12 Health shall be the head of the Office. The Director of 13 the Office of Minority Health shall be appointed by the 14 Under Secretary for Health from among individuals quali- 15 fied to perform the duties of the position. 16 ‘‘(c) FUNCTIONS.—The functions of the Office are as 17 follows: 18 ‘‘(1) To establish short-range and long-range 19 goals and objectives and coordinate all other activi- 20 ties within the Veterans Health Administration that 21 relate to disease prevention, health promotion, health 22 care services delivery, health and health care edu- 23 cation, health care quality, and health care research 24 concerning veterans who are members of a racial or 25 ethnic minority group. 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 391 •HR 7585 IH ‘‘(2) To support research, demonstrations, and 1 evaluations to test new and innovative models for 2 the discharge of activities described in paragraph 3 (1). 4 ‘‘(3) To increase knowledge and understanding 5 of health risk factors for veterans who are members 6 of a racial or ethnic minority group. 7 ‘‘(4) To develop mechanisms that support bet- 8 ter health care information dissemination, education, 9 prevention, and services delivery to veterans from 10 disadvantaged backgrounds, including veterans who 11 are members of a racial or ethnic minority group. 12 ‘‘(5) To enter into contracts or agreements with 13 appropriate public and nonprofit private entities to 14 develop and carry out programs to provide bilingual 15 or interpretive services to assist veterans who are 16 members of a racial or ethnic minority group and 17 who lack proficiency in speaking the English lan- 18 guage in accessing and receiving health care services 19 through the Veterans Health Administration. 20 ‘‘(6) To carry out programs to improve access 21 to health care services through the Veterans Health 22 Administration for veterans with limited proficiency 23 in speaking the English language, including the de- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 392 •HR 7585 IH velopment and evaluation of demonstration and pilot 1 projects for that purpose. 2 ‘‘(7) To advise the Under Secretary for Health 3 on matters relating to the development, implementa- 4 tion, and evaluation of health professions education 5 in decreasing disparities in health care outcomes be- 6 tween veterans who are members of a racial or eth- 7 nic minority group and other veterans, including cul- 8 tural competency as a method of eliminating such 9 health disparities. 10 ‘‘(8) To perform such other functions and du- 11 ties as the Secretary or the Under Secretary for 12 Health considers appropriate. 13 ‘‘(d) DEFINITIONS.—In this section: 14 ‘‘(1) The term ‘racial or ethnic minority group’ 15 means any of the following: 16 ‘‘(A) American Indians (including Alaska 17 Natives, Eskimos, and Aleuts). 18 ‘‘(B) Asian Americans. 19 ‘‘(C) Native Hawaiians and Pacific Island- 20 ers. 21 ‘‘(D) Blacks. 22 ‘‘(E) Hispanics. 23 ‘‘(2) The term ‘Hispanic’ means individuals 24 whose origin is Mexican, Puerto Rican, Cuban, Cen- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 393 •HR 7585 IH tral or South American, or any other Spanish-speak- 1 ing country.’’. 2 (b) CLERICAL AMENDMENT.—The table of sections 3 at the beginning of such subchapter is amended by insert- 4 ing after the item relating to section 7308 the following 5 new item: 6 ‘‘7308A. Office of Minority Health.’’. SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 7 ACCESS FOR LOW-INCOME PATIENTS. 8 (a) IN GENERAL.—Not later than January 1, 2021, 9 the Comptroller General of the United States shall con- 10 duct a study on how amendments made by the Patient 11 Protection and Affordable Care Act (Public Law 111– 12 148) and the Health Care and Education Reconciliation 13 Act of 2010 (Public Law 111–152) to titles XVIII and 14 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 15 42 U.S.C. 1396 et seq.) relating to disproportionate share 16 hospital adjustment payments under Medicare and Med- 17 icaid (and subsequent amendments made with respect to 18 such payments) affect the timely access to health care 19 services for low-income patients. Such study shall— 20 (1) evaluate and examine whether States elect- 21 ing to make medical assistance available under sec- 22 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 23 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 24 States making such an election through a waiver of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 394 •HR 7585 IH the State plan) to individuals described in such sec- 1 tion mitigate the need for payments to dispropor- 2 tionate share hospitals under section 1886(d)(5)(F) 3 of the Social Security Act (42 U.S.C. 4 1395ww(d)(5)(F)) and section 1923 of such Act (42 5 U.S.C. 1396r–4), including the impact of such 6 States electing to make medical assistance available 7 to such individuals on— 8 (A) the number of individuals in the 9 United States who are without health insurance 10 and the distribution of such individuals in rela- 11 tion to areas primarily served by dispropor- 12 tionate share hospitals; and 13 (B) the low-income utilization rate of such 14 hospitals and the resulting fiscal sustainability 15 of such hospitals; 16 (2) evaluate the appropriate level and distribu- 17 tion of such payments among such disproportionate 18 share hospitals for purposes of— 19 (A) sufficiently accounting for the level of 20 uncompensated care provided by such hospitals 21 to low-income patients; and 22 (B) providing timely access to health care 23 services for individuals in medically underserved 24 areas; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 395 •HR 7585 IH (3) assess, with respect to such disproportionate 1 share hospitals— 2 (A) the role played by such hospitals in 3 providing critical access to emergency, inpa- 4 tient, and outpatient health services, including 5 end-of-life services, as well as the location of 6 such hospitals in relation to medically under- 7 served areas; and 8 (B) the extent to which such hospitals sat- 9 isfy the requirements established for charitable 10 hospital organizations under section 501(r) of 11 the Internal Revenue Code of 1986 with respect 12 to community health needs assessments, finan- 13 cial assistance policy requirements, limitations 14 on charges, and billing and collection require- 15 ments. 16 (b) REPORTS.— 17 (1) REPORT TO CONGRESS.—Not later than 18 180 days after the date on which the study under 19 subsection (a) is completed, the Comptroller General 20 of the United States shall submit to the Committee 21 on Energy and Commerce of the House of Rep- 22 resentatives and the Committee on Finance of the 23 Senate a report that contains— 24 (A) the results of the study; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 396 •HR 7585 IH (B) recommendations to Congress for any 1 legislative changes to the payments to dis- 2 proportionate share hospitals under section 3 1886(d)(5)(F) of the Social Security Act (42 4 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 5 such Act (42 U.S.C. 1396r–4) that are needed 6 to ensure access to health services for low-in- 7 come patients that— 8 (i) are based on the number of indi- 9 viduals without health insurance, the 10 amount of uncompensated care provided by 11 such hospitals, and the impact of reduced 12 payment levels on low-income communities; 13 and 14 (ii) takes into account any reports 15 submitted by the Secretary of the Treas- 16 ury, in consultation with the Secretary of 17 Health and Human Services, to congres- 18 sional committees regarding the costs in- 19 curred by charitable hospital organizations 20 for charity care, bad debt, nonreimbursed 21 expenses for services provided to individ- 22 uals under the Medicare program under 23 title XVIII of the Social Security Act and 24 the Medicaid program under title XIX of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 397 •HR 7585 IH such Act, and any community benefit ac- 1 tivities provided by such organizations. 2 (2) REPORT TO THE SECRETARY OF HEALTH 3 AND HUMAN SERVICES.—Not later than 180 days 4 after the date on which the study under subsection 5 (a) is completed, the Comptroller General of the 6 United States shall submit to the Secretary of 7 Health and Human Services a report that con- 8 tains— 9 (A) the results of the study; and 10 (B) any recommendations for purposes of 11 assisting in the development of the methodology 12 for the adjustment of payments to dispropor- 13 tionate share hospitals, as required under sec- 14 tion 1886(r) of the Social Security Act (42 15 U.S.C. 1395ww(r)) and the reduction of such 16 payments under section 1923(f)(7) of such Act 17 (42 U.S.C. 1396r–4(f)(7)), taking into account 18 the reports referred to in paragraph (1)(B)(ii). 19 SEC. 4212. REAUTHORIZATION OF THE NATIVE HAWAIIAN 20 HEALTH CARE IMPROVEMENT ACT. 21 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 22 Section 6(h)(1) of the Native Hawaiian Health Care Im- 23 provement Act (42 U.S.C. 11705(h)(1)) is amended by 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 398 •HR 7585 IH striking ‘‘may be necessary for fiscal years 1993 through 1 2019’’ and inserting ‘‘are necessary’’. 2 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 3 LOKAHI.—Section 7(b) of the Native Hawaiian Health 4 Care Improvement Act (42 U.S.C. 11706(b)) is amended 5 by striking ‘‘may be necessary for fiscal years 1993 6 through 2019’’ and inserting ‘‘are necessary’’. 7 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 8 Section 10(c) of the Native Hawaiian Health Care Im- 9 provement Act (42 U.S.C. 11709(c)) is amended by strik- 10 ing ‘‘may be necessary for fiscal years 1993 through 11 2019’’ and inserting ‘‘are necessary’’. 12 PART 2—RURAL 13 SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOS- 14 PITAL (RCH) PROGRAM. 15 (a) IN GENERAL.—Section 1861 of the Social Secu- 16 rity Act (42 U.S.C. 1395x), as amended by the previous 17 sections, is amended by adding at the end of the following 18 new subsection: 19 ‘‘Rural Community Hospital; Rural Community Hospital 20 Services 21 ‘‘(lll)(1) The term ‘rural community hospital’ means 22 a hospital (as defined in subsection (e)) that— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 399 •HR 7585 IH ‘‘(A) is located in a rural area (as defined in 1 section 1886(d)(2)(D)) or treated as being so lo- 2 cated pursuant to section 1886(d)(8)(E); 3 ‘‘(B) subject to paragraph (2), has less than 51 4 acute care inpatient beds, as reported in its most re- 5 cent cost report; 6 ‘‘(C) makes available 24-hour emergency care 7 services; 8 ‘‘(D) subject to paragraph (3), has a provider 9 agreement in effect with the Secretary and is open 10 to the public as of January 1, 2010; and 11 ‘‘(E) applies to the Secretary for such designa- 12 tion. 13 ‘‘(2) For purposes of paragraph (1)(B), beds in a 14 psychiatric or rehabilitation unit of the hospital which is 15 a distinct part of the hospital shall not be counted. 16 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 17 hibit any of the following from qualifying as a rural com- 18 munity hospital: 19 ‘‘(A) A replacement facility (as defined by the 20 Secretary in regulations in effect on January 1, 21 2012) with the same service area (as defined by the 22 Secretary in regulations in effect on such date). 23 ‘‘(B) A facility obtaining a new provider num- 24 ber pursuant to a change of ownership. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 400 •HR 7585 IH ‘‘(C) A facility which has a binding written 1 agreement with an outside, unrelated party for the 2 construction, reconstruction, lease, rental, or financ- 3 ing of a building as of January 1, 2012. 4 ‘‘(4) Nothing in this subsection shall be construed as 5 prohibiting a critical access hospital from qualifying as a 6 rural community hospital if the critical access hospital 7 meets the conditions otherwise applicable to hospitals 8 under subsection (e) and section 1866. 9 ‘‘(5) Nothing in this subsection shall be construed as 10 prohibiting a rural community hospital participating in 11 the demonstration program under section 410A of the 12 Medicare Prescription Drug, Improvement, and Mod- 13 ernization Act of 2003 (Public Law 108–173; 117 Stat. 14 2313) from qualifying as a rural community hospital if 15 the rural community hospital meets the conditions other- 16 wise applicable to hospitals under subsection (e) and sec- 17 tion 1866.’’. 18 (b) PAYMENT.— 19 (1) INPATIENT HOSPITAL SERVICES.—Section 20 1814 of the Social Security Act (42 U.S.C. 1395f) 21 is amended by adding at the end the following new 22 subsection: 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 401 •HR 7585 IH ‘‘Payment for Inpatient Services Furnished in Rural 1 Community Hospitals 2 ‘‘(m) The amount of payment under this part for in- 3 patient hospital services furnished in a rural community 4 hospital, other than such services furnished in a psy- 5 chiatric or rehabilitation unit of the hospital which is a 6 distinct part, is, at the election of the hospital in the appli- 7 cation referred to in section 1861(lll)(1)(E)— 8 ‘‘(1) 101 percent of the reasonable costs of pro- 9 viding such services, without regard to the amount 10 of the customary or other charge, or 11 ‘‘(2) the amount of payment provided for under 12 the prospective payment system for inpatient hos- 13 pital services under section 1886(d).’’. 14 (2) OUTPATIENT SERVICES.—Section 1834 of 15 such Act (42 U.S.C. 1395m) is amended by adding 16 at the end the following new subsection: 17 ‘‘(z) PAYMENT FOR OUTPATIENT SERVICES FUR- 18 NISHED IN RURAL COMMUNITY HOSPITALS.—The 19 amount of payment under this part for outpatient services 20 furnished in a rural community hospital is, at the election 21 of the hospital in the application referred to in section 22 1861(lll)(1)(E)— 23 ‘‘(1) 101 percent of the reasonable costs of pro- 24 viding such services, without regard to the amount 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 402 •HR 7585 IH of the customary or other charge and any limitation 1 under section 1861(v)(1)(U), or 2 ‘‘(2) the amount of payment provided for under 3 the prospective payment system for covered OPD 4 services under section 1833(t).’’. 5 (3) EXEMPTION FROM 30-PERCENT REDUCTION 6 IN REIMBURSEMENT FOR BAD DEBT.—Section 7 1861(v)(1)(T) of such Act (42 U.S.C. 8 1395x(v)(1)(T)) is amended by inserting ‘‘(other 9 than for a rural community hospital)’’ after ‘‘In de- 10 termining such reasonable costs for hospitals’’. 11 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 12 SERVICES.—Section 1834(z) of such Act (as added by 13 subsection (b)(2)) is amended— 14 (1) by redesignating paragraphs (1) and (2) as 15 subparagraphs (A) and (B), respectively; 16 (2) by inserting ‘‘(1)’’ after ‘‘(z)’’; and 17 (3) by adding at the end the following: 18 ‘‘(2) The amounts of beneficiary cost-sharing for out- 19 patient services furnished in a rural community hospital 20 under this part shall be as follows: 21 ‘‘(A) For items and services that would have 22 been paid under section 1833(t) if furnished by a 23 hospital, the amount of cost-sharing determined 24 under paragraph (8) of such section. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 403 •HR 7585 IH ‘‘(B) For items and services that would have 1 been paid under section 1833(h) if furnished by a 2 provider of services or supplier, no cost-sharing shall 3 apply. 4 ‘‘(C) For all other items and services, the 5 amount of cost-sharing that would apply to the item 6 or service under the methodology that would be used 7 to determine payment for such item or service if pro- 8 vided by a physician, provider of services, or sup- 9 plier, as the case may be.’’. 10 (d) CONFORMING AMENDMENTS.— 11 (1) PART A PAYMENT.—Section 1814(b) of 12 such Act (42 U.S.C. 1395f(b)) is amended in the 13 matter preceding paragraph (1) by inserting ‘‘other 14 than inpatient hospital services furnished by a rural 15 community hospital,’’ after ‘‘critical access hospital 16 services,’’. 17 (2) PART B PAYMENT.—Section 1833(a) of 18 such Act (42 U.S.C. 1395l(a)), as amended by sec- 19 tion 207(b)(3), is amended— 20 (A) by striking ‘‘and’’ at the end of para- 21 graph (9); 22 (B) by striking the period at the end of 23 paragraph (10) and inserting ‘‘; and’’; and 24 (C) by adding at the end the following: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 404 •HR 7585 IH ‘‘(11) in the case of outpatient services fur- 1 nished by a rural community hospital, the amounts 2 described in section 1834(z).’’. 3 (3) TECHNICAL AMENDMENTS.— 4 (A) CONSULTATION WITH STATE AGEN- 5 CIES.—Section 1863 of such Act (42 U.S.C. 6 1395z) is amended by striking ‘‘and (dd)(2)’’ 7 and inserting ‘‘(dd)(2), and (lll)(1)’’. 8 (B) PROVIDER AGREEMENTS.—Section 9 1866(a)(2)(A) of such Act (42 U.S.C. 10 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 11 tion 1834(z)(2),’’ after ‘‘section 1833(b),’’. 12 (e) EFFECTIVE DATE.—The amendments made by 13 this section shall apply to items and services furnished on 14 or after October 1, 2022. 15 SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMIS- 16 SION AND DEMONSTRATION PROJECTS. 17 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 18 SION.— 19 (1) ESTABLISHMENT.—Not later than 6 20 months after the date of the enactment of this sec- 21 tion, the Secretary of Health and Human Services 22 (in this section referred to as the ‘‘Secretary’’) shall 23 establish a commission to be known as the Rural 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 405 •HR 7585 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 subparagraph (A)(i). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 406 •HR 7585 IH (3) MEMBERSHIP.— 1 (A) NUMBER.—The Commission shall be 2 composed of 11 members appointed by the Sec- 3 retary. 4 (B) SELECTION.—The Secretary shall se- 5 lect the members of the Commission from 6 among individuals with significant rural health 7 care and health care quality expertise, including 8 expertise in clinical health care, health care 9 quality research, end-of-life care, population or 10 public health, or purchaser organizations. 11 (4) CONTRACTING AUTHORITY.—Subject to the 12 availability of funds, the Commission may enter into 13 contracts and make other arrangements, as may be 14 necessary to carry out the duties described in para- 15 graph (2). 16 (5) STAFF.—Upon the request of the Commis- 17 sion, the Secretary may detail, on a reimbursable 18 basis, any of the personnel of the Office of Rural 19 Health Policy of the Health Resources and Services 20 Administration, the Agency for Healthcare Research 21 and Quality, or the Centers for Medicare & Medicaid 22 Services to the Commission to assist in carrying out 23 this subsection. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 407 •HR 7585 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 408 •HR 7585 IH for a total of 5 demonstration projects to implement 1 and evaluate methods for improving the quality of 2 health care in rural communities. Each such dem- 3 onstration project shall include— 4 (A) alternative community models that— 5 (i) will achieve greater integration of 6 personal and population health services; 7 and 8 (ii) address safety, effectiveness, 9 patient- or community-centeredness, timeli- 10 ness, efficiency, and equity (the 6 aims 11 identified by the National Academy of 12 Medicine (formerly known as the ‘‘Institute 13 of Medicine’’) in its report entitled ‘‘Cross- 14 ing the Quality Chasm: A New Health Sys- 15 tem for the 21st Century’’ released on 16 March 1, 2001); 17 (B) innovative approaches to the financing 18 and delivery of health care services to achieve 19 rural health quality and accessibility goals for 20 patients; and 21 (C) development of quality improvement 22 support structures to assist rural health sys- 23 tems and professionals in the provision of 24 health care (such as workforce support struc- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 409 •HR 7585 IH tures, quality monitoring and reporting, clinical 1 care protocols, and information technology ap- 2 plications). 3 (2) ELIGIBLE ENTITIES.—In this subsection, 4 the term ‘‘eligible entity’’ means a consortium 5 that— 6 (A) shall include— 7 (i) at least one health care provider or 8 health care delivery system located in a 9 rural area; and 10 (ii) at least one organization rep- 11 resenting multiple community stakeholders; 12 and 13 (B) may include other partners such as 14 rural research centers. 15 (3) CONSULTATION.—In developing the pro- 16 gram for awarding grants under this subsection, the 17 Secretary shall consult with the Administrator of the 18 Agency for Healthcare Research and Quality, rural 19 health care providers, rural health care researchers, 20 and private and nonprofit groups (including national 21 associations) which are undertaking similar efforts. 22 (4) EXPEDITED WAIVERS.—The Secretary shall 23 expedite the processing of any waiver that— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 410 •HR 7585 IH (A) is authorized under title XVIII or XIX 1 of the Social Security Act (42 U.S.C. 1395 et 2 seq.; 42 U.S.C. 1396 et seq.); and 3 (B) is necessary to carry out a demonstra- 4 tion project under this subsection. 5 (5) DEMONSTRATION PROJECT SITES.—The 6 Secretary shall ensure that the 5 demonstration 7 projects funded under this subsection are conducted 8 at a variety of sites representing the diversity of 9 rural communities in the United States. 10 (6) DURATION.—Each demonstration project 11 under this subsection shall be for a period of 4 12 years. 13 (7) INDEPENDENT EVALUATION.—The Sec- 14 retary shall enter into an arrangement with an enti- 15 ty that has experience working directly with rural 16 health systems for the conduct of an independent 17 evaluation of the program carried out under this 18 subsection. 19 (8) REPORT.—Not later than 1 year after the 20 conclusion of all of the demonstration projects fund- 21 ed under this subsection, the Secretary shall submit 22 a report to the Congress on the results of such 23 projects. The report shall include— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 411 •HR 7585 IH (A) an evaluation of patient access to care, 1 patient outcomes, and an analysis of the cost 2 effectiveness of each such project; and 3 (B) recommendations on Federal legisla- 4 tion, regulations, or administrative policies to 5 enhance rural health quality and outcomes. 6 (c) APPROPRIATION.— 7 (1) IN GENERAL.—Out of funds in the Treas- 8 ury not otherwise appropriated, there are appro- 9 priated to the Secretary to carry out this section 10 $30,000,000 for the period of fiscal years 2023 11 through 2027. 12 (2) AVAILABILITY.— 13 (A) IN GENERAL.—Funds appropriated 14 under paragraph (1) shall remain available for 15 expenditure through fiscal year 2027. 16 (B) REPORT.—For purposes of carrying 17 out subsection (b)(8), funds appropriated under 18 paragraph (1) shall remain available for ex- 19 penditure through fiscal year 2028. 20 (3) RESERVATION.—Of the amount appro- 21 priated under paragraph (1), the Secretary shall re- 22 serve— 23 (A) $5,000,000 to carry out subsection (a); 24 and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 412 •HR 7585 IH (B) $25,000,000 to carry out subsection 1 (b), of which— 2 (i) 2 percent shall be for the provision 3 of technical assistance to grant recipients; 4 and 5 (ii) 5 percent shall be for independent 6 evaluation under subsection (b)(7). 7 SEC. 4223. RURAL HEALTH CARE SERVICES. 8 Section 330A of the Public Health Service Act (42 9 U.S.C. 254c) is amended to read as follows: 10 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 11 RURAL HEALTH NETWORK DEVELOPMENT, 12 DELTA RURAL DISPARITIES AND HEALTH 13 SYSTEMS DEVELOPMENT, AND SMALL RURAL 14 HEALTH CARE PROVIDER QUALITY IMPROVE- 15 MENT GRANT PROGRAMS. 16 ‘‘(a) PURPOSE.—The purpose of this section is to 17 provide for grants— 18 ‘‘(1) under subsection (b), to promote rural 19 health care services outreach; 20 ‘‘(2) under subsection (c), to provide for the 21 planning and implementation of integrated health 22 care networks in rural areas; 23 ‘‘(3) under subsection (d), to assist rural com- 24 munities in the Delta Region to reduce health dis- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 413 •HR 7585 IH parities and to promote and enhance health system 1 development; and 2 ‘‘(4) under subsection (e), to provide for the 3 planning and implementation of small rural health 4 care provider quality improvement activities. 5 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 6 GRANTS.— 7 ‘‘(1) GRANTS.—The Director of the Office of 8 Rural Health Policy of the Health Resources and 9 Services Administration (referred to in this section 10 as the ‘Director’) may award grants to eligible enti- 11 ties to promote rural health care services outreach 12 by expanding the delivery of health care services to 13 include new and enhanced services in rural areas. 14 The Director may award the grants for periods of 15 not more than 3 years. 16 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 17 grant under this subsection for a project, an enti- 18 ty— 19 ‘‘(A) shall be a rural public or rural non- 20 profit private entity, a facility that qualifies as 21 a rural health clinic under title XVIII of the 22 Social Security Act, a public or nonprofit entity 23 existing exclusively to provide services to mi- 24 grant and seasonal farm workers in rural areas, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 414 •HR 7585 IH or a Tribal government whose grant-funded ac- 1 tivities will be conducted within federally recog- 2 nized Tribal areas; 3 ‘‘(B) shall represent a consortium com- 4 posed of members— 5 ‘‘(i) that include 3 or more independ- 6 ently owned health care entities; and 7 ‘‘(ii) that may be nonprofit or for- 8 profit entities; and 9 ‘‘(C) shall not previously have received a 10 grant under this subsection for the same or a 11 similar project, unless the entity is proposing to 12 expand the scope of the project or the area that 13 will be served through the project. 14 ‘‘(3) APPLICATIONS.—To be eligible to receive a 15 grant under this subsection, an eligible entity shall 16 prepare and submit to the Director an application at 17 such time, in such manner, and containing such in- 18 formation as the Director may require, including— 19 ‘‘(A) a description of the project that the 20 eligible entity will carry out using the funds 21 provided under the grant; 22 ‘‘(B) a description of the manner in which 23 the project funded under the grant will meet 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 415 •HR 7585 IH the health care needs of rural populations in 1 the local community or region to be served; 2 ‘‘(C) a plan for quantifying how health 3 care needs will be met through identification of 4 the target population and benchmarks of service 5 delivery or health status, such as— 6 ‘‘(i) quantifiable measurements of 7 health and health care status improvement 8 for projects focusing on health promotion; 9 or 10 ‘‘(ii) benchmarks of increased access 11 to primary and end-of-life care, including 12 tracking factors such as the number and 13 type of primary and end-of-life care visits, 14 identification of a medical home, or other 15 general measures of such access; 16 ‘‘(D) a description of how the local com- 17 munity or region to be served will be involved 18 in the development and ongoing operations of 19 the project; 20 ‘‘(E) a plan for sustaining the project after 21 Federal support for the project has ended; 22 ‘‘(F) a description of how the project will 23 be evaluated; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 416 •HR 7585 IH ‘‘(G) the administrative capacity to submit 1 annual performance data electronically as speci- 2 fied by the Director; and 3 ‘‘(H) other such information as the Direc- 4 tor determines to be appropriate. 5 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT 6 GRANTS.— 7 ‘‘(1) GRANTS.— 8 ‘‘(A) IN GENERAL.—The Director may 9 award rural health network development grants 10 to eligible entities to promote, through planning 11 and implementation, the development of inte- 12 grated health care networks that have combined 13 the functions of the entities participating in the 14 networks in order to— 15 ‘‘(i) achieve efficiencies and economies 16 of scale; 17 ‘‘(ii) expand access to, coordinate, and 18 improve the quality of the health care de- 19 livery system through development of orga- 20 nizational efficiencies; 21 ‘‘(iii) implement health information 22 technology to achieve efficiencies, reduce 23 medical errors, and improve quality; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 417 •HR 7585 IH ‘‘(iv) coordinate care and manage 1 chronic and terminal illness; and 2 ‘‘(v) strengthen the rural health care 3 system as a whole and across all facets of 4 the health care delivery system, including 5 end-of-life care, in such a manner as to 6 show a quantifiable return on investment 7 to the participants in the network. 8 ‘‘(B) GRANT PERIODS.—The Director may 9 award such a rural health network development 10 grant— 11 ‘‘(i) for a period of 3 years for imple- 12 mentation activities; or 13 ‘‘(ii) for a period of 1 year for plan- 14 ning activities to assist in the initial devel- 15 opment of an integrated health care net- 16 work, if the proposed participants in the 17 network do not have a history of collabo- 18 rative efforts and a 3-year grant would be 19 inappropriate. 20 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 21 grant under this subsection, an entity— 22 ‘‘(A) shall be a rural public or rural non- 23 profit private entity, a facility that qualifies as 24 a rural health clinic under title XVIII of the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 418 •HR 7585 IH Social Security Act, a public or nonprofit entity 1 existing exclusively to provide services to mi- 2 grant and seasonal farm workers in rural areas, 3 or a Tribal government whose grant-funded ac- 4 tivities will be conducted within federally recog- 5 nized Tribal areas; 6 ‘‘(B) shall represent a network composed 7 of participants— 8 ‘‘(i) that include 3 or more independ- 9 ently owned health care entities; and 10 ‘‘(ii) that may be nonprofit or for- 11 profit entities; and 12 ‘‘(C) shall not previously have received a 13 grant under this subsection (other than a 1- 14 year grant for planning activities) for the same 15 or a similar project. 16 ‘‘(3) APPLICATIONS.—To be eligible to receive a 17 grant under this subsection, an eligible entity, in 18 consultation with the appropriate State office of 19 rural health or another appropriate State entity, 20 shall prepare and submit to the Director an applica- 21 tion at such time, in such manner, and containing 22 such information as the Director may require, in- 23 cluding— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 419 •HR 7585 IH ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) an explanation of the reasons why 4 Federal assistance is required to carry out the 5 project; 6 ‘‘(C) a description of— 7 ‘‘(i) the history of collaborative activi- 8 ties carried out by the participants in the 9 network; 10 ‘‘(ii) the degree to which the partici- 11 pants are ready to integrate their func- 12 tions; and 13 ‘‘(iii) how the local community or re- 14 gion to be served will benefit from and be 15 involved in the activities carried out by the 16 network; 17 ‘‘(D) a description of how the local com- 18 munity or region to be served will experience in- 19 creased access to quality health care services 20 across the continuum of care as a result of the 21 integration activities carried out by the net- 22 work, including a description of— 23 ‘‘(i) return on investment for the com- 24 munity and the network members; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 420 •HR 7585 IH ‘‘(ii) other quantifiable performance 1 measures that show the benefit of the net- 2 work activities; 3 ‘‘(E) a plan for sustaining the project after 4 Federal support for the project has ended; 5 ‘‘(F) a description of how the project will 6 be evaluated; 7 ‘‘(G) the administrative capacity to submit 8 annual performance data electronically as speci- 9 fied by the Director; and 10 ‘‘(H) other such information as the Direc- 11 tor determines to be appropriate. 12 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 13 TEMS DEVELOPMENT GRANTS.— 14 ‘‘(1) GRANTS.—The Director may award grants 15 to eligible entities to support reduction of health dis- 16 parities, improve access to health care, and enhance 17 rural health system development in the Delta Re- 18 gion. 19 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 20 grant under this subsection, an entity shall be a 21 rural public or rural nonprofit private entity, a facil- 22 ity that qualifies as a rural health clinic under title 23 XVIII of the Social Security Act, a public or non- 24 profit entity existing exclusively to provide services 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 421 •HR 7585 IH to migrant and seasonal farm workers in rural 1 areas, or a Tribal government whose grant-funded 2 activities will be conducted within federally recog- 3 nized Tribal areas. 4 ‘‘(3) APPLICATIONS.—To be eligible to receive a 5 grant under this subsection, an eligible entity shall 6 prepare and submit to the Director an application at 7 such time, in such manner, and containing such in- 8 formation as the Director may require, including— 9 ‘‘(A) a description of the project that the 10 eligible entity will carry out using the funds 11 provided under the grant; 12 ‘‘(B) an explanation of the reasons why 13 Federal assistance is required to carry out the 14 project; 15 ‘‘(C) a description of the manner in which 16 the project funded under the grant will meet 17 the health care needs of the Delta Region; 18 ‘‘(D) a description of how the local com- 19 munity or region to be served will experience in- 20 creased access to quality health care services as 21 a result of the activities carried out by the enti- 22 ty; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 422 •HR 7585 IH ‘‘(E) a description of how health dispari- 1 ties will be reduced or the health system will be 2 improved; 3 ‘‘(F) a plan for sustaining the project after 4 Federal support for the project has ended; 5 ‘‘(G) a description of how the project will 6 be evaluated including process and outcome 7 measures related to the quality of care provided 8 or how the health care system improves its per- 9 formance; 10 ‘‘(H) a description of how the grantee will 11 develop an advisory group made up of rep- 12 resentatives of the communities to be served to 13 provide guidance to the grantee to best meet 14 community need; and 15 ‘‘(I) other such information as the Director 16 determines to be appropriate. 17 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 18 ITY IMPROVEMENT GRANTS.— 19 ‘‘(1) GRANTS.—The Director may award grants 20 to provide for the planning and implementation of 21 small rural health care provider quality improvement 22 activities. The Director may award the grants for 23 periods of 1 to 3 years. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 423 •HR 7585 IH ‘‘(2) ELIGIBILITY.—To be eligible for a grant 1 under this subsection, an entity— 2 ‘‘(A) shall be— 3 ‘‘(i) a rural public or rural nonprofit 4 private health care provider or provider of 5 health care services, such as a rural health 6 clinic; or 7 ‘‘(ii) another rural provider or net- 8 work of small rural providers identified by 9 the Director as a key source of local care; 10 and 11 ‘‘(B) shall not previously have received a 12 grant under this subsection for the same or a 13 similar project. 14 ‘‘(3) PREFERENCE.—In awarding grants under 15 this subsection, the Director shall give preference to 16 facilities that qualify as rural health clinics under 17 title XVIII of the Social Security Act. 18 ‘‘(4) APPLICATIONS.—To be eligible to receive a 19 grant under this subsection, an eligible entity shall 20 prepare and submit to the Director an application at 21 such time, in such manner, and containing such in- 22 formation as the Director may require, including— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 424 •HR 7585 IH ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) an explanation of the reasons why 4 Federal assistance is required to carry out the 5 project; 6 ‘‘(C) a description of the manner in which 7 the project funded under the grant will assure 8 continuous quality improvement in the provision 9 of services by the entity; 10 ‘‘(D) a description of how the local com- 11 munity or region to be served will experience in- 12 creased access to quality health care services as 13 a result of the activities carried out by the enti- 14 ty; 15 ‘‘(E) a plan for sustaining the project after 16 Federal support for the project has ended; 17 ‘‘(F) a description of how the project will 18 be evaluated including process and outcome 19 measures related to the quality of care pro- 20 vided; and 21 ‘‘(G) other such information as the Direc- 22 tor determines to be appropriate. 23 ‘‘(f) GENERAL REQUIREMENTS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 425 •HR 7585 IH ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 1 that receives a grant under this section may not use 2 funds provided through the grant— 3 ‘‘(A) to build or acquire real property; or 4 ‘‘(B) for construction. 5 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 6 The Director shall coordinate activities carried out 7 under grant programs described in this section, to 8 the extent practicable, with Federal and State agen- 9 cies and nonprofit organizations that are operating 10 similar grant programs, to maximize the effect of 11 public dollars in funding meritorious proposals. 12 ‘‘(g) REPORT.—Not later than September 30, 2024, 13 the Secretary shall prepare and submit to the appropriate 14 committees of Congress a report on the progress and ac- 15 complishments of the grant programs described in sub- 16 sections (b), (c), (d), and (e). 17 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec- 18 tion, the term ‘Delta Region’ has the meaning given to 19 the term ‘region’ in section 382A of the Consolidated 20 Farm and Rural Development Act (7 U.S.C. 2009aa). 21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2024 through 2027.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 426 •HR 7585 IH PART 3—INDIAN COMMUNITIES 1 SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH 2 SERVICE. 3 (a) REFERENCES.—Any reference in a law, regula- 4 tion, document, paper, or other record of the United 5 States to the Director of the Indian Health Service shall 6 be deemed to be a reference to the Assistant Secretary 7 of the Indian Health Service. 8 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 9 United States Code, is amended in the matter relating to 10 the Assistant Secretaries of Health and Human Services 11 by striking ‘‘(6)’’ and inserting ‘‘(7), one of whom shall 12 be the Assistant Secretary of the Indian Health Service’’. 13 (c) CONFORMING AMENDMENT.—Section 5316 of 14 title 5, United States Code, is amended by striking ‘‘Direc- 15 tor, Indian Health Service, Department of Health and 16 Human Services.’’. 17 SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSIST- 18 ANCE PERCENTAGE TO INDIAN HEALTH 19 CARE PROVIDERS. 20 Section 1905 of the Social Security Act (42 U.S.C. 21 1396d) is amended— 22 (1) in subsection (a), by amending paragraph 23 (9) to read as follows: 24 ‘‘(9) clinic services furnished by or under the 25 direction of a physician, without regard to whether 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 427 •HR 7585 IH the clinic itself is administered by a physician, in- 1 cluding— 2 ‘‘(A) such services furnished outside the 3 clinic by clinic personnel to an eligible indi- 4 vidual who does not reside in a permanent 5 dwelling or does not have a fixed home or mail- 6 ing address; and 7 ‘‘(B) such services furnished outside the 8 clinic by any Indian Health Service facility, a 9 health program or facility operated by a tribe or 10 tribal organization under the Indian Self-Deter- 11 mination Act (Public Law 93–638), or an 12 urban Indian organization receiving funds 13 under title V of the Indian Health Care Im- 14 provement Act;’’; and 15 (2) in subsection (b), by inserting after ‘‘Papa 16 Ola Lokahi under section 8 of such Act’’ the fol- 17 lowing: ‘‘; the Federal medical assistance percentage 18 shall also be 100 per centum with respect to 19 amounts expended as medical assistance for services 20 which are received by an Indian Health Service facil- 21 ity, a health program or facility operated by a tribe 22 or tribal organization under the Indian Self-Deter- 23 mination Act (Public Law 93–638), or an urban In- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 428 •HR 7585 IH dian organization receiving funds under title V of 1 the Indian Health Care Improvement Act’’. 2 SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZA- 3 TIONS. 4 Section 514(b) of the Indian Health Care Improve- 5 ment Act (25 U.S.C. 1660d) is amended to read as fol- 6 lows: 7 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 8 that the Service and the other agencies and offices of the 9 Department of Health and Human Services and the De- 10 partment of Veterans Affairs confer, to the maximum ex- 11 tent practicable, with urban Indian organizations in car- 12 rying out— 13 ‘‘(1) this Act; and 14 ‘‘(2) other provisions of law relating to Indian 15 health care.’’. 16 PART 4—PROVIDERS 17 SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE 18 SPEAKING PROVIDERS. 19 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 20 tient Protection and Affordable Care Act (42 U.S.C. 21 18031(c)(1)(B)) is amended by inserting before the semi- 22 colon the following: ‘‘and the ability of such provider to 23 provide care in a language other than English either 24 through the provider speaking such language or by the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 429 •HR 7585 IH provider having a qualified interpreter for an individual 1 with limited English proficiency (as defined in section 2 3400 of such Act) who speaks such language available 3 during office hours’’. 4 (b) EFFECTIVE DATE.—The amendment made by 5 subsection (a) shall not apply to any plan beginning on 6 or prior to the date that is 1 year after the date of the 7 enactment of this Act. 8 SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 9 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 10 1311(c)(1)(C) of the Patient Protection and Affordable 11 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 12 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 13 (2) by adding at the end the following new 14 clauses: 15 ‘‘(ii) not later than January 1, 2023, in- 16 crease the percentage of essential community 17 providers as described in clause (i) included in 18 its network by 10 percent annually (based on 19 the level in the plan for 2016) until 90 percent 20 of all federally qualified health centers and 75 21 percent of all other such essential community 22 providers in the contract service area are in-net- 23 work; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 430 •HR 7585 IH ‘‘(iii) include at least one essential commu- 1 nity provider in each of the essential community 2 provider categories described in section 3 156.235(a)(2)(ii)(B) of title 45, Code of Fed- 4 eral Regulations (as in effect on the date of en- 5 actment of the Health Equity and Account- 6 ability Act of 2022), in each county in the serv- 7 ice area, where available;’’. 8 (b) REPORTING REQUIREMENTS.—Section 9 1311(e)(3) of the Patient Protection and Affordable Care 10 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 11 end the following new subparagraph: 12 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 13 PROVIDERS.—The Secretary shall require quali- 14 fied health plans to submit annually to the Sec- 15 retary data on the percentage of essential com- 16 munity providers as described in clause (ii) of 17 subsection (c)(1)(C), by county, that contract 18 with each qualified health plan offered in that 19 county and the percentage of such essential 20 community providers, by category as described 21 in clause (iii) of such subsection, that contract 22 with each qualified health plan offered in that 23 county. Such data shall be made available to 24 the general public.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 431 •HR 7585 IH (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 1 APPLIED UNDER MEDICARE AND MEDICAID.— 2 (1) MEDICARE.—Section 1852(d)(1) of the So- 3 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 4 amended— 5 (A) by striking ‘‘and’’ at the end of sub- 6 paragraph (D); 7 (B) by striking the period at the end of 8 subparagraph (E) and inserting ‘‘; and’’; and 9 (C) by adding at the end the following new 10 subparagraph: 11 ‘‘(F) the plan meets the requirements of 12 clauses (ii) and (iii) of section 1311(c)(1)(C) of 13 the Patient Protection and Affordable Care Act 14 (relating to inclusion in networks of essential 15 community providers).’’. 16 (2) MEDICAID.—Section 1932(b)(5) of the So- 17 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 18 amended— 19 (A) by striking ‘‘and’’ at the end of sub- 20 paragraph (A); 21 (B) by striking the period at the end of 22 subparagraph (B) and inserting ‘‘; and’’; and 23 (C) by adding at the end the following new 24 subparagraph: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 432 •HR 7585 IH ‘‘(C) meets the requirements of clauses (ii) 1 and (iii) of section 1311(c)(1)(C) of the Patient 2 Protection and Affordable Care Act (relating to 3 inclusion in networks of essential community 4 providers) with respect to services offered in the 5 service area involved.’’. 6 SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMU- 7 NITIES OF COLOR. 8 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 9 tient Protection and Affordable Care Act (42 U.S.C. 10 18031(c)(1)(B)), as amended by section 4241(a), is fur- 11 ther amended— 12 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 13 (2) by adding at the end the following new 14 clauses: 15 ‘‘(ii) meet such network adequacy 16 standards as the Secretary may establish 17 with regard to— 18 ‘‘(I) appointment wait time; 19 ‘‘(II) travel time and distance to 20 health care provider facilities and pro- 21 viders by public and private transit; 22 ‘‘(III) hours of operation to ac- 23 commodate individuals who cannot 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 433 •HR 7585 IH come to provider appointments during 1 standard business hours; 2 ‘‘(IV) availability of health care 3 options for patients; and 4 ‘‘(V) other network adequacy 5 standards to ensure that care through 6 these plans is accessible to diverse 7 communities, including individuals 8 with limited English proficiency as de- 9 fined in section 3400 of such Act; and 10 ‘‘(iii) provide coverage for services for 11 enrollees through out-of-network providers 12 at no additional cost to the enrollees in 13 cases where in-network providers are un- 14 able to comply with the standards estab- 15 lished under subclause (III) or (IV) of 16 clause (ii) for such services and the out-of- 17 network providers can deliver such services 18 in compliance with such standards.’’. 19 (b) EFFECTIVE DATE.—The amendments made by 20 subsection (a) shall not apply to plans beginning on or 21 prior to the date that is 1 year after the date of the enact- 22 ment of the Health Equity and Accountability Act of 23 2022. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 434 •HR 7585 IH PART 5—DENTAL 1 SEC. 4251. IMPROVING ACCESS TO DENTAL CARE. 2 (a) REPORTS TO CONGRESS.— 3 (1) GAO REPORTS.—Not later than 1 year 4 after the date of the enactment of this Act, the 5 Comptroller General of the United States shall sub- 6 mit to Congress— 7 (A) a report on the Alaska Dental Health 8 Aide Therapists program and the Dental Ther- 9 apist and Advanced Dental Therapist programs 10 in Minnesota, to assess the effectiveness of den- 11 tal therapists in— 12 (i) improving access to timely dental 13 care among communities of color; 14 (ii) providing high-quality care; 15 (iii) providing culturally competent 16 care; and 17 (iv) providing accessible care to people 18 with disabilities; 19 (B) a report on State variations in the use 20 of dental hygienists and the effectiveness of ex- 21 panding the scope of practice for dental hygien- 22 ists in— 23 (i) improving access to timely dental 24 care among communities of color; 25 (ii) providing high-quality care; 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 435 •HR 7585 IH (iii) providing culturally competent 1 care; and 2 (iv) providing accessible care to people 3 with disabilities; and 4 (C) a report on the use of telehealth serv- 5 ices to enhance services provided by dental hy- 6 gienists and therapists, including recommenda- 7 tions for any modifications to the Medicare pro- 8 gram under title XVIII of the Social Security 9 Act and the Medicaid program under title XIX 10 of such Act to better provide for telehealth con- 11 sultations in conjunction with therapists’ and 12 hygienists’ care. 13 (2) HRSA REPORT ON DENTAL SHORTAGE 14 AREAS.—Not later than 1 year after the date of the 15 enactment of this Act, the Secretary of Health and 16 Human Services, acting through the Administrator 17 of the Health Resources and Services Administra- 18 tion, shall submit to Congress a report which details 19 geographic dental access shortages and the pre- 20 paredness of dental providers to offer culturally and 21 linguistically appropriate, affordable, accessible, and 22 timely services. 23 (b) EXPANSION OF DENTAL HEALTH AID THERA- 24 PISTS IN TRIBAL AND URBAN INDIAN COMMUNITIES.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 436 •HR 7585 IH Section 119 of the Indian Health Care Improvement Act 1 (25 U.S.C. 1616l) is amended— 2 (1) in subsection (d)— 3 (A) in paragraph (2), to read as follows: 4 ‘‘(2) REQUIREMENT; EXCLUSION.—Subject to 5 paragraphs (3) and (4), in establishing a national 6 program under paragraph (1), the Secretary— 7 ‘‘(A) shall not reduce the amounts pro- 8 vided for the Community Health Aide Program 9 described in subsections (a) and (b); 10 ‘‘(B) shall exclude dental health aide thera- 11 pist services from services covered under such 12 Program; and 13 ‘‘(C) shall include urban Indian organiza- 14 tions.’’; and 15 (B) in paragraph (3), by striking ‘‘or tribal 16 organization’’ each place it appears and insert- 17 ing ‘‘, tribal organization, or urban Indian orga- 18 nization’’; and 19 (2) in subsection (e), by striking ‘‘or a tribal or- 20 ganization’’ and inserting ‘‘a tribal organization, or 21 an urban Indian organization’’. 22 (c) COVERAGE OF DENTAL SERVICES UNDER THE 23 MEDICARE PROGRAM.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 437 •HR 7585 IH (1) COVERAGE.—Section 1861(s)(2) of the So- 1 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 2 ed— 3 (A) in subparagraph (GG), by striking 4 ‘‘and’’ at the end; 5 (B) in subparagraph (HH), by striking the 6 period and inserting ‘‘; and’’; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(II) dental and oral health services (as defined 10 in subsection (mmm));’’. 11 (2) DENTAL AND ORAL HEALTH SERVICES DE- 12 FINED.—Section 1861 of the Social Security Act (42 13 U.S.C. 1395x), as amended by previous provisions of 14 this Act, is amended by adding at the end the fol- 15 lowing new subsection: 16 ‘‘Dental and Oral Health Services 17 ‘‘(mmm)(1) The term ‘dental and oral health serv- 18 ices’ means services (as defined by the Secretary) that are 19 necessary to prevent disease and promote oral health, re- 20 store oral structures to health and function, and treat 21 emergency conditions, including— 22 ‘‘(A) routine diagnostic and preventive care 23 such as dental cleanings, exams, and x-rays; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 438 •HR 7585 IH ‘‘(B) basic dental services such as fillings and 1 extractions; 2 ‘‘(C) major dental services such as root canals, 3 crowns, and dentures; 4 ‘‘(D) emergency dental care; and 5 ‘‘(E) other necessary services related to dental 6 and oral health (as defined by the Secretary). 7 ‘‘(2) For purposes of paragraph (1), such term shall 8 include mobile and portable oral health services (as de- 9 fined by the Secretary) that— 10 ‘‘(A) are provided for the purpose of over- 11 coming mobility, transportation, and access barriers 12 for individuals; and 13 ‘‘(B) satisfy the standards and certification re- 14 quirements established under section 1902(a)(82)(B) 15 for the State in which the services are provided.’’. 16 (3) PAYMENT AND COINSURANCE.—Section 17 1833(a)(1) of the Social Security Act (42 U.S.C. 18 1395l(a)(1)) is amended— 19 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 20 (B) by inserting before the semicolon at 21 the end the following: ‘‘and (EE) with respect 22 to dental and oral health services (as defined in 23 section 1861(mmm)), the amount paid shall be 24 (i) in the case of such services that are preven- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 439 •HR 7585 IH tive, 100 percent of the lesser of the actual 1 charge for the services or the amount deter- 2 mined under the payment basis determined 3 under section 1848, and (ii) in the case of all 4 other such services, 80 percent of the lesser of 5 the actual charge for the services or the amount 6 determined under the payment basis determined 7 under section 1848’’. 8 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 9 ULE.—Section 1848(j)(3) of the Social Security Act 10 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 11 ‘‘, (2)(II),’’ after ‘‘(including administration of the 12 health risk assessment)’’. 13 (5) DENTURES.—Section 1861(s)(8) of the So- 14 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 15 ed— 16 (A) by striking ‘‘(other than dental)’’ and 17 inserting ‘‘(including dentures)’’; and 18 (B) by striking ‘‘internal body’’. 19 (6) REPEAL OF GROUND FOR EXCLUSION.— 20 Section 1862(a) of the Social Security Act (42 21 U.S.C. 1395y) is amended by striking paragraph 22 (12). 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 440 •HR 7585 IH (7) EFFECTIVE DATE.—The amendments made 1 by this section shall apply to services furnished on 2 or after January 1, 2023. 3 (d) REQUIRING COVERAGE OF DENTAL SERVICES 4 UNDER THE MEDICAID PROGRAM.— 5 (1) MANDATORY COVERAGE.— 6 (A) IN GENERAL.— 7 (i) REQUIREMENT.—Section 8 1902(a)(10)(A) of the Social Security Act 9 (42 U.S.C. 1396a(a)(10)(A)) is amended 10 by inserting ‘‘, (10)’’ after ‘‘(5)’’. 11 (ii) EFFECTIVE DATE.—The amend- 12 ment made by clause (i) shall apply with 13 respect to medical assistance furnished in 14 calendar quarters beginning on or after the 15 date that is 1 year after the date of the en- 16 actment of this Act. 17 (B) BENCHMARK COVERAGE.—Section 18 1937(b)(5) of the Social Security Act (42 19 U.S.C. 1396u–7(b)(5)) is amended by striking 20 the period and inserting ‘‘, and, beginning with 21 the first quarter beginning on or after the date 22 of the enactment of the Health Equity and Ac- 23 countability Act of 2022, coverage of dental and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 441 •HR 7585 IH oral health services (as defined in section 1 1905(jj)).’’. 2 (2) DEFINITION OF SERVICES.—Section 1905 3 of the Social Security Act (42 U.S.C. 1396d) is 4 amended— 5 (A) in subsection (a)(10), by striking ‘‘den- 6 tal services’’ and inserting ‘‘dental and oral 7 health services (as defined in subsection 8 (jj)(1))’’; and 9 (B) by adding at the end the following new 10 subsection: 11 ‘‘(jj) DENTAL AND ORAL HEALTH SERVICES.—(1) 12 For purposes of this title, the term ‘dental and oral health 13 services’ means services necessary to prevent disease and 14 promote oral health, restore oral structures to health and 15 function, reduce oral pain, and treat emergency oral condi- 16 tions. Such term includes the services specified in para- 17 graph (2). 18 ‘‘(2) For purposes of paragraph (1), the services 19 specified in this paragraph are the following: 20 ‘‘(A) Routine diagnostic and preventive care 21 (such as dental cleanings, exams, and x-rays). 22 ‘‘(B) Basic dental services (such as fillings and 23 extractions) and major dental services (such as root 24 canals, crowns, and dentures). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 442 •HR 7585 IH ‘‘(C) Emergency dental care. 1 ‘‘(D) Temporomandibular (TMD) and orofacial 2 pain disorder treatment. 3 ‘‘(E) Other necessary services related to dental 4 and oral health (as specified by the Secretary). 5 ‘‘(3) For purposes of paragraph (1), such term shall 6 not include dental care or services provided to individuals 7 under the age of 21 under subsection (r)(3).’’. 8 (3) CONFORMING AMENDMENTS.— 9 (A) STATE PLAN REQUIREMENTS.—Section 10 1902(a) of the Social Security Act (42 U.S.C. 11 1396a(a)) is amended— 12 (i) in paragraph (10)(A), in the mat- 13 ter preceding clause (i), by inserting 14 ‘‘(10),’’ after ‘‘(5),’’; 15 (ii) in paragraph (85), by striking 16 ‘‘and’’ at the end; 17 (iii) in paragraph (86), by striking the 18 period at the end and inserting ‘‘; and’’; 19 and 20 (iv) by inserting after paragraph (86) 21 the following: 22 ‘‘(87) provide for— 23 ‘‘(A) informing, in writing, all individuals 24 who have been determined to be eligible for 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 443 •HR 7585 IH medical assistance of the availability of oral 1 health services (as defined in section 1905(gg)); 2 ‘‘(B) conducting targeted outreach to preg- 3 nant women who have been determined to be el- 4 igible for medical assistance about the avail- 5 ability of medical assistance for such dental 6 services and the importance of receiving dental 7 care while pregnant; and 8 ‘‘(C) establishing and maintaining stand- 9 ards for and certification of mobile and portable 10 oral health services (as described in subsections 11 (r)(3)(C) and (jj)(2)(B) of section 1905).’’. 12 (B) DEFINITION OF MEDICAL ASSIST- 13 ANCE.—Section 1905(a)(12) of the Social Secu- 14 rity Act (42 U.S.C. 1396d(a)(12)) is amended 15 by striking ‘‘, dentures,’’. 16 (4) MOBILE AND PORTABLE ORAL HEALTH 17 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 18 Social Security Act (42 U.S.C. 1396d(r)(3)) is 19 amended— 20 (A) in subparagraph (A)(ii), by striking ‘‘; 21 and’’ and inserting a semicolon; 22 (B) in subparagraph (B), by striking the 23 period at the end and inserting ‘‘; and’’; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 444 •HR 7585 IH (C) by adding at the end the following new 1 subparagraph: 2 ‘‘(C) which shall include mobile and port- 3 able oral health services (as defined by the Sec- 4 retary) that— 5 ‘‘(i) are provided for the purpose of 6 overcoming mobility, transportation, or ac- 7 cess barriers for children; and 8 ‘‘(ii) satisfy the standards and certifi- 9 cation requirements established under sec- 10 tion 1902(a)(87)(C) for the State in which 11 the services are provided.’’. 12 (5) ENHANCED FMAP; MAINTENANCE OF EF- 13 FORT.— 14 (A) MEDICAID.—Section 1905 of the So- 15 cial Security Act (42 U.S.C. 1396d), as amend- 16 ed by paragraph (2), is further amended— 17 (i) in subsection (b), by striking ‘‘and 18 (ii)’’ and inserting ‘‘(ii), and (kk)’’; and 19 (ii) by adding at the end of the fol- 20 lowing new subsection: 21 ‘‘(kk) INCREASED FMAP FOR EXPENDITURES FOR 22 DENTAL AND ORAL HEALTH SERVICES.— 23 ‘‘(1) IN GENERAL.—The Federal medical assist- 24 ance percentage with respect to amounts expended 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 445 •HR 7585 IH by such State for medical assistance consisting of 1 dental and oral health services (as defined in sub- 2 section (jj)) furnished during the first calendar 3 quarter beginning on or after the date that is 1 year 4 after the date of the enactment of this subsection or 5 during any subsequent quarter) to individuals 21 6 years of age or older shall be equal to, in the case 7 of such services furnished— 8 ‘‘(A) during the 3-year period beginning on 9 the first day of such first calendar year, 100 10 percent; 11 ‘‘(B) during the 1-year period immediately 12 following the period described in subparagraph 13 (A), 95 percent; 14 ‘‘(C) during each subsequent 1-year period 15 (through the third such subsequent period), the 16 percentage specified under this paragraph for 17 the preceding 1-year period, reduced by 5 per- 18 centage points; and 19 ‘‘(D) during any quarter beginning after 20 the 7-year period beginning on the first day de- 21 scribed in subparagraph (A), 80 percent. 22 ‘‘(2) NO REDUCTION IN FMAP.—Paragraph (1) 23 shall not apply with respect to amounts expended by 24 a State if the Federal medical assistance percentage 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 446 •HR 7585 IH otherwise applicable to such amounts without appli- 1 cation of such paragraph would be higher than such 2 percentage available to such amounts with applica- 3 tion of such paragraph.’’. 4 (6) EXCLUSION OF AMOUNTS ATTRIBUTABLE 5 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 6 Section 1108 of the Social Security Act (42 U.S.C. 7 1308) is amended— 8 (A) in subsection (f), in the matter pre- 9 ceding paragraph (1), by striking ‘‘subsections 10 (g), (h), and (i)’’; and 11 (B) by adding at the end the following: 12 ‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB- 13 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN- 14 TAL AND ORAL SERVICES.—Any payment made to a terri- 15 tory for expenditures for medical assistance that are sub- 16 ject to an increase in the Federal medical assistance per- 17 centage applicable to such expenditures under section 18 1905(kk) shall not be taken into account for purposes of 19 applying payment limits under subsections (f) and (g) to 20 the extent that such payment exceeds the amount of the 21 payment that would have been made to the territory for 22 such expenditures without regard to such section.’’. 23 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 24 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 447 •HR 7585 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 448 •HR 7585 IH care services for veterans who are entitled to such 1 services from the Department of Veterans Affairs 2 and reside in rural and other underserved commu- 3 nities. 4 (2) TELEHEALTH.—For purposes of alternative 5 dental health care providers and other dental care 6 providers who are licensed to provide clinical care, 7 dental services provided under the demonstration 8 program under this subsection may be administered 9 by such providers through telehealth-enabled collabo- 10 ration and supervision when appropriate and fea- 11 sible. 12 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 13 VIDERS DEFINED.—In this subsection, the term ‘‘al- 14 ternative dental health care providers’’ has the 15 meaning given that term in section 340G–1(a)(2) of 16 the Public Health Service Act (42 U.S.C. 256g– 17 1(a)(2)). 18 (4) AUTHORIZATION OF APPROPRIATIONS.— 19 There are authorized to be appropriated such sums 20 as are necessary to carry out the demonstration pro- 21 gram under this subsection. 22 (g) DEMONSTRATION PROGRAM ON TRAINING AND 23 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 24 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 449 •HR 7585 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 a reserve component of 14 the Armed Forces in active status who are po- 15 tentially 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 (3) DEFINITIONS.—In this subsection: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 450 •HR 7585 IH (A) ACTIVE STATUS.—The term ‘‘active 1 status’’ has the meaning given that term in sec- 2 tion 101(d) of title 10, United States Code. 3 (B) ALTERNATIVE DENTAL HEALTH CARE 4 PROVIDERS.—The term ‘‘alternative dental 5 health care providers’’ has the meaning given 6 that term in section 340G–1(a)(2) of the Public 7 Health Service Act (42 U.S.C. 256g–1(a)(2)). 8 (4) AUTHORIZATION OF APPROPRIATIONS.— 9 There are authorized to be appropriated such sums 10 as are necessary to carry out the demonstration pro- 11 gram under this subsection. 12 (h) DEMONSTRATION PROGRAM ON TRAINING AND 13 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 14 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 15 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 16 PRISONS.— 17 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 18 The Attorney General, acting through the Director 19 of the Bureau of Prisons, may carry out a dem- 20 onstration program to establish programs to train 21 and employ alternative dental health care providers 22 in order to increase access to dental health services 23 for prisoners within the custody of the Bureau of 24 Prisons. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 451 •HR 7585 IH (2) TELEHEALTH.—For purposes of alternative 1 dental health care providers and other dental care 2 providers who are licensed to provide clinical care, 3 dental services provided under the demonstration 4 program under this subsection may be administered 5 by such providers through telehealth-enabled collabo- 6 ration and supervision when appropriate and fea- 7 sible. 8 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 9 VIDERS DEFINED.—In this subsection and sub- 10 section (i), the term ‘‘alternative dental health care 11 providers’’ has the meaning given that term in sec- 12 tion 340G–1(a)(2) of the Public Health Service Act 13 (42 U.S.C. 256g–1(a)(2)). 14 (4) AUTHORIZATION OF APPROPRIATIONS.— 15 There are authorized to be appropriated such sums 16 as are necessary to carry out the demonstration pro- 17 gram under this subsection. 18 (i) DEMONSTRATION PROGRAM ON TRAINING AND 19 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 20 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 21 UNDER THE INDIAN HEALTH SERVICE.— 22 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 23 The Secretary of Health and Human Services, act- 24 ing through the Indian Health Service, may carry 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 452 •HR 7585 IH out a demonstration program to establish programs 1 to train and employ alternative dental health care 2 providers in order to help eliminate oral health dis- 3 parities and increase access to dental services 4 through health programs operated by the Indian 5 Health Service, Indian tribes, tribal organizations, 6 and urban Indian organizations (as the preceding 3 7 terms are defined in section 4 of the Indian Health 8 Care Improvement Act (25 U.S.C. 1603)). 9 (2) TELEHEALTH.—For purposes of alternative 10 dental health care providers and other dental care 11 providers who are licensed to provide clinical care, 12 dental services provided under the demonstration 13 program under this subsection may be administered 14 by such providers through telehealth-enabled collabo- 15 ration and supervision when appropriate and fea- 16 sible. 17 (3) AUTHORIZATION OF APPROPRIATIONS.— 18 There are authorized to be appropriated such sums 19 as are necessary to carry out the demonstration pro- 20 gram under this subsection. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 453 •HR 7585 IH SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAM- 1 PAIGN. 2 The Public Health Service Act is amended by insert- 3 ing after section 340G–1 of such Act (42 U.S.C. 256g– 4 1) the following: 5 ‘‘SEC. 340G–2. ORAL HEALTH LITERACY AND AWARENESS. 6 ‘‘(a) CAMPAIGN.—The Secretary, acting through the 7 Administrator of the Health Resources and Services Ad- 8 ministration, shall establish a public education campaign 9 (referred to in this subsection as the ‘campaign’) across 10 all relevant programs of the Health Resources and Serv- 11 ices Administration (including the health center program, 12 oral health workforce programs, maternal and child health 13 programs, the Ryan White HIV/AIDS Program, and rural 14 health programs) to increase oral health literacy and 15 awareness. 16 ‘‘(b) STRATEGIES.—In carrying out the campaign, 17 the Secretary shall identify oral health literacy and aware- 18 ness strategies that are evidence-based and focused on oral 19 health care education, including education on prevention 20 of oral disease such as early childhood and other caries, 21 periodontal disease, and oral cancer. 22 ‘‘(c) FOCUS.—The Secretary shall design the cam- 23 paign to communicate directly with specific populations, 24 including children, pregnant women, parents, the elderly, 25 individuals with disabilities, and ethnic and racial minority 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 454 •HR 7585 IH populations, including Indians, Alaska Natives, and Na- 1 tive Hawaiians, in a culturally and linguistically appro- 2 priate manner. 3 ‘‘(d) OUTCOMES.—In carrying out the campaign, the 4 Secretary shall include a process for measuring outcomes 5 and effectiveness. 6 ‘‘(e) REPORT TO CONGRESS.—Not later than 3 years 7 after the date of enactment of this section, the Secretary 8 shall submit to the Committee on Energy and Commerce 9 of the House of Representatives and the Committee on 10 Health, Education, Labor, and Pensions of the Senate a 11 report on the outcomes and effectiveness of the campaign. 12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this section, there is authorized to be appro- 14 priated $750,000 for each of fiscal years 2023 through 15 2027.’’. 16 Subtitle D—Advancing Health Eq- 17 uity Through Payment and De- 18 livery Reform 19 SEC. 4301. SENSE OF CONGRESS. 20 It is the sense of Congress that— 21 (1) the sustainability of the health care system 22 in the United States hinges on restructuring how 23 health care is paid for, shifting away from paying 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 455 •HR 7585 IH for the volume of services provided to the value the 1 services provide; 2 (2) high value care is care that provides higher 3 quality care more efficiently, achieving greater 4 health improvement and better health outcomes at 5 lower cost (per patient and overall); 6 (3) a high value health care system must deliver 7 timely, accessible, well-coordinated, high-quality, cul- 8 turally centered, and language-appropriate care to 9 everyone; 10 (4) eliminating health and health care dispari- 11 ties and achieving health equity must be central to 12 and required in efforts to achieve a high value health 13 care system; 14 (5) eliminating such disparities and achieving 15 such equity will require tailored interventions and 16 targeted investments to address inequities in health 17 and health care to make sure that health care deliv- 18 ery and payment efforts are responsive to and inclu- 19 sive of the needs of communities of color and other 20 communities experiencing disparities; and 21 (6) new models of value-based payment and 22 care delivery should prioritize primary care and con- 23 sider the holistic needs of and other factors with re- 24 spect to the patient population, including with re- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 456 •HR 7585 IH spect to behavioral health, oral health, end-of-life 1 care, history of adverse childhood experiences and 2 adverse community environments, social deter- 3 minants of health, social risk factors, unmet social 4 needs, and the burden of intergenerational racial 5 and other inequities. 6 SEC. 4302. CENTERS FOR MEDICARE & MEDICAID SERVICES 7 REPORTING AND VALUE-BASED PROGRAMS. 8 (a) ADVANCING HEALTH EQUITY IN REPORTING AND 9 VALUE-BASED PAYMENT PROGRAMS.— 10 (1) IN GENERAL.—The Administrator of the 11 Centers for Medicare & Medicaid Services (in this 12 section referred to as the ‘‘Administrator’’) shall re- 13 quire that a clinician or other professional partici- 14 pating in any pay-for-reporting or value-based pay- 15 ment program stratify clinical quality measures by 16 disparity variables, including race, ethnicity, sex, pri- 17 mary language, disability status, sexual orientation, 18 gender identity, and socioeconomic status. A clini- 19 cian or other professional may use existing demo- 20 graphic data collection fields in certified electronic 21 health record technology (as defined in section 22 1848(o)(4) of the Social Security Act (42 U.S.C. 23 1395w–4(o)(4))) to carry out such data stratifica- 24 tion under the preceding sentence. Such stratified 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 457 •HR 7585 IH data will assist clinicians and other professionals in 1 the identification of disparities obscured in aggre- 2 gated data and assist with the provision of interven- 3 tions that target reducing those disparities. 4 (2) CLINICIAN.—In assessing performance in 5 any value-based payment program, the Adminis- 6 trator shall incorporate a clinician or other profes- 7 sional’s performance in reducing disparities across 8 race, ethnicity, sex, primary language, disability sta- 9 tus, sexual orientation, gender identity, and socio- 10 economic status. Linking performance payments to 11 the reduction of health care disparities across such 12 variables will assist in holding clinicians and other 13 professionals accountable for providing quality care 14 that can lead to decreased health inequities. 15 (3) REQUIREMENT OF ADOPTION OF CERT.—All 16 entities, clinicians, or other professionals partici- 17 pating in the Quality Payment Program of the Cen- 18 ters for Medicare & Medicaid Services shall be re- 19 quired to adopt 2015 certified electronic health 20 record technology (as so defined) as a condition of 21 participating in such program. 22 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad- 23 ministrator, upon yearly review of the Quality Payment 24 Program, shall add quality improvement activities that im- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 458 •HR 7585 IH plement the Culturally and Linguistically Accessible 1 Standards (CLAS) as Improvement Activities under the 2 Quality Payment Program. 3 SEC. 4303. DEVELOPMENT AND TESTING OF DISPARITY RE- 4 DUCING DELIVERY AND PAYMENT MODELS. 5 (a) IN GENERAL.—The Center for Medicare and 6 Medicaid Innovation established under section 1115A of 7 the Social Security Act (42 U.S.C. 1315a) (in this section 8 referred to as the ‘‘CMI’’) shall establish a dedicated fund 9 to identify, test, evaluate, and scale delivery and payment 10 models under the applicable titles (as defined in subsection 11 (a)(4)(B) of such section) that target health disparities 12 among racial and ethnic minorities, including models that 13 support high-value nonmedical services that address so- 14 cially determined barriers to health in all stages of the 15 life cycle through end-of-life, including English proficiency 16 status, low health and health care literacy, lack of access 17 to health care planning, including end-of-life care plan- 18 ning, case management, transportation, enrollment assist- 19 ance needs, stable and affordable housing, utility assist- 20 ance, employment and career development, and nutrition 21 and food security which will help to reduce disparities and 22 impact the overall cost of care. 23 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 24 second sentence of section 1115A(a)(1) of the Social Secu- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 459 •HR 7585 IH rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 1 ‘‘and improve health equity’’ after ‘‘expenditures’’. 2 (c) PILOT PROGRAMS.—The CMI shall prioritize the 3 testing of models under such section 1115A that include 4 partnerships with entities, including community based or- 5 ganizations or other nonprofit entities, to help address so- 6 cially determined barriers to health and health care. 7 (d) ALTERNATIVES.—Any model tested by the CMI 8 under such 1115A shall include measures to assess and 9 track the impact of the model on health disparities, using 10 existing measures such as the Healthcare Disparities and 11 Cultural Competency Measures endorsed by the entity 12 with a contract under section 1890(a) of the Social Secu- 13 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 14 ethnicity, English proficiency, gender identity, sexual ori- 15 entation, and disability status. 16 SEC. 4304. DIVERSITY IN CENTERS FOR MEDICARE AND 17 MEDICAID CONSULTATION. 18 (a) IN GENERAL.—In carrying out the duties under 19 this section, the CMI shall consult representatives of rel- 20 evant Federal agencies, and clinical and analytical experts 21 with expertise in medicine and health care management, 22 specifically such experts with expertise in— 23 (1) the health care needs of minority, rural, and 24 underserved populations; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 460 •HR 7585 IH (2) the financial needs of safety net, community 1 based, rural, and critical access providers, including 2 federally qualified health centers. 3 (b) OPEN DOOR FORUMS.—The CMI shall use open 4 door forums or other mechanisms to seek external feed- 5 back from interested parties and incorporate that feedback 6 into the development of models. 7 SEC. 4305. SUPPORTING SAFETY NET AND COMMUNITY- 8 BASED PROVIDERS TO COMPETE IN VALUE- 9 BASED PAYMENT SYSTEMS. 10 (a) IN GENERAL.—Any pay-for-performance or alter- 11 native payment model that is developed and tested by the 12 Center for Medicare and Medicaid Innovation established 13 under section 1115A of the Social Security Act (42 U.S.C. 14 1315a), or any other agency of the Department of Health 15 and Human Services with respect to the programs under 16 titles XVIII, XIX, or XXI of such Act, shall be assessed 17 for potential impact on safety net, community based, and 18 critical access providers, including Federally qualified 19 health centers. 20 (b) NEW MODELS.—The rollout of any such models 21 shall include training and additional up front resources for 22 community based and safety net providers to enable those 23 providers to participate in the model. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 461 •HR 7585 IH Subtitle E—Health Empowerment 1 Zones 2 SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT 3 ZONES. 4 (a) IN GENERAL.—The Secretary may, at the request 5 of an eligible community partnership described in sub- 6 section (b)(1), designate an eligible area described in sub- 7 section (b)(2) as a health empowerment zone for the pur- 8 pose of eligibility for a grant under section 4402. 9 (b) ELIGIBILITY CRITERIA.— 10 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 11 community partnership is eligible to submit a re- 12 quest under this section if the partnership— 13 (A) demonstrates widespread public sup- 14 port from key individuals and entities in the eli- 15 gible area, including members of the target 16 community, State and local governments, non- 17 profit organizations including national and re- 18 gional intermediaries with demonstrated capac- 19 ity to serve low-income urban communities, and 20 community and industry leaders, for designa- 21 tion of the eligible area as a health empower- 22 ment zone; and 23 (B) includes representatives of— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 462 •HR 7585 IH (i) a broad cross section of stake- 1 holders and residents from communities in 2 the eligible area experiencing dispropor- 3 tionate disparities in health status and 4 health care; and 5 (ii) organizations, facilities, and insti- 6 tutions that have a history of working 7 within and serving such communities. 8 (2) ELIGIBLE AREA.—An area is eligible to be 9 designated as a health empowerment zone under this 10 section if one or more communities in the area expe- 11 rience disproportionate disparities in health status 12 and health care. In determining whether a commu- 13 nity experiences such disparities, the Secretary shall 14 consider data collected by the Department of Health 15 and Human Services focusing on the following areas: 16 (A) Access to affordable, high-quality 17 health care services. 18 (B) The prevalence of disproportionate 19 rates of certain illnesses or diseases including 20 the following: 21 (i) Arthritis, osteoporosis, chronic 22 back conditions, and other musculoskeletal 23 diseases. 24 (ii) Cancer. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 463 •HR 7585 IH (iii) Chronic kidney disease. 1 (iv) Diabetes. 2 (v) Injury (intentional and uninten- 3 tional). 4 (vi) Violence (intimate and non- 5 intimate). 6 (vii) Maternal and paternal illnesses 7 and diseases. 8 (viii) Infant mortality. 9 (ix) Mental illness and other disabil- 10 ities. 11 (x) Substance use disorder treatment 12 and prevention, including underage drink- 13 ing. 14 (xi) Nutrition, obesity, and overweight 15 conditions. 16 (xii) Heart disease. 17 (xiii) Hypertension. 18 (xiv) Cerebrovascular disease or 19 stroke. 20 (xv) Tuberculosis. 21 (xvi) HIV/AIDS and other sexually 22 transmitted infections. 23 (xvii) Viral hepatitis. 24 (xviii) Asthma. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 464 •HR 7585 IH (xix) Tooth decay and other oral 1 health issues. 2 (C) Within the community, the historical 3 and persistent presence of conditions that have 4 been found to contribute to health disparities 5 including any such conditions respecting any of 6 the following: 7 (i) Poverty. 8 (ii) Educational status and the quality 9 of community schools. 10 (iii) Income. 11 (iv) Access to high-quality affordable 12 health care. 13 (v) Work and work environment. 14 (vi) Environmental conditions in the 15 community, including with respect to clean 16 water, clean air, and the presence or ab- 17 sence of pollutants. 18 (vii) Language and English pro- 19 ficiency. 20 (viii) Access to affordable healthy 21 food. 22 (ix) Access to ethnically and culturally 23 diverse health and human service providers 24 and practitioners. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 465 •HR 7585 IH (x) Access to culturally and linguis- 1 tically competent health and human serv- 2 ices and health and human service pro- 3 viders. 4 (xi) Health-supporting infrastructure. 5 (xii) Health insurance that is ade- 6 quate and affordable. 7 (xiii) Race, racism, and bigotry (con- 8 scious and unconscious). 9 (xiv) Sexual orientation. 10 (xv) Health and health care literacy. 11 (xvi) Place of residence (such as 12 urban areas, rural areas, and reservations 13 of Indian Tribes). 14 (xvii) Stress. 15 (c) PROCEDURE.— 16 (1) REQUEST.—A request under subsection (a) 17 shall— 18 (A) describe the bounds of the area to be 19 designated as a health empowerment zone and 20 the process used to select those bounds; 21 (B) demonstrate that the partnership sub- 22 mitting the request is an eligible community 23 partnership described in subsection (b)(1); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 466 •HR 7585 IH (C) demonstrate that the area is an eligible 1 area described in subsection (b)(2); 2 (D) include a comprehensive assessment of 3 disparities in health status and health care ex- 4 perience by one or more communities in the 5 area; 6 (E) set forth— 7 (i) a vision and a set of values for the 8 area; and 9 (ii) a comprehensive and holistic set of 10 goals to be achieved in the area through 11 designation as a health empowerment zone; 12 and 13 (F) include a strategic plan and an action 14 plan for achieving the goals described in sub- 15 paragraph (E)(ii). 16 (2) APPROVAL.—Not later than 60 days after 17 the receipt of a request for designation of an area 18 as a health empowerment zone under this section, 19 the Secretary shall approve or disapprove the re- 20 quest. 21 (d) MINIMUM NUMBER.—The Secretary— 22 (1) shall designate not more than 110 health 23 empowerment zones under this section; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 467 •HR 7585 IH (2) of such zones designated under paragraph 1 (1), shall designate at least one health empowerment 2 zone in each of the several States, the District of 3 Columbia, and each territory or possession of the 4 United States. 5 SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION. 6 At the request of any organization or entity seeking 7 to submit a request under section 4401(a), the Secretary 8 shall provide technical assistance, and may award a grant, 9 to assist such organization or entity— 10 (1) to form an eligible community partnership 11 described in section 4401(b)(1); 12 (2) to complete a health assessment, including 13 an assessment of health disparities under section 14 4401(c)(1)(D); or 15 (3) to prepare and submit a request, including 16 a strategic plan, in accordance with section 4401. 17 SEC. 4403. BENEFITS OF DESIGNATION. 18 (a) PRIORITY.—In awarding a grant under sub- 19 section (b), a Federal official shall give priority to any ap- 20 plicant that— 21 (1) meets the eligibility criteria for the grant; 22 (2) proposes to use the grant for activities in a 23 health empowerment zone; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 468 •HR 7585 IH (3) demonstrates that such activities will di- 1 rectly and significantly further the goals of the stra- 2 tegic plan approved for such zone under section 3 4401. 4 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 5 STRATEGIC PLAN.— 6 (1) IN GENERAL.—Upon designating an eligible 7 area as a health empowerment zone at the request 8 of an eligible community partnership, the Secretary 9 shall, subject to the availability of appropriations, 10 make a grant to the community partnership for im- 11 plementation of the strategic plan for such zone. 12 (2) GRANT PERIOD.—A grant under paragraph 13 (1) for a health empowerment zone shall be for a pe- 14 riod of 2 years and may be renewed, except that the 15 total period of grants under paragraph (1) for such 16 zone may not exceed 10 years. 17 (3) LIMITATION.—In awarding grants under 18 this subsection, the Secretary shall not give less pri- 19 ority to an applicant or reduce the amount of a 20 grant because the Secretary rendered technical as- 21 sistance or made a grant to the same applicant 22 under section 4401. 23 (4) REPORTING.—The Secretary shall establish 24 metrics for measuring the progress of grantees 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 469 •HR 7585 IH under this subsection and, based on such metrics, 1 require each such grantee to report to the Secretary 2 not less than every 6 months on the progress in im- 3 plementing the strategic plan for the health em- 4 powerment zone. 5 SEC. 4404. DEFINITION OF SECRETARY. 6 In this subtitle, the term ‘‘Secretary’’ means the Sec- 7 retary of Health and Human Services, acting through the 8 Administrator of the Health Resources and Services Ad- 9 ministration and the Deputy Assistant Secretary for Mi- 10 nority Health, and in cooperation with the Director of the 11 Office of Community Services and the Director of the Na- 12 tional Institute on Minority Health and Health Dispari- 13 ties. 14 SEC. 4405. AUTHORIZATION OF APPROPRIATIONS. 15 To carry out this subtitle, there is authorized to be 16 appropriated $100,000,000 for fiscal year 2023. 17 Subtitle F—Equitable Health Care 18 For All 19 SEC. 4501. FINDINGS. 20 Congress finds the following: 21 (1) In 1966, Dr. Martin Luther King, Jr., said 22 ‘‘Of all the forms of inequality, injustice in health 23 care is the most shocking and inhuman because it 24 often results in physical death.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 470 •HR 7585 IH (2) Inequity in health care remains a persistent 1 and devastating reality for many communities, and, 2 in particular, communities of color. 3 (3) The provision of inequitable health care has 4 complex causes, many stemming from systemic in- 5 equality in access to health care, housing, nutrition, 6 economic opportunity, education, and other factors. 7 (4) Health care outcomes for Black commu- 8 nities in particular lag far behind those of the popu- 9 lation as a whole. 10 (5) Dr. Anthony Fauci, Director of the Na- 11 tional Institute of Allergy and Infectious Diseases, 12 said on April 7, 2020, the coronavirus outbreak is 13 ‘‘shining a bright light’’ on ‘‘unacceptable’’ health 14 disparities in the Black community. 15 (6) A contributing factor in health disparities is 16 explicit and implicit bias in the delivery of health 17 care, resulting in inferior care and poorer outcomes 18 for some patients on the basis of factors that include 19 race, national origin, sex (including sexual orienta- 20 tion or gender identity), disability, age, and religion. 21 (7) The National Academy of Medicine (for- 22 merly known as the ‘‘Institute of Medicine’’) issued 23 a report in 2002 titled ‘‘Unequal Treatment’’, find- 24 ing that racial and ethnic minorities receive lower- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 471 •HR 7585 IH quality health care than Whites do, even when insur- 1 ance status, income, age, and severity of condition is 2 comparable. 3 (8) Just as Congress has sought to eliminate 4 bias, both explicit and implicit, in employment, hous- 5 ing, and other parts of our society, the elimination 6 of bias and the legacy of structural racism in health 7 care is of paramount importance. 8 SEC. 4502. DATA COLLECTION AND REPORTING. 9 (a) REQUIRED REPORTING.— 10 (1) IN GENERAL.—The Secretary of Health and 11 Human Services, in consultation with the Director 12 for Civil Rights and Health Equity, the Director of 13 the National Institutes of Health, the Administrator 14 of the Centers for Medicare & Medicaid Services, the 15 Director of the Agency for Healthcare Research and 16 Quality, the Deputy Assistant Secretary for Minority 17 Health, and the Director of the Centers for Disease 18 Control and Prevention, shall by regulation require 19 all health care providers and facilities that are re- 20 quired under other provisions of law to report data 21 on specific health outcomes to the Department of 22 Health and Human Services in aggregate form, to 23 disaggregate such data by demographic characteris- 24 tics, including by race, national origin, sex (including 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 472 •HR 7585 IH sexual orientation and gender identity), disability, 1 and age, as well as any other factor that the Sec- 2 retary of Health and Human Services determines 3 would be useful for determining a pattern of provi- 4 sion of inequitable health care. 5 (2) PROPOSED REGULATIONS.—Not later than 6 90 days after the date of enactment of this Act, the 7 Secretary of Health and Human Services shall issue 8 proposed regulations to carry out paragraph (1). 9 (b) REPOSITORY.—The Secretary of Health and 10 Human Services shall— 11 (1) not later than 1 year after the date of en- 12 actment of this Act, establish a repository of the 13 disaggregated data reported pursuant to subsection 14 (a); 15 (2) subject to paragraph (3), make the data in 16 such repository publicly available; and 17 (3) ensure that such repository does not contain 18 any data that is individually identifiable. 19 SEC. 4503. REQUIRING EQUITABLE HEALTH CARE IN THE 20 HOSPITAL VALUE-BASED PURCHASING PRO- 21 GRAM. 22 (a) EQUITABLE HEALTH CARE AS VALUE MEASURE- 23 MENT.—Section 1886(b)(3)(B)(viii) of the Social Security 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 473 •HR 7585 IH Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 1 adding at the end the following new subclause: 2 ‘‘(XIII)(aa) Effective for payments beginning with 3 fiscal year 2024, in expanding the number of measures 4 under subclause (III), the Secretary shall adopt measures 5 that relate to equitable health care furnished by hospitals 6 in inpatient settings. 7 ‘‘(bb) In carrying out this subclause, the Secretary 8 shall solicit input and recommendations from individuals 9 and groups representing communities of color and other 10 protected classes and ensure measures adopted pursuant 11 to this subclause account for social determinants of health, 12 as defined in section 7(e)(10) of the Equal Health Care 13 for All Act. 14 ‘‘(cc) For purposes of this subclause, the term ‘equi- 15 table health care’ refers to the principle that high-quality 16 care should be provided to all individuals and health care 17 treatment and services should not vary on account of the 18 real or perceived race, national origin, sex (including sex- 19 ual orientation and gender identity), disability, or age of 20 an individual, as well as any other factor that the Sec- 21 retary determines would be useful for determining a pat- 22 tern of provision of inequitable health care.’’. 23 (b) INCLUSION OF EQUITABLE HEALTH CARE MEAS- 24 URES.—Section 1886(o)(2)(B) of the Social Security Act 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 474 •HR 7585 IH (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 1 end the following new clause: 2 ‘‘(iv) INCLUSION OF EQUITABLE 3 HEALTH CARE MEASURES.—Beginning in 4 fiscal year 2024, measures selected under 5 subparagraph (A) shall include the equi- 6 table health care measures described in 7 subsection (b)(3)(B)(viii)(XIII).’’. 8 SEC. 4504. PROVISION OF INEQUITABLE HEALTH CARE AS A 9 BASIS FOR PERMISSIVE EXCLUSION FROM 10 MEDICARE AND STATE HEALTH CARE PRO- 11 GRAMS. 12 Section 1128(b) of the Social Security Act (42 U.S.C. 13 1320a–7(b)) is amended by adding at the end the fol- 14 lowing new paragraph: 15 ‘‘(18) PROVISION OF INEQUITABLE HEALTH 16 CARE.— 17 ‘‘(A) IN GENERAL.—Subject to subpara- 18 graph (B), any health care provider that the 19 Secretary determines has engaged in a pattern 20 of providing inequitable health care (as defined 21 in section 7(e)(7) of the Equal Health Care for 22 All Act) on the basis of race, national origin, 23 sex (including sexual orientation and gender 24 identity), disability, or age of an individual. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 475 •HR 7585 IH ‘‘(B) EXCEPTION.—For purposes of car- 1 rying out subparagraph (A), the Secretary shall 2 not exclude any health care provider from par- 3 ticipation in the Medicare program under title 4 XVIII of the Social Security Act or the Med- 5 icaid program under title XIX of such Act if 6 the exclusion of such health care provider would 7 result in increased difficulty in access to health 8 care services for underserved or low-income 9 communities.’’. 10 SEC. 4505. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY 11 OF THE DEPARTMENT OF HEALTH AND 12 HUMAN SERVICES. 13 (a) NAME OF OFFICE.—Beginning on the date of en- 14 actment of this Act, the Office for Civil Rights of the De- 15 partment of Health and Human Services shall be known 16 as the ‘‘Office for Civil Rights and Health Equity’’ of the 17 Department of Health and Human Services. Any ref- 18 erence to the Office for Civil Rights of the Department 19 of Health and Human Services in any law, regulation, 20 map, document, record, or other paper of the United 21 States shall be deemed to be a reference to the Office for 22 Civil Rights and Health Equity. 23 (b) HEAD OF OFFICE.—The head of the Office for 24 Civil Rights and Health Equity shall be the Director for 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 476 •HR 7585 IH Civil Rights and Health Equity, to be appointed by the 1 President. Any reference to the Director of the Office for 2 Civil Rights of the Department of Health and Human 3 Services in any law, regulation, map, document, record, 4 or other paper of the United States shall be deemed to 5 be a reference to the Director for Civil Rights and Health 6 Equity. 7 SEC. 4506. PROHIBITING DISCRIMINATION IN HEALTH 8 CARE. 9 (a) PROHIBITING DISCRIMINATION.— 10 (1) IN GENERAL.—No health care provider 11 may, on the basis, in whole or in part, of race, sex 12 (including sexual orientation and gender identity), 13 disability, age, or religion, subject an individual to 14 the provision of inequitable health care. 15 (2) NOTICE OF PATIENT RIGHTS.—The Sec- 16 retary shall provide to each patient a notice of a pa- 17 tient’s rights under this section. 18 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION 19 PROCESS.— 20 (1) COMPLAINTS AND ANSWERS.— 21 (A) IN GENERAL.—An aggrieved person 22 may, not later than 1 year after an alleged vio- 23 lation of subsection (a) has occurred or con- 24 cluded, file a complaint with the Director alleg- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 477 •HR 7585 IH ing inequitable provision of health care by a 1 provider described in subsection (a). 2 (B) COMPLAINT.—A complaint submitted 3 pursuant to subparagraph (A) shall be in writ- 4 ing and shall contain such information and be 5 in such form as the Director requires. 6 (C) OATH OR AFFIRMATION.—The com- 7 plaint and any answer made under this sub- 8 section shall be made under oath or affirmation, 9 and may be reasonably and fairly modified at 10 any time. 11 (2) RESPONSE TO COMPLAINTS.— 12 (A) IN GENERAL.—Upon the filing of a 13 complaint under this subsection, the following 14 procedures shall apply: 15 (i) COMPLAINANT NOTICE.—The Di- 16 rector shall serve notice upon the com- 17 plainant acknowledging receipt of such fil- 18 ing and advising the complainant of the 19 time limits and procedures provided under 20 this section. 21 (ii) RESPONDENT NOTICE.—The Di- 22 rector shall, not later than 30 days after 23 receipt of such filing— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 478 •HR 7585 IH (I) serve on the respondent a no- 1 tice of the complaint, together with a 2 copy of the original complaint; and 3 (II) advise the respondent of the 4 procedural rights and obligations of 5 respondents under this section. 6 (iii) ANSWER.—The respondent may 7 file, not later than 60 days after receipt of 8 the notice from the Director, an answer to 9 such complaint. 10 (iv) INVESTIGATIVE DUTIES.—The Di- 11 rector shall— 12 (I) make an investigation of the 13 alleged inequitable provision of health 14 care; and 15 (II) complete such investigation 16 within 180 days (unless it is impracti- 17 cable to complete such investigation 18 within 180 days) after the filing of 19 the complaint. 20 (B) INVESTIGATIONS.— 21 (i) PATTERN OR PRACTICE.—In the 22 course of investigating the complaint, the 23 Director may seek records of care provided 24 to patients other than the complainant if 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 479 •HR 7585 IH necessary to demonstrate or disprove an 1 allegation of inequitable provision of health 2 care or to determine whether there is a 3 pattern or practice of such care. 4 (ii) ACCOUNTING FOR SOCIAL DETER- 5 MINANTS OF HEALTH.—In investigating 6 the complaint and reaching a determina- 7 tion on the validity of the complaint, the 8 Director shall account for social deter- 9 minants of health and the effect of such 10 social determinants on health care out- 11 comes. 12 (iii) INABILITY TO COMPLETE INVES- 13 TIGATION.—If the Director is unable to 14 complete (or finds it is impracticable to 15 complete) the investigation within 180 16 days after the filing of the complaint (or, 17 if the Secretary takes further action under 18 paragraph (6)(B) with respect to a com- 19 plaint, within 180 days after the com- 20 mencement of such further action), the Di- 21 rector shall notify the complainant and re- 22 spondent in writing of the reasons in- 23 volved. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 480 •HR 7585 IH (iv) REPORT TO STATE LICENSING 1 AUTHORITIES.—On concluding each inves- 2 tigation under this subparagraph, the Di- 3 rector shall provide to the State licensing 4 authorities that were notified under sub- 5 paragraph (A), information specifying the 6 results of the investigation. 7 (C) REPORT.— 8 (i) FINAL REPORT.—On completing 9 each investigation under this paragraph, 10 the Director shall prepare a final investiga- 11 tive report. 12 (ii) MODIFICATION OF REPORT.—A 13 final report under this subparagraph may 14 be modified if additional evidence is later 15 discovered. 16 (3) CONCILIATION.— 17 (A) IN GENERAL.—During the period be- 18 ginning on the date on which a complaint is 19 filed under this subsection and ending on the 20 date of final disposition of such complaint (in- 21 cluding during an investigation under para- 22 graph (2)(B)), the Director shall, to the extent 23 feasible, engage in conciliation with respect to 24 such complaint. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 481 •HR 7585 IH (B) CONCILIATION AGREEMENT.—A con- 1 ciliation agreement arising out of such concilia- 2 tion shall be an agreement between the re- 3 spondent and the complainant, and shall be 4 subject to approval by the Director. 5 (C) RIGHTS PROTECTED.—The Director 6 shall approve a conciliation agreement only if 7 the agreement protects the rights of the com- 8 plainant and other persons similarly situated. 9 (D) PUBLICLY AVAILABLE AGREEMENT.— 10 (i) IN GENERAL.—Subject to clause 11 (ii), the Secretary shall make available to 12 the public a copy of a conciliation agree- 13 ment entered into pursuant to this sub- 14 section unless the complainant and re- 15 spondent otherwise agree, and the Sec- 16 retary determines, that disclosure is not re- 17 quired to further the purposes of this sub- 18 section. 19 (ii) LIMITATION.—A conciliation 20 agreement that is made available to the 21 public pursuant to clause (i) may not dis- 22 close individually identifiable health infor- 23 mation. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 482 •HR 7585 IH (4) FAILURE TO COMPLY WITH CONCILIATION 1 AGREEMENT.—Whenever the Director has reason- 2 able cause to believe that a respondent has breached 3 a conciliation agreement, the Director shall refer the 4 matter to the Attorney General to consider filing a 5 civil action to enforce such agreement. 6 (5) WRITTEN CONSENT FOR DISCLOSURE OF 7 INFORMATION.—Nothing said or done in the course 8 of conciliation under this subsection may be made 9 public, or used as evidence in a subsequent pro- 10 ceeding under this subsection, without the written 11 consent of the parties to the conciliation. 12 (6) PROMPT JUDICIAL ACTION.— 13 (A) IN GENERAL.—If the Director deter- 14 mines at any time following the filing of a com- 15 plaint under this subsection that prompt judi- 16 cial action is necessary to carry out the pur- 17 poses of this subsection, the Director may rec- 18 ommend that the Attorney General promptly 19 commence a civil action under subsection (d). 20 (B) IMMEDIATE SUIT.—If the Director de- 21 termines at any time following the filing of a 22 complaint under this subsection that the public 23 interest would be served by allowing the com- 24 plainant to bring a civil action under subsection 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 483 •HR 7585 IH (c) in a State or Federal court immediately, the 1 Director shall certify that the administrative 2 process has concluded and that the complainant 3 may file such a suit immediately. 4 (7) ANNUAL REPORT.—Not later than 1 year 5 after the date of enactment of this Act, and annually 6 thereafter, the Director shall make publicly available 7 a report detailing the activities of the Office for Civil 8 Rights and Health Equity under this subsection, in- 9 cluding— 10 (A) the number of complaints filed and the 11 basis on which the complaints were filed; 12 (B) the number of investigations under- 13 taken as a result of such complaints; and 14 (C) the disposition of all such investiga- 15 tions. 16 (c) ENFORCEMENT BY PRIVATE PERSONS.— 17 (1) IN GENERAL.— 18 (A) CIVIL ACTION.— 19 (i) IN SUIT.—A complainant under 20 subsection (b) may commence a civil action 21 to obtain appropriate relief with respect to 22 an alleged violation of subsection (a), or 23 for breach of a conciliation agreement 24 under subsection (b), in an appropriate 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 484 •HR 7585 IH district court of the United States or State 1 court— 2 (I) not sooner than the earliest 3 of— 4 (aa) the date a conciliation 5 agreement is reached under sub- 6 section (b); 7 (bb) the date of a final dis- 8 position of a complaint under 9 subsection (b); or 10 (cc) 180 days after the first 11 day of the alleged violation; and 12 (II) not later than 2 years after 13 the final day of the alleged violation. 14 (ii) STATUTE OF LIMITATIONS.—The 15 computation of such 2-year period shall 16 not include any time during which an ad- 17 ministrative proceeding (including inves- 18 tigation or conciliation) under subsection 19 (b) was pending with respect to a com- 20 plaint under such subsection. 21 (B) BARRING SUIT.—If the Director has 22 obtained a conciliation agreement under sub- 23 section (b) regarding an alleged violation of 24 subsection (a), no action may be filed under 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 485 •HR 7585 IH this paragraph by the complainant involved 1 with respect to the alleged violation except for 2 the purpose of enforcing the terms of such an 3 agreement. 4 (2) RELIEF WHICH MAY BE GRANTED.— 5 (A) IN GENERAL.—In a civil action under 6 paragraph (1), if the court finds that a viola- 7 tion of subsection (a) or breach of a conciliation 8 agreement has occurred, the court may award 9 to the plaintiff actual and punitive damages, 10 and may grant as relief, as the court deter- 11 mines to be appropriate, any permanent or tem- 12 porary injunction, temporary restraining order, 13 or other order (including an order enjoining the 14 defendant from engaging in a practice violating 15 subsection (a) or ordering such affirmative ac- 16 tion as may be appropriate). 17 (B) FEES AND COSTS.—In a civil action 18 under paragraph (1), the court, in its discre- 19 tion, may allow the prevailing party, other than 20 the United States, a reasonable attorney’s fee 21 and costs. The United States shall be liable for 22 such fees and costs to the same extent as a pri- 23 vate person. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 486 •HR 7585 IH (3) INTERVENTION BY ATTORNEY GENERAL.— 1 Upon timely application, the Attorney General may 2 intervene in a civil action under paragraph (1), if 3 the Attorney General certifies that the case is of 4 general public importance. 5 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 6 (1) COMMENCEMENT OF ACTIONS.— 7 (A) PATTERN OR PRACTICE CASES.—The 8 Attorney General may commence a civil action 9 in any appropriate district court of the United 10 States if the Attorney General has reasonable 11 cause to believe that any health care provider 12 covered by subsection (a)— 13 (i) is engaged in a pattern or practice 14 that violates such subsection; or 15 (ii) is engaged in a violation of such 16 subsection that raises an issue of signifi- 17 cant public importance. 18 (B) CASES BY REFERRAL.—The Director 19 may determine, based on a pattern of com- 20 plaints, a pattern of violations, a review of data 21 reported by a health care provider covered by 22 subsection (a), or any other means, that there 23 is reasonable cause to believe a health care pro- 24 vider is engaged in a pattern or practice that 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 487 •HR 7585 IH violates subsection (a). If the Director makes 1 such a determination, the Director shall refer 2 the related findings to the Attorney General. If 3 the Attorney General finds that such reasonable 4 cause exists, the Attorney General may com- 5 mence a civil action in any appropriate district 6 court of the United States. 7 (2) ENFORCEMENT OF SUBPOENAS.—The At- 8 torney General, on behalf of the Director, or another 9 party at whose request a subpoena is issued under 10 this subsection, may enforce such subpoena in ap- 11 propriate proceedings in the district court of the 12 United States for the district in which the person to 13 whom the subpoena was addressed resides, was 14 served, or transacts business. 15 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL 16 ACTIONS.— 17 (A) IN GENERAL.—In a civil action under 18 paragraph (1), the court— 19 (i) may award such preventive relief, 20 including a permanent or temporary in- 21 junction, temporary restraining order, or 22 other order against the person responsible 23 for a violation of subsection (a) as is nec- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 488 •HR 7585 IH essary to assure the full enjoyment of the 1 rights granted by this subsection; 2 (ii) may award such other relief as the 3 court determines to be appropriate, includ- 4 ing monetary damages, to aggrieved per- 5 sons; and 6 (iii) may, to vindicate the public inter- 7 est, assess punitive damages against the 8 respondent— 9 (I) in an amount not exceeding 10 $500,000, for a first violation; and 11 (II) in an amount not exceeding 12 $1,000,000, for any subsequent viola- 13 tion. 14 (B) FEES AND COSTS.—In a civil action 15 under this subsection, the court, in its discre- 16 tion, may allow the prevailing party, other than 17 the United States, a reasonable attorney’s fee 18 and costs. The United States shall be liable for 19 such fees and costs to the extent provided by 20 section 2412 of title 28, United States Code. 21 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 22 timely application, any person may intervene in a 23 civil action commenced by the Attorney General 24 under paragraphs (1) and (2) if the action involves 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 489 •HR 7585 IH an alleged violation of subsection (a) with respect to 1 which such person is an aggrieved person (including 2 a person who is a complainant under subsection (b)) 3 or a conciliation agreement to which such person is 4 a party. 5 (e) DEFINITIONS.—In this section: 6 (1) AGGRIEVED PERSON.—The term ‘‘aggrieved 7 person’’ means— 8 (A) a person who believes that the person 9 was or will be injured in violation of subsection 10 (a); or 11 (B) the personal representative or estate of 12 a deceased person who was injured in violation 13 of subsection (a). 14 (2) DIRECTOR.—The term ‘‘Director’’ refers to 15 the Director for Civil Rights and Health Equity of 16 the Department of Health and Human Services. 17 (3) DISABILITY.—The term ‘‘disability’’ has the 18 meaning given such term in section 3 of the Ameri- 19 cans with Disabilities Act of 1990 (42 U.S.C. 20 12102). 21 (4) CONCILIATION.—The term ‘‘conciliation’’ 22 means the attempted resolution of issues raised by 23 a complaint, or by the investigation of such com- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 490 •HR 7585 IH plaint, through informal negotiations involving the 1 complainant, the respondent, and the Secretary. 2 (5) CONCILIATION AGREEMENT.—The term 3 ‘‘conciliation agreement’’ means a written agreement 4 setting forth the resolution of the issues in concilia- 5 tion. 6 (6) INDIVIDUALLY IDENTIFIABLE HEALTH IN- 7 FORMATION.—The term ‘‘individually identifiable 8 health information’’ means any information, includ- 9 ing demographic information collected from an indi- 10 vidual— 11 (A) that is created or received by a health 12 care provider covered by subsection (a), health 13 plan, employer, or health care clearinghouse; 14 (B) that relates to the past, present, or fu- 15 ture physical or mental health or condition of, 16 the provision of health care to, or the past, 17 present, or future payment for the provision of 18 health care to, the individual; and 19 (C)(i) that identifies the individual; or 20 (ii) with respect to which there is a reason- 21 able basis to believe that the information can be 22 used to identify the individual. 23 (7) PROVISION OF INEQUITABLE HEALTH 24 CARE.—The term ‘‘provision of inequitable health 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 491 •HR 7585 IH care’’ means the provision of any health care service, 1 by a health care provider in a manner that— 2 (A) fails to meet a high-quality care stand- 3 ard, meaning the health care provider fails to— 4 (i) avoid harm to patients as a result 5 of the health services that are intended to 6 help the patient; 7 (ii) provide health services based on 8 scientific knowledge to all and to all pa- 9 tients who benefit; 10 (iii) refrain from providing services to 11 patients not likely to benefit; 12 (iv) provide care that is responsive to 13 patient preferences, needs, and values; and 14 (v) avoids waits or delays in care; and 15 (B) is discriminatory in intent or effect 16 based at least in part on a basis specified in 17 subsection (a). 18 (8) RESPONDENT.—The term ‘‘respondent’’ 19 means the person or other entity accused in a com- 20 plaint of a violation of subsection (a). 21 (9) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services. 23 (10) SOCIAL DETERMINANTS OF HEALTH.—The 24 term ‘‘social determinants of health’’ means condi- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 492 •HR 7585 IH tions in the environments in which individuals live, 1 work, attend school, and worship, that affect a wide 2 range of health, functioning, and quality-of-life out- 3 comes and risks. 4 (f) RULE OF CONSTRUCTION.—Nothing in this sec- 5 tion shall be construed as repealing or limiting the effect 6 of title VI of the Civil Rights Act of 1964 (42 U.S.C. 7 2000b et seq.), section 1557 of the Patient Protection and 8 Affordable Care Act (42 U.S.C. 18116), section 504 of 9 the Rehabilitation Act of 1973 (29 U.S.C. 794), or the 10 Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). 11 SEC. 4507. FEDERAL HEALTH EQUITY COMMISSION. 12 (a) ESTABLISHMENT OF COMMISSION.— 13 (1) IN GENERAL.—There is established the 14 Federal Health Equity Commission (in this section 15 referred to as the ‘‘Commission’’). 16 (2) MEMBERSHIP.— 17 (A) IN GENERAL.—The Commission shall 18 be composed of— 19 (i) 8 voting members appointed under 20 subparagraph (B); and 21 (ii) the nonvoting, ex officio members 22 listed in subparagraph (C). 23 (B) VOTING MEMBERS.—Not more than 4 24 of the members described in subparagraph 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 493 •HR 7585 IH (A)(i) shall at any one time be of the same po- 1 litical party. Such members shall have recog- 2 nized expertise in and personal experience with 3 racial and ethnic health inequities, health care 4 needs of vulnerable and marginalized popu- 5 lations, and health equity as a vehicle for im- 6 proving health status and health outcomes. 7 Such members shall be appointed to the Com- 8 mission as follows: 9 (i) 4 members of the Commission 10 shall be appointed by the President. 11 (ii) 2 members of the Commission 12 shall be appointed by the President pro 13 tempore of the Senate, upon the rec- 14 ommendations of the majority leader and 15 the minority leader of the Senate. Each 16 member appointed to the Commission 17 under this clause shall be appointed from 18 a different political party. 19 (iii) 2 members of the Commission 20 shall be appointed by the Speaker of the 21 House of Representatives upon the rec- 22 ommendations of the majority leader and 23 the minority leader of the House of Rep- 24 resentatives. Each member appointed to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 494 •HR 7585 IH the Commission under this clause shall be 1 appointed from a different political party. 2 (C) EX OFFICIO MEMBER.—The Commis- 3 sion shall have the following nonvoting, ex offi- 4 cio members: 5 (i) The Director for Civil Rights and 6 Health Equity of the Department of 7 Health and Human Services. 8 (ii) The Deputy Assistant Secretary 9 for Minority Health of the Department of 10 Health and Human Services. 11 (iii) The Director of the National In- 12 stitute on Minority Health and Health Dis- 13 parities. 14 (iv) The Chairperson of the Advisory 15 Committee on Minority Health established 16 under section 1707(c) of the Public Health 17 Service Act (42 U.S.C. 300u–6(c)). 18 (3) TERMS.—The term of office of each mem- 19 ber appointed under paragraph (2)(B) of the Com- 20 mission shall be 6 years. 21 (4) CHAIRPERSON; VICE CHAIRPERSON.— 22 (A) CHAIRPERSON.—The President shall, 23 with the concurrence of a majority of the mem- 24 bers of the Commission appointed under para- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 495 •HR 7585 IH graph (2)(B), designate a Chairperson from 1 among the members of the Commission ap- 2 pointed under such paragraph. 3 (B) VICE CHAIRPERSON.— 4 (i) DESIGNATION.—The Speaker of 5 the House of Representatives shall, in con- 6 sultation with the majority leaders and the 7 minority leaders of the Senate and the 8 House of Representatives and with the 9 concurrence of a majority of the members 10 of the Commission appointed under para- 11 graph (2)(B), designate a Vice Chairperson 12 from among the members of the Commis- 13 sion appointed under such paragraph. The 14 Vice Chairperson may not be a member of 15 the same political party as the Chair- 16 person. 17 (ii) DUTY.—The Vice Chairperson 18 shall act in place of the Chairperson in the 19 absence of the Chairperson. 20 (5) REMOVAL OF MEMBERS.—The President 21 may remove a member of the Commission only for 22 neglect of duty or malfeasance in office. 23 (6) QUORUM.—A majority of members of the 24 Commission appointed under paragraph (2)(B) shall 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 496 •HR 7585 IH constitute a quorum of the Commission, but a lesser 1 number of members may hold hearings. 2 (b) DUTIES OF THE COMMISSION.— 3 (1) IN GENERAL.—The Commission shall— 4 (A) monitor and report on the implementa- 5 tion of this Act; and 6 (B) investigate, monitor, and report on 7 progress towards health equity and the elimi- 8 nation of health disparities. 9 (2) ANNUAL REPORT.—The Commission 10 shall— 11 (A) submit to the President and Congress 12 at least one report annually on health equity 13 and health disparities; and 14 (B) include in such report— 15 (i) a description of actions taken by 16 the Department of Health and Human 17 Services and any other Federal agency re- 18 lated to health equity or health disparities; 19 and 20 (ii) recommendations on ensuring eq- 21 uitable health care and eliminating health 22 disparities. 23 (c) POWERS.— 24 (1) HEARINGS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 497 •HR 7585 IH (A) IN GENERAL.—The Commission or, at 1 the direction of the Commission, any sub- 2 committee or member of the Commission, may, 3 for the purpose of carrying out this section, as 4 the Commission or the subcommittee or mem- 5 ber considers advisable— 6 (i) hold such hearings, meet and act 7 at such times and places, take such testi- 8 mony, receive such evidence, and admin- 9 ister such oaths; and 10 (ii) require, by subpoena or otherwise, 11 the attendance and testimony of such wit- 12 nesses and the production of such books, 13 records, correspondence, memoranda, pa- 14 pers, documents, tapes, and materials. 15 (B) LIMITATION ON HEARINGS.—The 16 Commission may hold a hearing under subpara- 17 graph (A)(i) only if the hearing is approved— 18 (i) by a majority of the members of 19 the Commission appointed under sub- 20 section (a)(2)(B); or 21 (ii) by a majority of such members 22 present at a meeting when a quorum is 23 present. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 498 •HR 7585 IH (2) ISSUANCE AND ENFORCEMENT OF SUB- 1 POENAS.— 2 (A) ISSUANCE.—A subpoena issued under 3 paragraph (1) shall— 4 (i) bear the signature of the Chair- 5 person of the Commission; and 6 (ii) be served by any person or class 7 of persons designated by the Chairperson 8 for that purpose. 9 (B) ENFORCEMENT.—In the case of contu- 10 macy or failure to obey a subpoena issued 11 under paragraph (1), the United States district 12 court for the district in which the subpoenaed 13 person resides, is served, or may be found may 14 issue an order requiring the person to appear at 15 any designated place to testify or to produce 16 documentary or other evidence. 17 (C) NONCOMPLIANCE.—Any failure to 18 obey the order of the court may be punished by 19 the court as a contempt of court. 20 (3) WITNESS ALLOWANCES AND FEES.— 21 (A) IN GENERAL.—Section 1821 of title 22 28, United States Code, shall apply to a witness 23 requested or subpoenaed to appear at a hearing 24 of the Commission. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 499 •HR 7585 IH (B) EXPENSES.—The per diem and mile- 1 age allowances for a witness shall be paid from 2 funds available to pay the expenses of the Com- 3 mission. 4 (4) POSTAL SERVICES.—The Commission may 5 use the United States mails in the same manner and 6 under the same conditions as other agencies of the 7 Federal Government. 8 (5) GIFTS.—The Commission may accept, use, 9 and dispose of gifts or donations of services or prop- 10 erty. 11 (d) ADMINISTRATIVE PROVISIONS.— 12 (1) STAFF.— 13 (A) DIRECTOR.—There shall be a full-time 14 staff director for the Commission who shall— 15 (i) serve as the administrative head of 16 the Commission; and 17 (ii) be appointed by the Chairperson 18 with the concurrence of the Vice Chair- 19 person. 20 (B) OTHER PERSONNEL.—The Commis- 21 sion may— 22 (i) appoint such other personnel as it 23 considers advisable, subject to the provi- 24 sions of title 5, United States Code, gov- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 500 •HR 7585 IH erning appointments in the competitive 1 service, and the provisions of chapter 51 2 and subchapter III of chapter 53 of that 3 title relating to classification and General 4 Schedule pay rates; and 5 (ii) may procure temporary and inter- 6 mittent services under section 3109(b) of 7 title 5, United States Code, at rates for in- 8 dividuals not in excess of the daily equiva- 9 lent paid for positions at the maximum 10 rate for GS–15 of the General Schedule 11 under section 5332 of title 5, United 12 States Code. 13 (2) COMPENSATION OF MEMBERS.— 14 (A) NON-FEDERAL EMPLOYEES.—Each 15 member of the Commission who is not an offi- 16 cer or employee of the Federal Government 17 shall be compensated at a rate equal to the 18 daily equivalent of the annual rate of basic pay 19 prescribed for level IV of the Executive Sched- 20 ule under section 5315 of title 5, United States 21 Code, for each day (including travel time) dur- 22 ing which the member is engaged in the per- 23 formance of the duties of the Commission. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 501 •HR 7585 IH (B) FEDERAL EMPLOYEES.—Each member 1 of the Commission who is an officer or em- 2 ployee of the Federal Government shall serve 3 without compensation in addition to the com- 4 pensation received for the services of the mem- 5 ber as an office or employee of the Federal 6 Government. 7 (C) TRAVEL EXPENSES.—A member of the 8 Commission shall be allowed travel expenses, in- 9 cluding per diem in lieu of subsistence, at rates 10 authorized for an employee of an agency under 11 subchapter I of chapter 57 of title 5, United 12 States Code, while away from the home or reg- 13 ular place of business of the member in the per- 14 formance of the duties of the Commission. 15 (3) COOPERATION.—The Commission may se- 16 cure directly from any Federal department or agency 17 such information as the Commission considers nec- 18 essary to carry out this Act. Upon request of the 19 Chairman of the Commission, the head of such de- 20 partment or agency shall furnish such information to 21 the Commission. 22 (e) PERMANENT COMMISSION.—Section 14 of the 23 Federal Advisory Committee Act (5 U.S.C. App.) shall not 24 apply to the Commission. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 502 •HR 7585 IH (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated for fiscal year 2022 and 2 each fiscal year thereafter such sums as may be necessary 3 to carry out the duties of the Commission. 4 SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUI- 5 TABLE HEALTH CARE AND OUTCOMES. 6 (a) IN GENERAL.—Not later than 180 days after the 7 date of the enactment of this Act, the Secretary of Health 8 and Human Services (in this section referred to as the 9 ‘‘Secretary’’) shall award grants to hospitals to promote 10 equitable health care treatment and services, and reduce 11 disparities in care and outcomes. 12 (b) CONSULTATION.—In establishing the criteria for 13 grants under this section and evaluating applications for 14 such grants, the Secretary shall consult with the Director 15 for Civil Rights and Health Equity of the Department of 16 Health and Human Services. 17 (c) USE OF FUNDS.—A hospital shall use funds re- 18 ceived from a grant under this section to establish or ex- 19 pand programs to provide equitable health care to all pa- 20 tients and to ensure equitable health care outcomes. Such 21 uses may include— 22 (1) providing explicit and implicit bias training 23 to medical providers and staff; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 503 •HR 7585 IH (2) providing translation or interpretation serv- 1 ices for patients; 2 (3) recruiting and training a diverse workforce; 3 (4) tracking data related to care and outcomes; 4 and 5 (5) training on cultural sensitivity. 6 (d) PRIORITY.—In awarding grants under this sec- 7 tion, the Secretary shall give priority to hospitals that 8 have received disproportionate share hospital payments 9 under section 1886(r) of the Social Security Act (42 10 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 11 1396r–4) with respect to fiscal year 2021. 12 (e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 13 under this section shall be used to supplement, not sup- 14 plant, any nongovernment efforts, or other Federal, State, 15 or local funds provided to a recipient. 16 (f) EQUITABLE HEALTH CARE DEFINED.—The term 17 ‘‘equitable health care’’ has the meaning given such term 18 in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu- 19 rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 20 added by section 4(a). 21 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 22 out this section, there are authorized to be appropriated 23 such sums as may be necessary for each of fiscal years 24 2022 through 2027. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 504 •HR 7585 IH Subtitle G—Investing in Equity 1 SEC. 4601. DEFINITIONS. 2 In this subtitle: 3 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 4 Council’’ means the Pay for Equity Council con- 5 vened under section 4603. 6 (2) SECRETARY.—The term ‘‘Secretary’’ means 7 the Secretary of Health and Human Services. 8 (3) STRATEGY.—The term ‘‘Strategy’’ means 9 the Pay for Equity Strategy set forth under section 10 4602. 11 SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 12 (a) IN GENERAL.—The Secretary, in consultation 13 with the heads of other appropriate Federal agencies, shall 14 develop jointly with the Advisory Council and submit to 15 the Committee on Finance of the Senate and the Com- 16 mittee on Energy and Commerce and the Committee on 17 Ways and Means of the House of Representatives, and 18 make publicly available on the internet website of the De- 19 partment of Health and Human Services, a Pay for Eq- 20 uity Strategy. 21 (b) CONTENTS.—The Strategy shall establish goals 22 for Federal programs, including those authorized under ti- 23 tles XVIII and XIX of the Social Security Act, to 24 incentivize health equity, which may include at least— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 505 •HR 7585 IH (1) incorporating measures of equity into all 1 payment models by 2025; 2 (2) tying a percentage of reimbursement in 3 value-based payment models to equity measure per- 4 formance by 2028; and 5 (3) increasing the number of safety net pro- 6 viders participating in value-based payment by a set 7 percentage by 2030. 8 (c) DUTIES OF THE SECRETARY.—The Secretary, in 9 carrying out subsection (a), shall oversee the following: 10 (1) Collecting and making publicly available in- 11 formation submitted by the Advisory Council. 12 (2) Coordinating and assessing existing Federal 13 Government programs and activities to assess capac- 14 ity to meet equity goals. 15 (3) Providing technical assistance, as appro- 16 priate, such as disseminating identified best prac- 17 tices and information sharing based on reports de- 18 veloped as a result of this subtitle. 19 (d) INITIAL STRATEGY; UPDATES.—The Secretary 20 shall— 21 (1) not later than 18 months after the date of 22 enactment of this Act, develop, publish, and submit 23 to the Committee on Finance of the Senate and the 24 Committee on Energy and Commerce and the Com- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 506 •HR 7585 IH mittee on Ways and Means of the House of Rep- 1 resentatives the strategy outlined in subsection (a); 2 and 3 (2) biennially update, publish, and submit to 4 Congress an updated strategy to— 5 (A) reflect new developments, challenges, 6 opportunities, and solutions; and 7 (B) review progress and, based on the re- 8 sults of such review, recommend priority actions 9 for improving the implementation of such rec- 10 ommendations, as appropriate. 11 (e) PROCESS FOR PUBLIC INPUT.—The Secretary 12 shall establish a process for public input to inform the de- 13 velopment of, and updates to, the Strategy, including a 14 process for the public to submit recommendations to the 15 Advisory Council and an opportunity for public comment 16 on the proposed Strategy. 17 SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 18 (a) CONVENING.—The Secretary shall convene a Pay 19 for Equity Advisory Council to advise and provide rec- 20 ommendations, including identified best practices, to the 21 Secretary on the Pay for Equity Strategy. 22 (b) MEMBERSHIP.— 23 (1) IN GENERAL.—The members of the Advi- 24 sory Council shall consist of— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 507 •HR 7585 IH (A) the appointed members under para- 1 graph (2); and 2 (B) the Federal members under paragraph 3 (3). 4 (2) APPOINTED MEMBERS.—In addition to the 5 Federal members under paragraph (3), the Sec- 6 retary shall appoint not more than 15 voting mem- 7 bers of the Advisory Council who are not representa- 8 tives of Federal departments or agencies and who 9 shall include at least 1 representative of each of the 10 following: 11 (A) Beneficiaries of Medicare and Med- 12 icaid. 13 (B) Safety net health care providers. 14 (C) Value-based payment experts. 15 (D) Other members with expertise and 16 lived experience the Secretary deems appro- 17 priate. 18 (3) FEDERAL MEMBERS.—The Federal mem- 19 bers of the Advisory Council, who shall be nonvoting 20 members, shall consist of the following: 21 (A) The Administrator of the Centers for 22 Medicare & Medicaid Services (or the Adminis- 23 trator’s designee). 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 508 •HR 7585 IH (B) The Administrator of the Health Re- 1 sources and Services Administration. 2 (4) DIVERSE REPRESENTATION.—The Sec- 3 retary shall ensure that the membership of the Advi- 4 sory Council reflects the diversity of individuals im- 5 pacted by Federal health payment programs. 6 (c) MEETINGS.—The Advisory Council shall meet 7 quarterly during the 1-year period beginning on the date 8 of enactment of this Act and at least 3 times during each 9 year thereafter. Meetings of the Advisory Council shall be 10 open to the public. 11 TITLE V—IMPROVING HEALTH 12 OUTCOMES FOR WOMEN, 13 CHILDREN, AND FAMILIES 14 Subtitle A—In General 15 SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER- 16 SERVED COMMUNITIES. 17 Part Q of title III of the Public Health Service Act 18 (42 U.S.C. 280h et seq.) is amended by adding at the end 19 the following: 20 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER- 21 SERVED COMMUNITIES. 22 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 23 laboration with the Administrator of the Health Resources 24 and Services Administration and other Federal officials 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 509 •HR 7585 IH determined appropriate by the Secretary, is authorized to 1 award grants to eligible entities— 2 ‘‘(1) to promote health for medically under- 3 served communities, with preference given to 4 projects that benefit racial and ethnic minority 5 women, racial and ethnic minority children, adoles- 6 cents, and lesbian, gay, bisexual, transgender, queer, 7 nonbinary, gender-nonconforming, or questioning 8 communities; and 9 ‘‘(2) to strengthen health outreach initiatives in 10 medically underserved communities, including lin- 11 guistically isolated populations. 12 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 13 subsection (a) may be used to support the activities of 14 community health workers, including such activities— 15 ‘‘(1) to educate and provide outreach regarding 16 enrollment in health insurance including the State 17 Children’s Health Insurance Program under title 18 XXI of the Social Security Act, Medicare under title 19 XVIII of such Act, and Medicaid under title XIX of 20 such Act; 21 ‘‘(2) to educate and provide outreach in a com- 22 munity setting regarding health problems prevalent 23 among medically underserved communities, and es- 24 pecially among racial and ethnic minority women, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 510 •HR 7585 IH racial and ethnic minority children, adolescents, and 1 lesbian, gay, bisexual, transgender, queer, nonbinary, 2 gender-nonconforming, or questioning communities; 3 ‘‘(3) to educate and provide experiential learn- 4 ing opportunities and target risk factors and healthy 5 behaviors that impede or contribute to achieving 6 positive health outcomes, including— 7 ‘‘(A) healthy nutrition; 8 ‘‘(B) physical activity; 9 ‘‘(C) overweight or obesity; 10 ‘‘(D) tobacco use, including the use of e- 11 cigarettes and vaping; 12 ‘‘(E) alcohol and substance use; 13 ‘‘(F) injury and violence; 14 ‘‘(G) sexual health; 15 ‘‘(H) mental health; 16 ‘‘(I) musculoskeletal health and arthritis; 17 ‘‘(J) prenatal and postnatal care; 18 ‘‘(K) dental and oral health; 19 ‘‘(L) understanding informed consent; 20 ‘‘(M) stigma; and 21 ‘‘(N) environmental hazards; 22 ‘‘(4) to promote community wellness and aware- 23 ness; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 511 •HR 7585 IH ‘‘(5) to educate and refer target populations to 1 appropriate health care agencies and community- 2 based programs and organizations in order to in- 3 crease access to quality health care services, includ- 4 ing preventive health services. 5 ‘‘(c) APPLICATION.— 6 ‘‘(1) IN GENERAL.—Each eligible entity that 7 desires to receive a grant under subsection (a) shall 8 submit an application to the Secretary, at such time, 9 in such manner, and accompanied by such additional 10 information as the Secretary may require. 11 ‘‘(2) CONTENTS.—Each application submitted 12 pursuant to paragraph (1) shall— 13 ‘‘(A) describe the activities for which as- 14 sistance under this section is sought; 15 ‘‘(B) contain an assurance that, with re- 16 spect to each community health worker pro- 17 gram receiving funds under the grant awarded, 18 such program provides in-language training and 19 supervision to community health workers to en- 20 able such workers to provide authorized pro- 21 gram activities in (at least) the most commonly 22 used languages within a particular geographic 23 region; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 512 •HR 7585 IH ‘‘(C) contain an assurance that the appli- 1 cant will evaluate the effectiveness of commu- 2 nity health worker programs receiving funds 3 under the grant; 4 ‘‘(D) contain an assurance that each com- 5 munity health worker program receiving funds 6 under the grant will provide culturally com- 7 petent services in the linguistic context most 8 appropriate for the individuals served by the 9 program; 10 ‘‘(E) contain a plan to document and dis- 11 seminate project descriptions and results to 12 other States and organizations as identified by 13 the Secretary; and 14 ‘‘(F) describe plans to enhance the capac- 15 ity of individuals to utilize health services and 16 health-related social services under Federal, 17 State, and local programs by— 18 ‘‘(i) assisting individuals in estab- 19 lishing eligibility under the programs and 20 in receiving the services or other benefits 21 of the programs; and 22 ‘‘(ii) providing other services, as the 23 Secretary determines to be appropriate, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 513 •HR 7585 IH which may include transportation and 1 translation services. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Secretary shall give priority to those appli- 4 cants— 5 ‘‘(1) who propose to target geographic areas 6 that— 7 ‘‘(A)(i) have a high percentage of residents 8 who are uninsured or underinsured (if the tar- 9 geted geographic area is located in a State that 10 has elected to make medical assistance available 11 under section 1902(a)(10)(A)(i)(VIII) of the 12 Social Security Act to individuals described in 13 such section); 14 ‘‘(ii) have a high percentage of under- 15 insured residents in a particular geographic 16 area (if the targeted geographic area is located 17 in a State that has not so elected); or 18 ‘‘(iii) have a high number of households ex- 19 periencing extreme poverty; and 20 ‘‘(B) have a high percentage of families for 21 whom English is not their primary language or 22 including smaller limited English-proficient 23 communities within the region that are not oth- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 514 •HR 7585 IH erwise reached by linguistically appropriate 1 health services; 2 ‘‘(2) with experience in providing health or 3 health-related social services to individuals who are 4 underserved with respect to such services; and 5 ‘‘(3) with documented community activity and 6 experience with community health workers. 7 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 8 TIONS.—The Secretary shall encourage community health 9 worker programs receiving funds under this section to col- 10 laborate with academic institutions, including minority- 11 serving institutions. Nothing in this section shall be con- 12 strued to require such collaboration. 13 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 14 NESS.—The Secretary shall establish guidelines for ensur- 15 ing the quality of the training and supervision of commu- 16 nity health workers under the programs funded under this 17 section and for ensuring the cost effectiveness of such pro- 18 grams. 19 ‘‘(g) MONITORING.—The Secretary shall monitor 20 community health worker programs identified in approved 21 applications and shall determine whether such programs 22 are in compliance with the guidelines established under 23 subsection (f). 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 515 •HR 7585 IH ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 1 provide technical assistance to community health worker 2 programs identified in approved applications with respect 3 to planning, developing, and operating programs under the 4 grant. 5 ‘‘(i) REPORT TO CONGRESS.— 6 ‘‘(1) IN GENERAL.—Not later than 4 years 7 after the date on which the Secretary first awards 8 grants under subsection (a), the Secretary shall sub- 9 mit to Congress a report regarding the grant 10 project. 11 ‘‘(2) CONTENTS.—The report required under 12 paragraph (1) shall include the following: 13 ‘‘(A) A description of the programs for 14 which grant funds were used. 15 ‘‘(B) The number of individuals served. 16 ‘‘(C) An evaluation of— 17 ‘‘(i) the effectiveness of these pro- 18 grams; 19 ‘‘(ii) the cost of these programs; and 20 ‘‘(iii) the impact of these programs on 21 the health outcomes of the community resi- 22 dents. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 516 •HR 7585 IH ‘‘(D) Recommendations for sustaining the 1 community health worker programs developed 2 or assisted under this section. 3 ‘‘(E) Recommendations regarding training 4 to enhance career opportunities for community 5 health workers. 6 ‘‘(j) DEFINITIONS.—In this section: 7 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 8 ‘community health worker’ means an individual who 9 promotes health or nutrition within the community 10 in which the individual resides— 11 ‘‘(A) by serving as a liaison between com- 12 munities and health care agencies; 13 ‘‘(B) by providing guidance and social as- 14 sistance to community residents; 15 ‘‘(C) by enhancing community residents’ 16 ability to effectively communicate with health 17 care providers; 18 ‘‘(D) by providing culturally and linguis- 19 tically appropriate health or nutrition edu- 20 cation; 21 ‘‘(E) by advocating for individual and com- 22 munity health, including dental, oral, mental, 23 and environmental health, or nutrition needs; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 517 •HR 7585 IH ‘‘(F) by taking into consideration the 1 needs of the communities served, including the 2 prevalence rates of risk factors that impede 3 achieving positive healthy outcomes among 4 pregnant, birthing, and postpartum people and 5 children, especially among racial and ethnic mi- 6 nority pregnant, birthing, and postpartum peo- 7 ple and children; and 8 ‘‘(G) by providing referral and followup 9 services. 10 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 11 nity setting’ means a home or a community organi- 12 zation that serves a population. 13 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 14 tity’ means— 15 ‘‘(A) a unit of State, territorial, local, or 16 Tribal government (including a federally recog- 17 nized Tribe or Alaska Native village); or 18 ‘‘(B) a community-based organization. 19 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 20 The term ‘medically underserved community’ means 21 a community— 22 ‘‘(A) that has a substantial number of in- 23 dividuals who are members of a medically un- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 518 •HR 7585 IH derserved population, as defined by section 1 330(b)(3); 2 ‘‘(B) a significant portion of which is a 3 health professional shortage area as designated 4 under section 332; and 5 ‘‘(C) that includes populations that are lin- 6 guistically isolated, such as geographic areas 7 with a shortage of health professionals able to 8 provide linguistically appropriate services. 9 ‘‘(5) SUPPORT.—The term ‘support’ means the 10 provision of training, supervision, and materials 11 needed to effectively deliver the services described in 12 subsection (b), reimbursement for services, and 13 other benefits. 14 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 $15,000,000 for each of fiscal years 2023 through 2027.’’. 17 Subtitle B—Pregnancy Screening 18 SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 19 DEMONSTRATION PROGRAM. 20 Part P of title III of the Public Health Service Act 21 (42 U.S.C. 280g et seq.), as amended by section 22 5203(c)(6), is further amended by adding at the end the 23 following: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 519 •HR 7585 IH ‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA- 1 TIVE DEMONSTRATION PROGRAM. 2 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 3 acting through the Director of the Centers for Disease 4 Control and Prevention, shall establish a demonstration 5 program to facilitate the clinical adoption of pregnancy in- 6 tention screening initiatives by health care and social serv- 7 ices providers. 8 ‘‘(b) GRANTS.—The Secretary may carry out the 9 demonstration program through awarding grants to eligi- 10 ble entities to implement pregnancy intention screening 11 initiatives, collect data, and evaluate such initiatives. 12 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to seek a 13 grant under this section, an entity shall— 14 ‘‘(1) provide non-directive, comprehensive, 15 medically accurate information; and 16 ‘‘(2) be a community-based organization, vol- 17 untary health organization, public health depart- 18 ment, community health center, or other interested 19 public or private primary, behavioral, or other health 20 care or social service provider or organization. 21 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 22 TIVE.—For purposes of this section, the term ‘pregnancy 23 intention screening initiative’ means any initiative by an 24 eligible entity to routinely screen people with respect to 25 their pregnancy intentions and goals to either prevent un- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 520 •HR 7585 IH intended pregnancies or improve the likelihood of healthy 1 pregnancies, in order to better provide health care that 2 meets the contraceptive or pre-pregnancy needs and goals 3 of such people. 4 ‘‘(e) EVALUATION.— 5 ‘‘(1) IN GENERAL.—The Secretary, acting 6 through the Director of the Centers for Disease 7 Control and Prevention, shall, by grant or contract, 8 and after consultation as described in paragraph (2), 9 conduct an evaluation of the demonstration pro- 10 gram, with respect to pregnancy intention screening 11 initiatives, conducted under this section. Such eval- 12 uation shall include: 13 ‘‘(A) Assessment of the implementation of 14 pregnancy intention screening protocols among 15 a diverse group of patients and providers, in- 16 cluding collecting data on the experiences and 17 outcomes for diverse patient populations in a 18 variety of clinical settings. 19 ‘‘(B) Analysis of outcome measures that 20 will facilitate effective and widespread adoption 21 of such protocols by health care providers for 22 inquiring about and responding to pregnancy 23 goals of people with both contraceptive and pre- 24 pregnancy care. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 521 •HR 7585 IH ‘‘(C) Consideration of health inequities 1 among the population served. 2 ‘‘(D) Assessment of the equitable and vol- 3 untary application of such initiatives to minor- 4 ity and medically underserved communities. 5 ‘‘(E) Assessment of the training, capacity, 6 and ongoing technical assistance needed for 7 providers to effectively implement such preg- 8 nancy intention screening protocols. 9 ‘‘(F) Assessment of whether referral sys- 10 tems for selected protocols follow evidence-based 11 standards that ensure access to comprehensive 12 health services and appropriate follow-up care. 13 ‘‘(G) Measuring through rigorous methods 14 the effect of such initiatives on key health out- 15 comes. 16 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX- 17 PERT ADVISORY PANEL.—In conducting the evalua- 18 tion under paragraph (1), the Director of the Cen- 19 ters for Disease Control and Prevention shall consult 20 with physicians, physician assistants, advanced prac- 21 tice registered nurses, nurse midwives, and other 22 health care providers who specialize in women’s 23 health, and other experts in public health, clinical 24 practice, program evaluation, and research. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 522 •HR 7585 IH ‘‘(3) REPORT.—Not later than one year after 1 the last day of the demonstration program under 2 this section, the Director of the Centers for Disease 3 Control and Prevention shall— 4 ‘‘(A) submit to Congress a report on the 5 results of the evaluation conducted under para- 6 graph (1); and 7 ‘‘(B) make the report publicly available. 8 ‘‘(f) FUNDING.— 9 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 10 To carry out this section, there is authorized to be 11 appropriated $10,000,000 for each of fiscal years 12 2023 through 2027. 13 ‘‘(2) LIMITATION.—Not more than 20 percent 14 of funds appropriated to carry out this section pur- 15 suant to paragraph (1) for a fiscal year may be used 16 for purposes of the evaluation under subsection 17 (e).’’. 18 SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 19 AND AWARENESS. 20 (a) IN GENERAL.—The Secretary shall establish and 21 implement a birth defects prevention and public awareness 22 program, consisting of the activities described in sub- 23 sections (c) and (d). 24 (b) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 523 •HR 7585 IH (1) MATERNAL.—The term ‘‘maternal’’ refers 1 to people who are pregnant or breastfeeding. 2 (2) PREGNANCY AND BREASTFEEDING INFOR- 3 MATION SERVICES.—The term ‘‘pregnancy and 4 breastfeeding information services’’ includes only— 5 (A) information services to provide accu- 6 rate, evidence-based, clinical information re- 7 garding maternal exposures during pregnancy 8 or breastfeeding that may be associated with 9 birth defects, health risks to a breastfed infant, 10 or other health risks, such as exposures to 11 medications, chemicals, infections, foodborne 12 pathogens, illnesses, nutrition, lifestyle, or 13 climate- and weather-related factors; 14 (B) the provision of accurate, evidence- 15 based information weighing risks of exposures 16 during breastfeeding against the benefits of 17 breastfeeding; and 18 (C) the provision of information described 19 in subparagraph (A), (B), or (C) through coun- 20 selors, websites, fact sheets, telephonic or elec- 21 tronic communication, community outreach ef- 22 forts, or other appropriate means. 23 (3) SECRETARY.—The term ‘‘Secretary’’ means 24 the Secretary of Health and Human Services, acting 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 524 •HR 7585 IH through the Director of the Centers for Disease 1 Control and Prevention. 2 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 3 subsection (a), the Secretary shall conduct or support a 4 nationwide media campaign to increase awareness among 5 health care providers and at-risk populations about preg- 6 nancy and breastfeeding information services. 7 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 8 INFORMATION SERVICES.— 9 (1) IN GENERAL.—In carrying out subsection 10 (a), the Secretary shall award grants to State or re- 11 gional agencies or organizations for any of the fol- 12 lowing: 13 (A) INFORMATION SERVICES.—The provi- 14 sion of, or campaigns to increase awareness 15 about, pregnancy and breastfeeding information 16 services. 17 (B) SURVEILLANCE AND RESEARCH.—The 18 conduct or support of— 19 (i) surveillance of or research on— 20 (I) maternal exposures and ma- 21 ternal health conditions that may in- 22 fluence the risk of birth defects, pre- 23 maturity, or other adverse pregnancy 24 outcomes; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 525 •HR 7585 IH (II) maternal exposures that may 1 influence health risks to a breastfed 2 infant; or 3 (ii) networking to facilitate surveil- 4 lance or research described in this sub- 5 paragraph. 6 (2) PREFERENCE FOR CERTAIN STATES.—The 7 Secretary, in making any grant under this sub- 8 section, shall give preference to States, otherwise 9 equally qualified, that have pregnancy and 10 breastfeeding information services in place. 11 (3) MATCHING FUNDS.—The Secretary may 12 only award a grant under this subsection to a State 13 or regional agency or organization that agrees, with 14 respect to the costs to be incurred in carrying out 15 the grant activities, to make available (directly or 16 through donations from public or private entities) 17 non-Federal funds toward such costs in an amount 18 equal to not less than 25 percent of the amount of 19 the grant. 20 (4) COORDINATION.—The Secretary shall en- 21 sure that activities funded through a grant under 22 this subsection are coordinated, to the maximum ex- 23 tent practicable, with other birth defects prevention 24 and environmental health activities of the Federal 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 526 •HR 7585 IH Government, including with respect to pediatric envi- 1 ronmental health specialty units and children’s envi- 2 ronmental health centers. 3 (e) EVALUATION.—The Secretary shall provide for an 4 evaluation of pregnancy and breastfeeding information 5 services carried out by States to identify efficient and ef- 6 fective models of— 7 (1) providing information; 8 (2) raising awareness and increasing knowledge 9 about birth defects prevention measures and tar- 10 geting education to at-risk groups; 11 (3) modifying risk behaviors; or 12 (4) other outcome measures as determined ap- 13 propriate by the Secretary. 14 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated— 16 (1) $5,000,000 for fiscal year 2023; 17 (2) $6,000,000 for fiscal year 2024; 18 (3) $7,000,000 for fiscal year 2025; 19 (4) $8,000,000 for fiscal year 2026; and 20 (5) $9,000,000 for fiscal year 2027. 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 527 •HR 7585 IH Subtitle C—Pregnancy-Related 1 Care 2 SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND 3 MORBIDITY AWARENESS. 4 (a) IMPROVING FEDERAL EFFORTS WITH RESPECT 5 TO PREVENTION OF MATERNAL MORTALITY.— 6 (1) TECHNICAL ASSISTANCE FOR STATES WITH 7 RESPECT TO REPORTING MATERNAL MORTALITY.— 8 Not later than one year after the date of enactment 9 of this Act, the Director of the Centers for Disease 10 Control and Prevention (referred to in this section 11 as the ‘‘Director’’), in consultation with the Admin- 12 istrator of the Health Resources and Services Ad- 13 ministration, shall provide technical assistance to 14 States that elect to report comprehensive data on 15 maternal mortality and factors relating to such mor- 16 tality (including oral and mental health), intimate 17 partner violence, and breastfeeding health informa- 18 tion, for the purpose of encouraging uniformity in 19 the reporting of such data and to encourage the 20 sharing of such data among the respective States. 21 (2) BEST PRACTICES RELATING TO PREVEN- 22 TION OF MATERNAL MORTALITY.— 23 (A) IN GENERAL.—Not later than one year 24 after the date of enactment of this Act— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 528 •HR 7585 IH (i) the Director, in consultation with 1 relevant patient and provider groups, shall 2 issue best practices to State maternal mor- 3 tality review committees on how best to 4 identify and review maternal mortality 5 cases, taking into account any data made 6 available by States relating to maternal 7 mortality, including data on oral, mental, 8 and breastfeeding health, and utilization of 9 any emergency services; and 10 (ii) the Director, working in collabora- 11 tion with the Health Resources and Serv- 12 ices Administration, shall issue best prac- 13 tices to hospitals, State professional society 14 groups, and perinatal quality collaboratives 15 on how best to prevent maternal mortality. 16 (B) AUTHORIZATION OF APPROPRIA- 17 TIONS.—For purposes of carrying out this 18 paragraph, there is authorized to be appro- 19 priated $5,000,000 for each of fiscal years 20 2023 through 2027. 21 (3) ALLIANCE FOR INNOVATION ON MATERNAL 22 HEALTH GRANT PROGRAM.— 23 (A) IN GENERAL.—Not later than one year 24 after the date of enactment of this Act, the Sec- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 529 •HR 7585 IH retary of Health and Human Services, acting 1 through the Associate Administrator of the Ma- 2 ternal and Child Health Bureau of the Health 3 Resources and Services Administration (re- 4 ferred to in this paragraph as the ‘‘Secretary’’), 5 shall establish a grant program to be known as 6 the Alliance for Innovation on Maternal Health 7 Grant Program (referred to in this subsection 8 as ‘‘AIM’’) under which the Secretary shall 9 award grants to eligible entities for the purpose 10 of— 11 (i) directing widespread adoption and 12 implementation of maternal safety bundles 13 through collaborative State-based teams; 14 and 15 (ii) collecting and analyzing process, 16 structure, and outcome data to drive con- 17 tinuous improvement in the implementa- 18 tion of such safety bundles by such State- 19 based teams with the ultimate goal of 20 eliminating preventable maternal mortality 21 and severe maternal morbidity in the 22 United States. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 530 •HR 7585 IH (B) ELIGIBLE ENTITIES.—In order to be 1 eligible for a grant under subparagraph (A), an 2 entity shall— 3 (i) submit to the Secretary an applica- 4 tion at such time, in such manner, and 5 containing such information as the Sec- 6 retary may require; and 7 (ii) demonstrate in such application 8 that the entity is an interdisciplinary, 9 multi-stakeholder, national organization 10 with a national data-driven maternal safety 11 and quality improvement initiative based 12 on implementation approaches that have 13 been proven to improve maternal safety 14 and outcomes in the United States. 15 (C) USE OF FUNDS.—An eligible entity 16 that receives a grant under subparagraph (A) 17 shall use such grant funds— 18 (i) to develop and implement, through 19 a robust, multi-stakeholder process, mater- 20 nal safety bundles to assist States, 21 perinatal quality collaboratives, and health 22 care systems in aligning national, State, 23 and hospital-level quality improvement ef- 24 forts to improve maternal health outcomes, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 531 •HR 7585 IH specifically the reduction of maternal mor- 1 tality and severe maternal morbidity; 2 (ii) to ensure, in developing and im- 3 plementing maternal safety bundles under 4 clause (i), that such maternal safety bun- 5 dles— 6 (I) satisfy the quality improve- 7 ment needs of a State, perinatal qual- 8 ity collaborative, or health care system 9 by factoring in the results and find- 10 ings of relevant data reviews, such as 11 reviews conducted by a State maternal 12 mortality review committee; and 13 (II) address topics which may in- 14 clude— 15 (aa) information on evi- 16 dence-based practices to improve 17 the quality and safety of mater- 18 nal health care in hospitals and 19 other health care settings of a 20 State or health care system, in- 21 cluding by addressing topics com- 22 monly associated with health 23 complications or risks related to 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 532 •HR 7585 IH prenatal care, labor care, birth- 1 ing, and postpartum care; 2 (bb) best practices for im- 3 proving maternal health care 4 based on data findings and re- 5 views conducted by a State ma- 6 ternal mortality review committee 7 that address topics of relevance 8 to common complications or 9 health risks related to prenatal 10 care, labor care, birthing, and 11 postpartum care; 12 (cc) information on address- 13 ing determinants of health that 14 impact maternal health outcomes 15 for people before, during, and 16 after pregnancy; 17 (dd) obstetric hemorrhage; 18 (ee) obstetric and 19 postpartum care for people with 20 substance use disorders, includ- 21 ing opioid use disorder; 22 (ff) maternal cardiovascular 23 system; 24 (gg) maternal mental health; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 533 •HR 7585 IH (hh) postpartum care basics 1 for maternal safety; 2 (ii) reduction of peripartum 3 racial and ethnic inequities; 4 (jj) reduction of primary 5 caesarean birth; 6 (kk) severe hypertension in 7 pregnancy; 8 (ll) severe maternal mor- 9 bidity reviews; 10 (mm) support after a severe 11 maternal morbidity event; 12 (nn) thromboembolism; 13 (oo) optimization of support 14 for breastfeeding; 15 (pp) maternal oral health; 16 and 17 (qq) intimate partner vio- 18 lence; and 19 (iii) to provide ongoing technical as- 20 sistance at the national and State levels to 21 support implementation of maternal safety 22 bundles under clause (i). 23 (D) MATERNAL SAFETY BUNDLE DE- 24 FINED.—For purposes of this paragraph, the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 534 •HR 7585 IH term ‘‘maternal safety bundle’’ means standard- 1 ized, evidence-informed processes for maternal 2 health care. 3 (E) AUTHORIZATION OF APPROPRIA- 4 TIONS.—For purposes of carrying out this 5 paragraph, there is authorized to be appro- 6 priated $10,000,000 for each of fiscal years 7 2023 through 2027. 8 (4) FUNDING FOR STATE-BASED PERINATAL 9 QUALITY COLLABORATIVES DEVELOPMENT AND SUS- 10 TAINABILITY.— 11 (A) IN GENERAL.—Not later than one year 12 after the date of enactment of this Act, the Sec- 13 retary of Health and Human Services (referred 14 to in this paragraph as the ‘‘Secretary’’), acting 15 through the Division of Reproductive Health of 16 the Centers for Disease Control and Prevention, 17 shall establish a grant program to be known as 18 the State-Based Perinatal Quality Collaborative 19 grant program under which the Secretary 20 awards grants to eligible entities for the pur- 21 pose of development and sustainability of 22 perinatal quality collaboratives in every State, 23 the District of Columbia, and eligible terri- 24 tories, in order to measurably improve perinatal 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 535 •HR 7585 IH care and perinatal health outcomes for preg- 1 nant and postpartum people and their infants. 2 (B) GRANT AMOUNTS.—Grants awarded 3 under this paragraph shall be in amounts not to 4 exceed $250,000 per year, for the duration of 5 the grant period. 6 (C) STATE-BASED PERINATAL QUALITY 7 COLLABORATIVE DEFINED.—For purposes of 8 this paragraph, the term ‘‘State-based perinatal 9 quality collaborative’’ means a network of teams 10 that— 11 (i) is multidisciplinary in nature and 12 includes the full range of perinatal and 13 maternity care providers; 14 (ii) works to improve measurable out- 15 comes for maternal and infant health by 16 advancing evidence-informed clinical prac- 17 tices using quality improvement principles; 18 (iii) works with hospital-based or out- 19 patient facility-based clinical teams, ex- 20 perts, and stakeholders, including patients 21 and families, to spread best practices and 22 optimize resources to improve perinatal 23 care and outcomes; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 536 •HR 7585 IH (iv) employs strategies that include 1 the use of the collaborative learning model 2 to provide opportunities for hospitals and 3 clinical teams to collaborate on improve- 4 ment strategies, rapid-response data to 5 provide timely feedback to hospital and 6 other clinical teams to track progress, and 7 quality improvement science to provide 8 support and coaching to hospital and clin- 9 ical teams; 10 (v) has the goal of improving popu- 11 lation-level outcomes in maternal and in- 12 fant health; and 13 (vi) has the goal of improving out- 14 comes of all birthing people, through the 15 coordination, integration, and collaboration 16 across birth settings. 17 (D) AUTHORIZATION OF APPROPRIA- 18 TIONS.—For purposes of carrying out this 19 paragraph, there is authorized to be appro- 20 priated $14,000,000 per year for each of fiscal 21 years 2023 through 2027. 22 (5) EXPANSION OF MEDICAID AND CHIP COV- 23 ERAGE FOR PREGNANT AND POSTPARTUM PEO- 24 PLE.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 537 •HR 7585 IH (A) REQUIRING COVERAGE OF ORAL 1 HEALTH SERVICES FOR PREGNANT AND 2 POSTPARTUM PEOPLE.— 3 (i) MEDICAID.—Section 1905 of the 4 Social Security Act (42 U.S.C. 1396d) is 5 amended— 6 (I) in subsection (a)(4)— 7 (aa) by redesignating sub- 8 paragraphs (E) and (F) as sub- 9 paragraphs (F) and (G), respec- 10 tively; 11 (bb) by striking ‘‘; and (F)’’ 12 and inserting ‘‘; (F)’’; 13 (cc) by inserting ‘‘; and (G) 14 oral health services for pregnant 15 and postpartum people (as de- 16 fined in subsection (ii))’’ before 17 the semicolon at the end; and 18 (II) by adding at the end the fol- 19 lowing new subsection: 20 ‘‘(jj) ORAL HEALTH SERVICES FOR PREGNANT AND 21 POSTPARTUM PEOPLE.— 22 ‘‘(1) IN GENERAL.—For purposes of this title, 23 the term ‘oral health services for pregnant and 24 postpartum people’ means dental services necessary 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 538 •HR 7585 IH to prevent disease and promote oral health, restore 1 oral structures to health and function, and treat 2 emergency conditions that are furnished to a person 3 during pregnancy (or during the 1-year period be- 4 ginning on the last day of the pregnancy). 5 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 6 the requirement to provide oral health services for 7 pregnant and postpartum people, a State shall pro- 8 vide coverage for preventive, diagnostic, periodontal, 9 and restorative care consistent with recommenda- 10 tions for perinatal oral health care and dental care 11 during pregnancy from the American Academy of 12 Pediatric Dentistry and the American College of Ob- 13 stetricians and Gynecologists.’’. 14 (ii) CHIP.—Section 2103(c)(6)(A) of 15 the Social Security Act (42 U.S.C. 16 1397cc(c)(6)(A)) is amended by inserting 17 ‘‘or a targeted low-income pregnant per- 18 son’’ after ‘‘targeted low-income child’’. 19 (B) EXTENDING MEDICAID COVERAGE FOR 20 PREGNANT AND POSTPARTUM PEOPLE.—Sec- 21 tion 1902 of the Social Security Act (42 U.S.C. 22 1396a) is amended— 23 (i) in subsection (e)— 24 (I) in paragraph (5)— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 539 •HR 7585 IH (aa) by inserting ‘‘(including 1 oral health services for pregnant 2 and postpartum people (as de- 3 fined in section 1905(jj)))’’ after 4 ‘‘postpartum medical assistance 5 under the plan’’; and 6 (bb) by striking ‘‘60-day’’ 7 and inserting ‘‘1-year’’; and 8 (II) in paragraph (6), by striking 9 ‘‘60-day’’ and inserting ‘‘1-year’’; and 10 (ii) in subsection (l)(1)(A), by striking 11 ‘‘60-day’’ and inserting ‘‘1-year’’. 12 (C) EXTENDING MEDICAID COVERAGE FOR 13 LAWFUL RESIDENTS.—Section 1903(v)(4)(A)(i) 14 of the Social Security Act (42 U.S.C. 15 1396b(v)(4)(A)(i)) is amended by striking ‘‘60- 16 day’’ and inserting ‘‘1-year’’. 17 (D) EXTENDING CHIP COVERAGE FOR 18 PREGNANT AND POSTPARTUM PEOPLE.—Sec- 19 tion 2112(d)(2)(A) of the Social Security Act 20 (42 U.S.C. 1397ll(d)(2)(A)) is amended by 21 striking ‘‘60-day’’ and inserting ‘‘1-year’’. 22 (E) MAINTENANCE OF EFFORT.— 23 (i) MEDICAID.—Section 1902(l) of the 24 Social Security Act (42 U.S.C. 1396a(l)) is 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 540 •HR 7585 IH amended by adding at the end the fol- 1 lowing new paragraph: 2 ‘‘(5) During the period that begins on the date of 3 enactment of this paragraph and ends on the date that 4 is five years after such date of enactment, as a condition 5 for receiving any Federal payments under section 1903(a) 6 for calendar quarters occurring during such period, a 7 State shall not have in effect, with respect to people who 8 are eligible for medical assistance under the State plan 9 or under a waiver of such plan on the basis of being preg- 10 nant or having been pregnant, eligibility standards, meth- 11 odologies, or procedures under the State plan or waiver 12 that are more restrictive than the eligibility standards, 13 methodologies, or procedures, respectively, under such 14 plan or waiver that are in effect on the date of enactment 15 of this paragraph.’’. 16 (ii) CHIP.—Section 2105(d) of the 17 Social Security Act (42 U.S.C. 1397ee(d)) 18 is amended by adding at the end the fol- 19 lowing new paragraph: 20 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR- 21 GETED LOW-INCOME PREGNANT PEOPLE.—During 22 the period that begins on the date of enactment of 23 this paragraph and ends on the date that is five 24 years after such date of enactment, as a condition 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 541 •HR 7585 IH of receiving payments under subsection (a) and sec- 1 tion 1903(a), a State that elects to provide assist- 2 ance to people on the basis of being pregnant (in- 3 cluding pregnancy-related assistance provided to tar- 4 geted low-income pregnant people (as defined in sec- 5 tion 2112(d)), pregnancy-related assistance provided 6 to people who are eligible for such assistance 7 through application of section 1902(v)(4)(A)(i) 8 under section 2107(e)(1), or any other assistance 9 under the State child health plan (or a waiver of 10 such plan) which is provided to people on the basis 11 of being pregnant) shall not have in effect, with re- 12 spect to such people, eligibility standards, meth- 13 odologies, or procedures under such plan (or waiver) 14 that are more restrictive than the eligibility stand- 15 ards, methodologies, or procedures, respectively, 16 under such plan (or waiver) that are in effect on the 17 date of enactment of this paragraph.’’. 18 (F) INFORMATION ON BENEFITS.—The 19 Secretary of Health and Human Services shall 20 make publicly available on the internet website 21 of the Department of Health and Human Serv- 22 ices, information regarding benefits available to 23 pregnant and postpartum people and under the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 542 •HR 7585 IH Medicaid program and the Children’s Health 1 Insurance Program, including information on— 2 (i) benefits that States are required to 3 provide to pregnant and postpartum people 4 under such programs; 5 (ii) optional benefits that States may 6 provide to pregnant and postpartum people 7 under such programs; and 8 (iii) the availability of different kinds 9 of benefits for pregnant and postpartum 10 people, including oral health and mental 11 health benefits, under such programs. 12 (G) FEDERAL FUNDING FOR COST OF EX- 13 TENDED MEDICAID AND CHIP COVERAGE FOR 14 POSTPARTUM PEOPLE.— 15 (i) MEDICAID.—Section 1905 of the 16 Social Security Act (42 U.S.C. 1396d), as 17 amended by subparagraph (A), is further 18 amended— 19 (I) in subsection (b), by striking 20 ‘‘and (ii)’’ and inserting ‘‘(ii), and 21 (kk)’’; and 22 (II) by adding at the end the fol- 23 lowing: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 543 •HR 7585 IH ‘‘(kk) INCREASED FMAP FOR EXTENDED MEDICAL 1 ASSISTANCE FOR POSTPARTUM PEOPLE.—Notwith- 2 standing subsection (b), the Federal medical assistance 3 percentage for a State, with respect to amounts expended 4 by such State for medical assistance for a person who is 5 eligible for such assistance on the basis of being pregnant 6 or having been pregnant that is provided during the period 7 that begins on the 60th day after the last day of their 8 pregnancy (including any such assistance provided during 9 the month in which such period ends), shall be equal to— 10 ‘‘(1) 100 percent for the first 20 calendar quar- 11 ters during which this subsection is in effect; and 12 ‘‘(2) 90 percent for calendar quarters there- 13 after.’’. 14 (ii) CHIP.—Section 2105(c) of the 15 Social Security Act (42 U.S.C. 1397ee(c)) 16 is amended by adding at the end the fol- 17 lowing new paragraph: 18 ‘‘(13) ENHANCED PAYMENT FOR EXTENDED 19 ASSISTANCE PROVIDED TO PREGNANT PEOPLE.— 20 Notwithstanding subsection (b), the enhanced 21 FMAP, with respect to payments under subsection 22 (a) for expenditures under the State child health 23 plan (or a waiver of such plan) for assistance pro- 24 vided under the plan (or waiver) to a person who is 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 544 •HR 7585 IH eligible for such assistance on the basis of being 1 pregnant (including pregnancy-related assistance 2 provided to a targeted low-income pregnant person 3 (as defined in section 2112(d)), pregnancy-related 4 assistance provided to a person who is eligible for 5 such assistance through application of section 6 1902(v)(4)(A)(i) under section 2107(e)(1), or any 7 other assistance under the plan (or waiver) provided 8 to a person who is eligible for such assistance on the 9 basis of being pregnant) during the 305-day period 10 that begins on the 60th day after the last day of her 11 pregnancy (including any such assistance provided 12 during the month in which such period ends), shall 13 be equal to— 14 ‘‘(A) 100 percent for the first 20 calendar 15 quarters during which this paragraph is in ef- 16 fect; and 17 ‘‘(B) 90 percent for calendar quarters 18 thereafter.’’. 19 (H) GUIDANCE ON STATE OPTIONS FOR 20 MEDICAID COVERAGE OF DOULA SERVICES.— 21 Not later than 1 year after the date of the en- 22 actment of this Act, the Secretary of Health 23 and Human Services, acting through the Ad- 24 ministrator of the Centers for Medicare & Med- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 545 •HR 7585 IH icaid Services, shall issue guidance for the 1 States concerning options for Medicaid coverage 2 and payment for support services provided by 3 doulas. 4 (I) EFFECTIVE DATE.— 5 (i) IN GENERAL.—Subject to clause 6 (ii), the amendments made by this para- 7 graph shall take effect on the first day of 8 the first calendar quarter that begins on or 9 after the date that is one year after the 10 date of enactment of this Act. 11 (ii) EXCEPTION FOR STATE LEGISLA- 12 TION.—In the case of a State plan under 13 title XIX of the Social Security Act or a 14 State child health plan under title XXI of 15 such Act that the Secretary of Health and 16 Human Services determines requires State 17 legislation in order for the respective plan 18 to meet any requirement imposed by 19 amendments made by this paragraph, the 20 respective plan shall not be regarded as 21 failing to comply with the requirements of 22 such title solely on the basis of its failure 23 to meet such an additional requirement be- 24 fore the first day of the first calendar 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 546 •HR 7585 IH quarter beginning after the close of the 1 first regular session of the State legislature 2 that begins after the date of enactment of 3 this Act. For purposes of the previous sen- 4 tence, in the case of a State that has a 2- 5 year legislative session, each year of the 6 session shall be considered to be a separate 7 regular session of the State legislature. 8 (6) REGIONAL CENTERS OF EXCELLENCE.— 9 Part P of title III of the Public Health Service Act 10 (42 U.S.C. 280g et seq.), as amended by section 11 5101, is further amended by adding at the end the 12 following new section: 13 ‘‘SEC. 399V–9. REGIONAL CENTERS OF EXCELLENCE AD- 14 DRESSING IMPLICIT BIAS AND CULTURAL 15 COMPETENCY IN PATIENT-PROVIDER INTER- 16 ACTIONS EDUCATION. 17 ‘‘(a) IN GENERAL.—Not later than one year after the 18 date of enactment of this section, the Secretary, in con- 19 sultation with such other agency heads as the Secretary 20 determines appropriate, shall award cooperative agree- 21 ments for the establishment or support of regional centers 22 of excellence addressing implicit bias, cultural competency, 23 and respectful care practices in patient-provider inter- 24 actions education for the purpose of enhancing and im- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 547 •HR 7585 IH proving how health care professionals are educated in im- 1 plicit bias and delivering culturally competent health care. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper- 3 ative agreement under subsection (a), an entity shall— 4 ‘‘(1) be a public or other nonprofit entity speci- 5 fied by the Secretary that provides educational and 6 training opportunities for students and health care 7 professionals, which may be a health system, teach- 8 ing hospital, community health center, medical 9 school, school of public health, school of nursing, 10 dental school, social work school, school of profes- 11 sional psychology, or any other health professional 12 school or program at an institution of higher edu- 13 cation (as defined in section 101 of the Higher Edu- 14 cation Act of 1965) focused on the prevention, treat- 15 ment, or recovery of health conditions that con- 16 tribute to maternal mortality and the prevention of 17 maternal mortality and severe maternal morbidity; 18 ‘‘(2) demonstrate community engagement and 19 participation, such as through partnerships with 20 home visiting and case management programs; 21 ‘‘(3) demonstrate engagement with groups en- 22 gaged in the implementation of health care profes- 23 sional training in implicit bias and delivering cul- 24 turally competent care, such as departments of pub- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 548 •HR 7585 IH lic health, perinatal quality collaboratives, hospital 1 systems, and health care professional groups, in 2 order to obtain input on resources needed for effec- 3 tive implementation strategies; and 4 ‘‘(4) provide to the Secretary such information, 5 at such time and in such manner, as the Secretary 6 may require. 7 ‘‘(c) DIVERSITY.—In awarding a cooperative agree- 8 ment under subsection (a), the Secretary shall take into 9 account any regional differences among eligible entities 10 and make an effort to ensure geographic diversity among 11 award recipients. 12 ‘‘(d) DISSEMINATION OF INFORMATION.— 13 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 14 shall make publicly available on the internet website 15 of the Department of Health and Human Services 16 information submitted to the Secretary under sub- 17 section (b)(3). 18 ‘‘(2) EVALUATION.—The Secretary shall evalu- 19 ate each regional center of excellence established or 20 supported pursuant to subsection (a) and dissemi- 21 nate the findings resulting from each such evalua- 22 tion to the appropriate public and private entities. 23 ‘‘(3) DISTRIBUTION.—The Secretary shall share 24 evaluations and overall findings with State depart- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 549 •HR 7585 IH ments of health and other relevant State level offices 1 to inform State and local best practices. 2 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec- 3 tion, the term ‘maternal mortality’ means death of a per- 4 son that occurs during pregnancy or within the one-year 5 period following the end of such pregnancy. 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 7 purposes of carrying out this section, there is authorized 8 to be appropriated $5,000,000 for each of fiscal years 9 2023 through 2027.’’. 10 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO- 11 GRAM FOR PEOPLE, INFANTS, AND CHILDREN.—Sec- 12 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 13 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 14 (A) by striking the clause designation and 15 heading and all that follows through ‘‘A State’’ 16 and inserting the following: 17 ‘‘(ii) PREGNANT AND POSTPARTUM 18 PEOPLE.— 19 ‘‘(I) BREASTFEEDING PEOPLE.— 20 A State’’; 21 (B) in subclause (I) (as so designated), by 22 striking ‘‘1 year’’ and all that follows through 23 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 24 and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 550 •HR 7585 IH (C) by adding at the end the following: 1 ‘‘(II) POSTPARTUM PEOPLE.—A 2 State may elect to certify a 3 postpartum person for a period of 2 4 years.’’. 5 (8) DEFINITIONS.—In this subsection: 6 (A) MATERNAL MORTALITY.—The term 7 ‘‘maternal mortality’’ means death of a person 8 that occurs during pregnancy or within the one- 9 year period following the end of such preg- 10 nancy. 11 (B) PREGNANCY RELATED DEATH.—The 12 term ‘‘pregnancy related death’’ includes the 13 death of a person during pregnancy or within 14 one year of the end of pregnancy from a preg- 15 nancy complication, a chain of events initiated 16 by pregnancy, or the aggravation of an unre- 17 lated condition by the physiologic effects of 18 pregnancy. 19 (C) SEVERE MATERNAL MORBIDITY.—The 20 term ‘‘severe maternal morbidity’’ includes un- 21 expected outcomes of labor and delivery that re- 22 sult in significant short-term or long-term con- 23 sequences to a person’s health. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 551 •HR 7585 IH (b) INCREASE IN TAX ON CERTAIN TOBACCO PROD- 1 UCTS AND IMPOSITION OF TAX ON NICOTINE.— 2 (1) INCREASING TAX ON CIGARETTES.— 3 (A) SMALL CIGARETTES.—Section 4 5701(b)(1) of the Internal Revenue Code of 5 1986 is amended by striking ‘‘$50.33’’ and in- 6 serting ‘‘$100.66’’. 7 (B) LARGE CIGARETTES.—Section 8 5701(b)(2) of the Internal Revenue Code of 9 1986 is amended by striking ‘‘$105.69’’ and in- 10 serting ‘‘$211.39’’. 11 (2) TAX PARITY FOR SMALL CIGARS.—Section 12 5701(a)(1) of the Internal Revenue Code of 1986 is 13 amended by striking ‘‘$50.33’’ and inserting 14 ‘‘$100.66’’. 15 (3) TAX PARITY FOR LARGE CIGARS.—Section 16 5701(a)(2) of the Internal Revenue Code of 1986 is 17 amended by striking ‘‘52.75 percent’’ and all that 18 follows through the period and inserting ‘‘$49.56 per 19 pound and a proportionate tax at the like rate on all 20 fractional parts of a pound but not less than 10.06 21 cents per cigar.’’. 22 (4) TAX PARITY FOR SMOKELESS TOBACCO.— 23 (A) Section 5701(e) of the Internal Rev- 24 enue Code of 1986 is amended— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 552 •HR 7585 IH (i) in paragraph (1), by striking 1 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 2 (ii) in paragraph (2), by striking 3 ‘‘50.33 cents’’ and inserting ‘‘$10.70’’; and 4 (iii) by adding at the end the fol- 5 lowing new paragraph: 6 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 7 SINGLE-USE UNITS.—On discrete single-use units, 8 $100 per thousand.’’. 9 (B) Section 5702(m) of the Internal Rev- 10 enue Code of 1986 is amended— 11 (i) in paragraph (1), by striking ‘‘or 12 chewing tobacco’’ and inserting ‘‘, chewing 13 tobacco, or discrete single-use unit’’; 14 (ii) in paragraphs (2) and (3), by in- 15 serting ‘‘and that is not a discrete single- 16 use unit’’ before the period at the end of 17 each such paragraph; and 18 (iii) by adding at the end the fol- 19 lowing new paragraph: 20 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 21 ‘discrete single-use unit’ means any product con- 22 taining tobacco that— 23 ‘‘(A) is not intended to be smoked, and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 553 •HR 7585 IH ‘‘(B) is in the form of a lozenge, tablet, 1 pill, pouch, dissolvable strip, or other discrete 2 single-use or single-dose unit.’’. 3 (5) TAX PARITY FOR PIPE TOBACCO.—Section 4 5701(f) of the Internal Revenue Code of 1986 is 5 amended by striking ‘‘$2.8311 cents’’ and inserting 6 ‘‘$49.56’’. 7 (6) TAX PARITY FOR ROLL-YOUR-OWN TO- 8 BACCO.—Section 5701(g) of the Internal Revenue 9 Code of 1986 is amended by striking ‘‘$24.78’’ and 10 inserting ‘‘$49.56’’. 11 (7) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 12 AND CERTAIN PROCESSED TOBACCO.—Section 13 5702(o) of the Internal Revenue Code of 1986 is 14 amended by inserting ‘‘, and includes processed to- 15 bacco that is removed for delivery or delivered to a 16 person other than a person with a permit provided 17 under section 5713, but does not include removals of 18 processed tobacco for exportation’’ after ‘‘wrappers 19 thereof’’. 20 (8) IMPOSITION OF TAX ON NICOTINE FOR USE 21 IN VAPING, ETC.— 22 (A) IN GENERAL.—Section 5701 of the In- 23 ternal Revenue Code of 1986 is amended by re- 24 designating subsection (h) as subsection (i) and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 554 •HR 7585 IH by inserting after subsection (g) the following 1 new subsection: 2 ‘‘(h) NICOTINE.—On taxable nicotine, manufactured 3 in or imported into the United States, there shall be im- 4 posed a tax equal to the dollar amount specified in section 5 5701(b)(1) per 1,810 milligrams of nicotine (and a pro- 6 portionate tax at the like rate on any fractional part there- 7 of).’’. 8 (B) TAXABLE NICOTINE.—Section 5702 of 9 the Internal Revenue Code of 1986 is amended 10 by adding at the end the following new sub- 11 section: 12 ‘‘(q) TAXABLE NICOTINE.— 13 ‘‘(1) IN GENERAL.—Except as otherwise pro- 14 vided in this subsection, the term ‘taxable nicotine’ 15 means any nicotine which has been extracted, con- 16 centrated, or synthesized. 17 ‘‘(2) EXCEPTION FOR PRODUCTS APPROVED BY 18 FOOD AND DRUG ADMINISTRATION.—Such term 19 shall not include any nicotine if the manufacturer or 20 importer thereof demonstrates to the satisfaction of 21 the Secretary of Health and Human Services that 22 such nicotine will be used in— 23 ‘‘(A) a drug— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 555 •HR 7585 IH ‘‘(i) that is approved under section 1 505 of the Federal Food, Drug, and Cos- 2 metic Act or licensed under section 351 of 3 the Public Health Service Act; or 4 ‘‘(ii) for which an investigational use 5 exemption has been authorized under sec- 6 tion 505(i) of the Federal Food, Drug, and 7 Cosmetic Act or under section 351(a) of 8 the Public Health Service Act; or 9 ‘‘(B) a combination product (as described 10 in section 503(g) of the Federal Food, Drug, 11 and Cosmetic Act), the constituent parts of 12 which were approved or cleared under section 13 505, 510(k), or 515 of such Act. 14 ‘‘(3) COORDINATION WITH TAXATION OF OTHER 15 TOBACCO PRODUCTS.—Tobacco products meeting 16 the definition of cigars, cigarettes, smokeless to- 17 bacco, pipe tobacco, and roll-your-own tobacco in 18 this section shall be classified and taxed as such de- 19 spite any concentration of the nicotine inherent in 20 those products or any addition of nicotine to those 21 products during the manufacturing process. 22 ‘‘(4) REGULATIONS.—The Secretary shall pre- 23 scribe such regulations or other guidance as is nec- 24 essary or appropriate to carry out the purposes of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 556 •HR 7585 IH this subsection, including regulations or other guid- 1 ance for coordinating the taxation of tobacco prod- 2 ucts and taxable nicotine to protect revenue and pre- 3 vent double taxation.’’. 4 (C) TAXABLE NICOTINE TREATED AS A TO- 5 BACCO PRODUCT.—Section 5702(c) of the In- 6 ternal Revenue Code of 1986 is amended by 7 striking ‘‘and roll-your-own tobacco’’ and in- 8 serting ‘‘roll-your-own tobacco, and taxable nic- 9 otine’’. 10 (D) MANUFACTURER OF TAXABLE NICO- 11 TINE.—Section 5702 of the Internal Revenue 12 Code of 1986, as amended by subparagraph 13 (B), is amended by adding at the end the fol- 14 lowing new subsection: 15 ‘‘(r) MANUFACTURER OF TAXABLE NICOTINE.— 16 ‘‘(1) IN GENERAL.—Any person who extracts, 17 concentrates, or synthesizes nicotine shall be treated 18 as a manufacturer of taxable nicotine (and as manu- 19 facturing such taxable nicotine). 20 ‘‘(2) APPLICATION OF RULES RELATED TO 21 MANUFACTURERS OF TOBACCO PRODUCTS.—Any 22 reference to a manufacturer of tobacco products, or 23 to manufacturing tobacco products, shall be treated 24 as including a reference to a manufacturer of tax- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 557 •HR 7585 IH able nicotine, or to manufacturing taxable nicotine, 1 respectively.’’. 2 (9) REPEAL OF SPECIAL RULES FOR DETER- 3 MINING PRICE OF CIGARS.—Section 5702 of the In- 4 ternal Revenue Code of 1986 is amended by striking 5 subsection (l). 6 (10) FLOOR STOCKS TAXES.— 7 (A) IMPOSITION OF TAX.—On covered to- 8 bacco products, and cigarette papers and tubes, 9 manufactured in or imported into the United 10 States which are removed before the tax in- 11 crease date and held on such date for sale by 12 any person, there is hereby imposed a tax in an 13 amount equal to the excess of— 14 (i) the tax which would be imposed 15 under section 5701 of the Internal Rev- 16 enue Code of 1986 on the article if the ar- 17 ticle had been removed on such date; over 18 (ii) the prior tax (if any) imposed 19 under section 5701 of such Code on such 20 article. 21 (B) COVERED TOBACCO PRODUCTS.—For 22 purposes of this paragraph, the term ‘‘covered 23 tobacco products’’ means any tobacco product 24 other than— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 558 •HR 7585 IH (i) cigars described in section 1 5701(a)(2) of the Internal Revenue Code 2 of 1986; 3 (ii) discrete single-use units (as de- 4 fined in section 5702(m)(4) of such Code, 5 as amended by this subsection); and 6 (iii) taxable nicotine (as defined in 7 section 5702(q) of such Code, as amended 8 by this subsection). 9 (C) CREDIT AGAINST TAX.—Each person 10 shall be allowed as a credit against the taxes 11 imposed by subparagraph (A) an amount equal 12 to the lesser of $1,000 or the amount of such 13 taxes. For purposes of the preceding sentence, 14 all persons treated as a single employer under 15 subsection (b), (c), (m), or (o) of section 414 of 16 the Internal Revenue Code of 1986 shall be 17 treated as 1 person for purposes of this sub- 18 paragraph. 19 (D) LIABILITY FOR TAX AND METHOD OF 20 PAYMENT.— 21 (i) LIABILITY FOR TAX.—The person 22 referred to in subparagraph (A) shall be 23 liable for the tax imposed by such subpara- 24 graph. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 559 •HR 7585 IH (ii) METHOD OF PAYMENT.—The tax 1 imposed by subparagraph (A) shall be paid 2 in such manner as the Secretary may pro- 3 vide. 4 (E) ARTICLES IN FOREIGN TRADE 5 ZONES.— 6 (i) IN GENERAL.—Notwithstanding 7 the Act of June 18, 1934 (commonly 8 known as the Foreign Trade Zone Act, 48 9 Stat. 998, 19 U.S.C. 81a et seq.) or any 10 other provision of law, any covered tobacco 11 products, or cigarette papers and tubes, 12 which are located in a foreign trade zone 13 on the tax increase date, shall be subject 14 to the tax imposed by subparagraph (A) 15 if— 16 (I) internal revenue taxes have 17 been determined, or customs duties 18 liquidated, with respect to such article 19 before such date pursuant to a re- 20 quest made under the 1st proviso of 21 section 3(a) of such Act; or 22 (II) such article is held on such 23 date under the supervision of an offi- 24 cer of the United States Customs and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 560 •HR 7585 IH Border Protection of the Department 1 of Homeland Security pursuant to the 2 2d proviso of such section 3(a). 3 (F) TAX INCREASE DATE.—For purposes 4 of this paragraph, the term ‘‘tax increase date’’ 5 means the first day of the first calendar quarter 6 described in paragraph (11)(A). 7 (G) CERTAIN OTHER DEFINITIONS.— 8 Terms used in this paragraph which are also 9 used in section 5702 of the Internal Revenue 10 Code of 1986 shall have the same meaning as 11 when used in such section. 12 (11) EFFECTIVE DATE.— 13 (A) IN GENERAL.—Except as otherwise 14 provided in this paragraph, the amendments 15 made by this subsection shall apply to articles 16 removed in calendar quarters beginning after 17 the date of the enactment of this Act. 18 (B) DELAYED EFFECTIVE DATE FOR CER- 19 TAIN PRODUCTS.—The amendments made by 20 paragraphs (3), (4)(A)(iii), (4)(B), and (8) 21 shall apply to articles removed in calendar 22 quarters beginning after the date which is 180 23 days after the date of the enactment of this 24 Act. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 561 •HR 7585 IH (12) TRANSITION RULE FOR PERMIT AND BOND 1 REQUIREMENTS.—A person which is lawfully en- 2 gaged in business as a manufacturer or importer of 3 taxable nicotine (within the meaning of subchapter 4 A of chapter 52 of the Internal Revenue Code of 5 1986, as amended by this subsection) on the date of 6 the enactment of this Act, first becomes subject to 7 the requirements of subchapter B of chapter 52 of 8 such Code by reason of the amendments made by 9 this subsection, and submits an application under 10 such subchapter B to engage in such business not 11 later than 90 days after the date of the enactment 12 of this Act, shall not be denied the right to carry on 13 such business by reason of such requirements before 14 final action on such application. 15 SEC. 5202. MOMMIES. 16 (a) GAO STUDY AND REPORT.— 17 (1) IN GENERAL.—Not later than 1 year after 18 the date of the enactment of this Act, the Comp- 19 troller General of the United States shall submit to 20 Congress a report on the gaps in coverage with re- 21 spect to— 22 (A) pregnant individuals enrolled under a 23 State plan (or waiver of such plan) under title 24 XIX of the Social Security Act (42 U.S.C. 1396 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 562 •HR 7585 IH et seq.) and the Children’s Health Insurance 1 Program under title XXI of the Social Security 2 Act (42 U.S.C. 1397aa et seq.); and 3 (B) postpartum individuals enrolled under 4 a State plan (or waiver of such plan) under title 5 XIX of the Social Security Act (42 U.S.C. 1396 6 et seq.) and the Children’s Health Insurance 7 Program under title XXI of the Social Security 8 Act (42 U.S.C. 1397aa et seq.) who received as- 9 sistance under either such program during their 10 pregnancy. 11 (2) CONTENT OF REPORT.—The report re- 12 quired under this paragraph shall include the fol- 13 lowing: 14 (A) Information about the abilities and 15 successes of State Medicaid agencies in deter- 16 mining whether pregnant and postpartum indi- 17 viduals are eligible under another insurance af- 18 fordability program, and in transitioning any 19 such individuals who are so eligible to coverage 20 under such a program at the end of their period 21 of eligibility for medical assistance, pursuant to 22 section 435.1200 of the title 42, Code of Fed- 23 eral Regulations (as in effect on September 1, 24 2018). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 563 •HR 7585 IH (B) Information on factors contributing to 1 gaps in coverage that disproportionately impact 2 underserved populations, including low-income 3 individuals, Black, Indigenous, and other indi- 4 viduals of color, individuals who reside in a 5 health professional shortage area (as defined in 6 section 332(a)(1)(A) of the Public Health Serv- 7 ice Act (42 U.S.C. 254e(a)(1)(A))) or individ- 8 uals who are members of a medically under- 9 served population (as defined by section 10 330(b)(3) of such Act (42 U.S.C. 11 254b(b)(3)(A))). 12 (C) Recommendations for addressing and 13 reducing such gaps in coverage. 14 (D) Such other information as the Comp- 15 troller General deems necessary. 16 (3) DATA DISAGGREGATION.—To the greatest 17 extent possible, the Comptroller General shall 18 disaggregate data presented in the report, including 19 by age, gender identity, race, ethnicity, income level, 20 and other demographic factors. 21 (b) MATERNITY CARE HOME DEMONSTRATION 22 PROJECT.—Title XIX of the Social Security Act (42 23 U.S.C. 1396 et seq.) is amended by inserting the following 24 new section after section 1947: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 564 •HR 7585 IH ‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 1 PROJECT. 2 ‘‘(a) IN GENERAL.—Not later than 1 year after the 3 date of the enactment of this section, the Secretary shall 4 establish a demonstration project (in this section referred 5 to as the ‘demonstration project’) under which the Sec- 6 retary shall provide grants to States to enter into arrange- 7 ments with eligible entities to implement or expand a ma- 8 ternity care home model for eligible individuals. 9 ‘‘(b) GOALS OF DEMONSTRATION PROJECT.—The 10 goals of the demonstration project are the following: 11 ‘‘(1) To improve— 12 ‘‘(A) maternity and infant care outcomes; 13 ‘‘(B) birth equity; 14 ‘‘(C) health equity for— 15 ‘‘(i) Black, Indigenous, and other peo- 16 ple of color; 17 ‘‘(ii) lesbian, gay, bisexual, 18 transgender, queer, non-binary, and gender 19 nonconfirming individuals; 20 ‘‘(iii) people with disabilities; and 21 ‘‘(iv) other underserved populations; 22 ‘‘(D) communication by maternity, infant 23 care, and social services providers; 24 ‘‘(E) integration of perinatal support serv- 25 ices, including community health workers, 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 565 •HR 7585 IH doulas, social workers, public health nurses, 1 peer lactation counselors, lactation consultants, 2 childbirth educators, peer mental health work- 3 ers, and others, into health care entities and or- 4 ganizations; 5 ‘‘(F) care coordination between maternity, 6 infant care, oral health services, and social serv- 7 ices providers within the community; 8 ‘‘(G) the quality and safety of maternity 9 and infant care; 10 ‘‘(H) the experience of individuals receiv- 11 ing maternity care, including by increasing the 12 ability of an individual to develop and follow 13 their own birthing plans; and 14 ‘‘(I) access to adequate prenatal and 15 postpartum care, including— 16 ‘‘(i) prenatal care that is initiated in 17 a timely manner; 18 ‘‘(ii) not fewer than 5 post-pregnancy 19 visits to a maternity care provider; and 20 ‘‘(iii) interpregnancy care. 21 ‘‘(2) To provide coordinated, evidence-based, re- 22 spectful, culturally and linguistically appropriate, 23 and person-centered maternity care management. 24 ‘‘(3) To decrease— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 566 •HR 7585 IH ‘‘(A) severe and preventable maternal mor- 1 bidity and maternal mortality; 2 ‘‘(B) overall health care spending; 3 ‘‘(C) unnecessary emergency department 4 visits; 5 ‘‘(D) inequities in maternal and infant care 6 outcomes, including racial, economic, disability, 7 gender-based, and geographical inequities; 8 ‘‘(E) racial, gender, economic, and other 9 discrimination among health care professionals; 10 ‘‘(F) racism, discrimination, disrespect, 11 and abuse in maternity care settings; 12 ‘‘(G) the rate of cesarean deliveries for 13 low-risk pregnancies; 14 ‘‘(H) the rate of pre-term births and in- 15 fants born with low birth weight; and 16 ‘‘(I) the rate of avoidable maternal and 17 newborn hospitalizations and admissions to in- 18 tensive care units. 19 ‘‘(c) CONSULTATION.—In designing and imple- 20 menting the demonstration project the Secretary shall 21 consult with stakeholders, including— 22 ‘‘(1) States; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 567 •HR 7585 IH ‘‘(2) organizations representing relevant health 1 care professionals, including oral health services pro- 2 fessionals; 3 ‘‘(3) organizations, particularly reproductive 4 justice and birth justice organizations led by people 5 of color, that represent consumers of maternal 6 health care, including consumers of maternal health 7 care who are disproportionately impacted by poor 8 maternal health outcomes; 9 ‘‘(4) representatives with experience imple- 10 menting other maternity care home models, includ- 11 ing representatives from the Center for Medicare 12 and Medicaid Innovation; 13 ‘‘(5) community-based health care professionals, 14 including doulas, lactation consultants, and other 15 stakeholders; 16 ‘‘(6) experts in promoting health equity and 17 combating racial bias in health care settings; and 18 ‘‘(7) Black, Indigenous, and other maternal 19 health care consumers of color who have experienced 20 severe maternal morbidity. 21 ‘‘(d) APPLICATION AND SELECTION OF STATES.— 22 ‘‘(1) IN GENERAL.—A State seeking to partici- 23 pate in the demonstration project shall submit an 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 568 •HR 7585 IH application to the Secretary at such time and in 1 such manner as the Secretary shall require. 2 ‘‘(2) SELECTION OF STATES.— 3 ‘‘(A) IN GENERAL.—The Secretary shall 4 select at least 10 States to participate in the 5 demonstration project. 6 ‘‘(B) SELECTION REQUIREMENTS.—In se- 7 lecting States to participate in the demonstra- 8 tion project, the Secretary shall— 9 ‘‘(i) ensure that there is geographic 10 and regional diversity in the areas in which 11 activities will be carried out under the 12 project; 13 ‘‘(ii) ensure that States with signifi- 14 cant inequities in maternal and infant 15 health outcomes, including severe maternal 16 morbidity, and other inequities based on 17 race, income, or access to maternity care, 18 are included; and 19 ‘‘(iii) ensure that at least 1 territory 20 is included. 21 ‘‘(e) GRANTS.— 22 ‘‘(1) IN GENERAL.—From amounts appro- 23 priated under subsection (l), the Secretary shall 24 award 1 grant for each year of the demonstration 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 569 •HR 7585 IH project to each State that is selected to participate 1 in the demonstration project. 2 ‘‘(2) USE OF GRANT FUNDS.—A State may use 3 funds received under this section to— 4 ‘‘(A) award grants or make payments to 5 eligible entities as part of an arrangement de- 6 scribed in subsection (f)(2); 7 ‘‘(B) provide financial incentives to health 8 care professionals, including community-based 9 health care workers and community-based 10 doulas, who participate in the State’s maternity 11 care home model; 12 ‘‘(C) provide adequate training for health 13 care professionals, including community-based 14 health care workers, doulas, and care coordina- 15 tors, who participate in the State’s maternity 16 care home model, which may include training 17 for cultural humility and antiracism, racial bias, 18 health equity, reproductive and birth justice, 19 trauma-informed care, home visiting skills, and 20 respectful communication and listening skills, 21 particularly in regards to maternal health; 22 ‘‘(D) pay for personnel and administrative 23 expenses associated with designing, imple- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 570 •HR 7585 IH menting, and operating the State’s maternity 1 care home model; 2 ‘‘(E) pay for items and services that are 3 furnished under the State’s maternity care 4 home model and for which payment is otherwise 5 unavailable under this title; 6 ‘‘(F) pay for services and materials to en- 7 sure culturally and linguistically appropriate 8 communication, including— 9 ‘‘(i) language services such as inter- 10 preters and translation of written mate- 11 rials; and 12 ‘‘(ii) development of culturally and lin- 13 guistically appropriate materials; and aux- 14 iliary aids and services; and 15 ‘‘(G) pay for other costs related to the 16 State’s maternity care home model, as deter- 17 mined by the Secretary. 18 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT 19 EVALUATOR.— 20 ‘‘(A) IN GENERAL.—From the amounts 21 appropriated under subsection (l), prior to 22 awarding any grants under paragraph (1), the 23 Secretary shall enter into a contract with a na- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 571 •HR 7585 IH tional external entity to create a single, uniform 1 process to— 2 ‘‘(i) ensure that States that receive 3 grants under paragraph (1) comply with 4 the requirements of this section; and 5 ‘‘(ii) evaluate the outcomes of the 6 demonstration project in each participating 7 State. 8 ‘‘(B) ANNUAL REPORT.—The contract de- 9 scribed in subparagraph (A) shall require the 10 national external entity to submit to the Sec- 11 retary— 12 ‘‘(i) a yearly evaluation report for 13 each year of the demonstration project; 14 and 15 ‘‘(ii) a final impact report after the 16 demonstration project has concluded. 17 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 18 in this paragraph shall prevent the Secretary 19 from making a determination that a State is 20 not in compliance with the requirements of this 21 section without the national external entity 22 making such a determination. 23 ‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 572 •HR 7585 IH ‘‘(1) IN GENERAL.—As a condition of receiving 1 a grant under this section, a State shall enter into 2 an arrangement with one or more eligible entities 3 that meets the requirements of paragraph (2). 4 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI- 5 TIES.—Under an arrangement between a State and 6 an eligible entity under this subsection, the eligible 7 entity shall perform the following functions, with re- 8 spect to eligible individuals enrolled with the entity 9 under the State’s maternity care home model— 10 ‘‘(A) provide culturally and linguistically 11 appropriate congruent care, which may include 12 prenatal care, family planning services, medical 13 care, mental and behavioral care, postpartum 14 care, and oral health services to such eligible in- 15 dividuals through a team of health care profes- 16 sionals, which may include obstetrician-gyne- 17 cologists, maternal-fetal medicine specialists, 18 family physicians, primary care providers, oral 19 health providers, physician assistants, advanced 20 practice registered nurses such as nurse practi- 21 tioners and certified nurse midwives, certified 22 midwives, certified professional midwives, phys- 23 ical therapists, social workers, traditional and 24 community-based doulas, lactation consultants, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 573 •HR 7585 IH childbirth educators, community health workers, 1 peer mental health supporters, and other health 2 care professionals; 3 ‘‘(B) conduct a risk assessment of each 4 such eligible individual to determine if their 5 pregnancy is high or low risk, and establish a 6 tailored pregnancy care plan, which takes into 7 consideration the individual’s own preferences 8 and pregnancy care and birthing plans and de- 9 termines the appropriate support services to re- 10 duce the individual’s medical, social, and envi- 11 ronmental risk factors, for each such eligible in- 12 dividual based on the results of such risk as- 13 sessment; 14 ‘‘(C) assign each such eligible individual to 15 a culturally and linguistically appropriate care 16 coordinator, which may be a nurse, social work- 17 er, traditional or community-based doula, com- 18 munity health worker, midwife, or other health 19 care provider, who is responsible for ensuring 20 that such eligible individual receives the nec- 21 essary medical care and connections to essential 22 support services; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 574 •HR 7585 IH ‘‘(D) provide, or arrange for the provision 1 of, essential support services, such as services 2 that address— 3 ‘‘(i) food access, nutrition, and exer- 4 cise; 5 ‘‘(ii) smoking cessation; 6 ‘‘(iii) substance use disorder and ad- 7 diction treatment; 8 ‘‘(iv) anxiety, depression, trauma, and 9 other mental and behavioral health issues; 10 ‘‘(v) breast feeding, chestfeeding, or 11 other infant feeding options supports, initi- 12 ation, continuation, and duration; 13 ‘‘(vi) stable, affordable, safe, and 14 healthy housing; 15 ‘‘(vii) transportation; 16 ‘‘(viii) intimate partner violence; 17 ‘‘(ix) community and police violence; 18 ‘‘(x) home visiting services; 19 ‘‘(xi) childbirth and newborn care edu- 20 cation; 21 ‘‘(xii) oral health education; 22 ‘‘(xiii) continuous labor support; 23 ‘‘(xiv) group prenatal care; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 575 •HR 7585 IH ‘‘(xv) family planning and contracep- 1 tive care and supplies; and 2 ‘‘(xvi) affordable child care; 3 ‘‘(E) as appropriate, facilitate connections 4 to a usual primary care provider, which may be 5 a reproductive health care provider; 6 ‘‘(F) refer to guidelines and opinions of 7 medical associations when determining whether 8 an elective delivery should be performed on an 9 eligible individual before 39 weeks of gestation; 10 ‘‘(G) provide such eligible individual with 11 evidence-based and culturally and linguistically 12 appropriate education and resources to identify 13 potential warning signs of pregnancy and 14 postpartum complications and when and how to 15 obtain medical attention; 16 ‘‘(H) provide, or arrange for the provision 17 of, culturally and linguistically appropriate 18 pregnancy and postpartum health services, in- 19 cluding family planning counseling and services, 20 to eligible individuals; 21 ‘‘(I) track and report postpartum health 22 and birth outcomes of such eligible individuals 23 and their children; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 576 •HR 7585 IH ‘‘(J) ensure that care is person-centered, 1 culturally and linguistically appropriate, and 2 patient-led, including by engaging eligible indi- 3 viduals in their own care, including through 4 communication and education; and 5 ‘‘(K) ensure adequate training for appro- 6 priately serving the population of individuals el- 7 igible for medical assistance under the State 8 plan (or waiver of such plan), including through 9 reproductive justice, birth justice, birth equity, 10 and anti-racist frameworks, home visiting skills, 11 and knowledge of social services. 12 ‘‘(g) TERM OF DEMONSTRATION PROJECT.—The 13 Secretary shall conduct the demonstration project for a 14 period of 5 years. 15 ‘‘(h) REPORT.—Not later than 18 months after the 16 date of the enactment of this section and annually there- 17 after for each year of the demonstration project term, the 18 Secretary shall submit a report to Congress on the results 19 of the demonstration project, including— 20 ‘‘(1) the results of the final report of the na- 21 tional external entity required under subsection 22 (e)(3)(B)(ii); and 23 ‘‘(2) recommendations on whether the model 24 studied in the demonstration project should be con- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 577 •HR 7585 IH tinued or more widely adopted, including by private 1 health plans. 2 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 3 Secretary determines necessary in order to carry out the 4 demonstration project, the Secretary may waive section 5 1902(a)(1) (relating to statewideness) and section 6 1902(a)(10)(B) (relating to comparability). 7 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 8 establish a process to provide technical assistance to 9 States that are awarded grants under this section and to 10 eligible entities and other providers participating in a 11 State maternity care home model funded by such a grant. 12 ‘‘(k) DEFINITIONS.—In this section: 13 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 14 tity’ means an entity or organization that provides 15 medically accurate, comprehensive maternity services 16 to individuals who are eligible for medical assistance 17 under a State plan under this title or a waiver of 18 such a plan, and may include: 19 ‘‘(A) A freestanding birth center. 20 ‘‘(B) An entity or organization receiving 21 assistance under section 330 of the Public 22 Health Service Act. 23 ‘‘(C) A federally qualified health center. 24 ‘‘(D) A rural health clinic. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 578 •HR 7585 IH ‘‘(E) A health facility operated by an In- 1 dian tribe or tribal organization (as those terms 2 are defined in section 4 of the Indian Health 3 Care Improvement Act). 4 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 5 individual’ means a pregnant individual or a for- 6 merly pregnant individual during the 1-year period 7 beginning on the last day of the pregnancy, or such 8 longer period beginning on such day as a State may 9 elect, who is— 10 ‘‘(A) enrolled in a State plan under this 11 title, a waiver of such a plan, or a State child 12 health plan under title XXI; and 13 ‘‘(B) a patient of an eligible entity which 14 has entered into an arrangement with a State 15 under subsection (g). 16 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to the Secretary, for 18 each of fiscal years 2023 through 2030, such sums as may 19 be necessary to carry out this section.’’. 20 (c) REAPPLICATION OF MEDICARE PAYMENT RATE 21 FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER 22 MEDICAID AND INCLUSION OF ADDITIONAL PRO- 23 VIDERS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 579 •HR 7585 IH (1) REAPPLICATION OF PAYMENT FLOOR; ADDI- 1 TIONAL PROVIDERS.— 2 (A) IN GENERAL.—Section 1902(a)(13) of 3 the Social Security Act (42 U.S.C. 4 1396a(a)(13)) is amended— 5 (i) in subparagraph (B), by striking ‘‘; 6 and’’ and inserting a semicolon; 7 (ii) in subparagraph (C), by striking 8 the semicolon and inserting ‘‘; and’’; and 9 (iii) by adding at the end the fol- 10 lowing new subparagraph: 11 ‘‘(D) payment for primary care services (as 12 defined in subsection (jj)(1)) furnished in the 13 period that begins on the first day of the first 14 month that begins after the date of enactment 15 of this subparagraph by a provider described in 16 subsection (jj)(2)— 17 ‘‘(i) at a rate that is not less than 100 18 percent of the payment rate that applies to 19 such services and the provider of such 20 services under part B of title XVIII (or, if 21 greater, the payment rate that would be 22 applicable under such part if the conver- 23 sion factor under section 1848(d) for the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 580 •HR 7585 IH year were the conversion factor under such 1 section for 2009); 2 ‘‘(ii) in the case of items and services 3 that are not items and services provided 4 under such part, at a rate to be established 5 by the Secretary; and 6 ‘‘(iii) in the case of items and services 7 that are furnished in rural areas (as de- 8 fined in section 1886(d)(2)(D)), health 9 professional shortage areas (as defined in 10 section 332(a)(1)(A) of the Public Health 11 Service Act (42 U.S.C. 254e(a)(1)(A))), or 12 medically underserved areas (according to 13 a designation under section 330(b)(3)(A) 14 of the Public Health Service Act (42 15 U.S.C. 254b(b)(3)(A))), at the rate other- 16 wise applicable to such items or services 17 under clause (i) or (ii) increased, at the 18 Secretary’s discretion, by not more than 25 19 percent;’’. 20 (B) CONFORMING AMENDMENTS.— 21 (i) Section 1902(a)(13)(C) of the So- 22 cial Security Act (42 U.S.C. 23 1396a(a)(13)(C)) is amended by striking 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 581 •HR 7585 IH ‘‘subsection (jj)’’ and inserting ‘‘subsection 1 (jj)(1)’’. 2 (ii) Section 1905(dd) of the Social Se- 3 curity Act (42 U.S.C. 1396d(dd)) is 4 amended— 5 (I) by striking ‘‘Notwith- 6 standing’’ and inserting the following: 7 ‘‘(1) IN GENERAL.—Notwithstanding’’; 8 (II) by striking ‘‘section 9 1902(a)(13)(C)’’ and inserting ‘‘sub- 10 paragraph (C) of section 11 1902(a)(13)’’; 12 (III) by inserting ‘‘or for services 13 described in subparagraph (D) of sec- 14 tion 1902(a)(13) furnished during an 15 additional period specified in para- 16 graph (2),’’ after ‘‘2015,’’; 17 (IV) by striking ‘‘under such sec- 18 tion’’ and inserting ‘‘under subpara- 19 graph (C) or (D) of section 20 1902(a)(13), as applicable’’; and 21 (V) by adding at the end the fol- 22 lowing: 23 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 24 paragraph (1), the following are additional periods: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 582 •HR 7585 IH ‘‘(A) The period that begins on the first 1 day of the first month that begins after the 2 date of enactment of this paragraph.’’. 3 (2) IMPROVED TARGETING OF PRIMARY 4 CARE.—Section 1902(jj) of the Social Security Act 5 (42 U.S.C. 1396a(jj)) is amended— 6 (A) by redesignating paragraphs (1) and 7 (2) as clauses (i) and (ii), respectively, and re- 8 aligning the left margins accordingly; 9 (B) by striking ‘‘For purposes of sub- 10 section (a)(13)(C)’’ and inserting the following: 11 ‘‘(1) IN GENERAL.— 12 ‘‘(A) DEFINITION.—For purposes of sub- 13 paragraphs (C) and (D) of subsection (a)(13)’’; 14 and 15 (C) by inserting after clause (ii) (as so re- 16 designated) the following: 17 ‘‘(B) EXCLUSIONS.—Such term does not 18 include any services described in subparagraph 19 (A) or (B) of paragraph (1) if such services are 20 provided in an emergency department of a hos- 21 pital. 22 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 23 of subparagraph (D) of subsection (a)(13), a pro- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 583 •HR 7585 IH vider described in this paragraph is any of the fol- 1 lowing: 2 ‘‘(A) A physician with a primary specialty 3 designation of family medicine, general internal 4 medicine, or pediatric medicine, or obstetrics 5 and gynecology. 6 ‘‘(B) An advanced practice clinician, as de- 7 fined by the Secretary, that works under the 8 supervision of— 9 ‘‘(i) a physician that satisfies the cri- 10 teria specified in subparagraph (A); 11 ‘‘(ii) a nurse practitioner or a physi- 12 cian assistant (as such terms are defined 13 in section 1861(aa)(5)(A)) who is working 14 in accordance with State law; or 15 ‘‘(iii) or a certified nurse-midwife (as 16 defined in section 1861(gg)) or a certified 17 professional midwife who is working in ac- 18 cordance with State law. 19 ‘‘(C) A rural health clinic, federally quali- 20 fied health center, health center that receives 21 funding under title X of the Public Health 22 Service Act, or other health clinic that receives 23 reimbursement on a fee schedule applicable to 24 a physician. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 584 •HR 7585 IH ‘‘(D) An advanced practice clinician super- 1 vised by a physician described in subparagraph 2 (A), another advanced practice clinician, or a 3 certified nurse-midwife. 4 ‘‘(E) A midwife who is working in accord- 5 ance with State law.’’. 6 (3) ENSURING PAYMENT BY MANAGED CARE 7 ENTITIES.— 8 (A) IN GENERAL.—Section 1903(m)(2)(A) 9 of the Social Security Act (42 U.S.C. 10 1396b(m)(2)(A)) is amended— 11 (i) in clause (xii), by striking ‘‘and’’ 12 after the semicolon; 13 (ii) by realigning the left margin of 14 clause (xiii) so as to align with the left 15 margin of clause (xii) and by striking the 16 period at the end of clause (xiii) and in- 17 serting ‘‘; and’’; and 18 (iii) by inserting after clause (xiii) the 19 following: 20 ‘‘(xiv) such contract provides that (I) payments 21 to providers specified in section 1902(a)(13)(D) for 22 primary care services (as defined in section 1902(jj)) 23 that are furnished during a year or period (as speci- 24 fied in section 1902(a)(13)(D) and section 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 585 •HR 7585 IH 1905(dd)) are at least equal to the amounts set 1 forth and required by the Secretary by regulation; 2 (II) the entity shall, upon request, provide docu- 3 mentation to the State, sufficient to enable the State 4 and the Secretary to ensure compliance with sub- 5 clause (I); and (III) the Secretary shall approve pay- 6 ments described in subclause (I) that are furnished 7 through an agreed upon capitation, partial capita- 8 tion, or other value-based payment arrangement if 9 the capitation, partial capitation, or other value- 10 based payment arrangement is based on a reason- 11 able methodology and the entity provides docu- 12 mentation to the State sufficient to enable the State 13 and the Secretary to ensure compliance with sub- 14 clause (I).’’. 15 (B) CONFORMING AMENDMENT.—Section 16 1932(f) of the Social Security Act (42 U.S.C. 17 1396u–2(f)) is amended— 18 (i) by striking ‘‘section 19 1902(a)(13)(C)’’ and inserting ‘‘sub- 20 sections (C) and (D) of section 21 1902(a)(13)’’; and 22 (ii) by inserting ‘‘, and clause (xiv) of 23 section 1903(m)(2)(A)’’ before the period. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 586 •HR 7585 IH (d) MACPAC REPORT AND CMS GUIDANCE ON IN- 1 CREASING ACCESS TO DOULA SERVICES FOR MEDICAID 2 BENEFICIARIES.— 3 (1) MACPAC REPORT.— 4 (A) IN GENERAL.—Not later than 1 year 5 after the date of the enactment of this Act, the 6 Medicaid and CHIP Payment and Access Com- 7 mission (referred to in this subsection as 8 ‘‘MACPAC’’) shall publish a report on the cov- 9 erage of doula services under State Medicaid 10 programs, which shall at a minimum include 11 the following: 12 (i) Information about coverage for 13 doula services under State Medicaid pro- 14 grams that currently provide coverage for 15 such care, including the type of doula serv- 16 ices offered (such as prenatal, labor and 17 delivery, postpartum support, and also 18 community-based and traditional doula 19 services). 20 (ii) An analysis of barriers to covering 21 doula services under State Medicaid pro- 22 grams. 23 (iii) An identification of effective 24 strategies to increase the use of doula serv- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 587 •HR 7585 IH ices in order to provide better care and 1 achieve better maternal and infant health 2 outcomes, including strategies that States 3 may use to recruit, train, and certify a di- 4 verse doula workforce, particularly from 5 underserved communities, communities of 6 color, and communities facing linguistic or 7 cultural barriers. 8 (iv) Recommendations for legislative 9 and administrative actions to increase ac- 10 cess to doula services in State Medicaid 11 programs, including actions that ensure 12 doulas may earn a living wage that ac- 13 counts for their time and costs associated 14 with providing care and community-based 15 doula program administration and oper- 16 ation. 17 (B) STAKEHOLDER CONSULTATION.—In 18 developing the report required under subpara- 19 graph (A), MACPAC shall consult with relevant 20 stakeholders, including— 21 (i) States; 22 (ii) organizations, especially reproduc- 23 tive justice and birth justice organizations 24 led by people of color, representing con- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 588 •HR 7585 IH sumers of maternal health care, including 1 those that are disproportionately impacted 2 by poor maternal health outcomes; 3 (iii) organizations and individuals rep- 4 resenting doulas, including community- 5 based doula programs and those who serve 6 underserved communities, including com- 7 munities of color, and communities facing 8 linguistic or cultural barriers; 9 (iv) organizations representing health 10 care providers; and 11 (v) Black, Indigenous, and other ma- 12 ternal health care consumers of color who 13 have experienced severe maternal mor- 14 bidity. 15 (2) CMS GUIDANCE.— 16 (A) IN GENERAL.—Not later than 1 year 17 after the date that MACPAC publishes the re- 18 port required under paragraph (1)(A), the Ad- 19 ministrator of the Centers for Medicare & Med- 20 icaid Services shall issue guidance to States on 21 increasing access to doula services under Med- 22 icaid. Such guidance shall at a minimum in- 23 clude— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 589 •HR 7585 IH (i) options for States to provide med- 1 ical assistance for doula services under 2 State Medicaid programs; 3 (ii) best practices for ensuring that 4 doulas, including community-based doulas, 5 receive reimbursement for doula services 6 provided under a State Medicaid program, 7 at a level that allows doulas to earn a liv- 8 ing wage that accounts for their time and 9 costs associated with providing care and 10 community-based doula program adminis- 11 tration; and 12 (iii) best practices for increasing ac- 13 cess to doula services, including services 14 provided by community-based doulas, 15 under State Medicaid programs. 16 (B) STAKEHOLDER CONSULTATION.—In 17 developing the guidance required under sub- 18 paragraph (A), the Administrator of the Cen- 19 ters for Medicare & Medicaid Services shall con- 20 sult with MACPAC and other relevant stake- 21 holders, including— 22 (i) State Medicaid officials; 23 (ii) organizations representing con- 24 sumers of maternal health care, including 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 590 •HR 7585 IH those that are disproportionately impacted 1 by poor maternal health outcomes; 2 (iii) organizations representing doulas, 3 including community-based doulas and 4 those who serve underserved communities, 5 such as communities of color and commu- 6 nities facing linguistic or cultural barriers; 7 and 8 (iv) organizations representing med- 9 ical professionals. 10 (e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 11 USE OF TELEHEALTH TO INCREASE ACCESS TO MATER- 12 NITY CARE.—Not later than 1 year after the date of the 13 enactment of this Act, the Comptroller General of the 14 United States shall submit a report to Congress on State 15 Medicaid programs’ use of telehealth to increase access to 16 maternity care. Such report shall include the following: 17 (1) The number of State Medicaid programs 18 that utilize telehealth that increases access to mater- 19 nity care. 20 (2) With respect to State Medicaid programs 21 that utilize telehealth that increases access to mater- 22 nity care, information about— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 591 •HR 7585 IH (A) common characteristics of such pro- 1 grams’ approaches to utilizing telehealth that 2 increases access to maternity care; 3 (B) differences in States’ approaches to 4 utilizing telehealth to improve access to mater- 5 nity care, and the resulting differences in State 6 maternal health outcomes, as determined by 7 factors described in subsection (C); and 8 (C) when compared to patients who receive 9 maternity care in-person, what is known 10 about— 11 (i) the demographic characteristics, 12 such as race, ethnicity, sex, sexual orienta- 13 tion, gender identity, disability status, age, 14 and preferred language of the individuals 15 enrolled in such programs who use tele- 16 health to access maternity care; 17 (ii) health outcomes for such individ- 18 uals, including frequency of mortality and 19 severe morbidity, as compared to individ- 20 uals with similar characteristics who did 21 not use telehealth to access maternity care; 22 (iii) the services provided to individ- 23 uals through telehealth, including family 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 592 •HR 7585 IH planning services, mental health care serv- 1 ices, and oral health services; 2 (iv) the devices and equipment pro- 3 vided to individuals for remote patient 4 monitoring and telehealth, including blood 5 pressure monitors and blood glucose mon- 6 itors; 7 (v) the quality of maternity care pro- 8 vided through telehealth, including whether 9 maternity care provided through telehealth 10 is culturally and linguistically appropriate; 11 (vi) the level of patient satisfaction 12 with maternity care provided through tele- 13 health to individuals enrolled in State Med- 14 icaid programs; 15 (vii) the impact of utilizing telehealth 16 to increase access to maternity care on 17 spending, cost savings, access to care, and 18 utilization of care under State Medicaid 19 programs; and 20 (viii) the accessibility and effectiveness 21 of telehealth for maternity care during the 22 COVID–19 pandemic. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 593 •HR 7585 IH (3) An identification and analysis of the bar- 1 riers to using telehealth to increase access to mater- 2 nity care under State Medicaid programs. 3 (4) Recommendations for such legislative and 4 administrative actions related to increasing access to 5 telehealth maternity services under Medicaid as the 6 Comptroller General deems appropriate. 7 SEC. 5203. JUSTICE FOR INCARCERATED MOMS. 8 (a) SENSE OF CONGRESS.—It is the sense of Con- 9 gress that— 10 (1) the respect and proper care that birthing 11 people deserve is inclusive; and 12 (2) regardless of race, ethnicity, gender iden- 13 tity, sexual orientation, religion, marital status, fa- 14 milial status, socioeconomic status, immigration sta- 15 tus, incarceration status, or disability, all deserve 16 dignity. 17 (b) ENDING THE SHACKLING OF PREGNANT INDI- 18 VIDUALS.— 19 (1) IN GENERAL.—Beginning on the date that 20 is 6 months after the date of enactment of this Act, 21 and annually thereafter, in each State that receives 22 a grant under subpart 1 of part E of title I of the 23 Omnibus Crime Control and Safe Streets Act of 24 1968 (34 U.S.C. 10151 et seq.) (commonly referred 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 594 •HR 7585 IH to as the ‘‘Edward Byrne Memorial Justice Grant 1 Program’’) and that does not have in effect through- 2 out the State for such fiscal year laws restricting the 3 use of restraints on pregnant individuals in prison 4 that are substantially similar to the rights, proce- 5 dures, requirements, effects, and penalties set forth 6 in section 4322 of title 18, United States Code, the 7 amount of such grant that would otherwise be allo- 8 cated to such State under such subpart for the fiscal 9 year shall be decreased by 25 percent. 10 (2) REALLOCATION.—Amounts not allocated to 11 a State for failure to comply with paragraph (1) 12 shall be reallocated in accordance with subpart 1 of 13 part E of title I of the Omnibus Crime Control and 14 Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) 15 to States that have complied with such paragraph. 16 (c) CREATING MODEL PROGRAMS FOR THE CARE OF 17 INCARCERATED INDIVIDUALS IN THE PRENATAL AND 18 POSTPARTUM PERIODS.— 19 (1) IN GENERAL.—Not later than 1 year after 20 the date of enactment of this Act, the Attorney Gen- 21 eral, acting through the Director of the Bureau of 22 Prisons (in this subsection referred to as the ‘‘Direc- 23 tor’’), shall establish, in not fewer than 6 Bureau of 24 Prisons facilities, programs to optimize maternal 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 595 •HR 7585 IH health outcomes for pregnant and postpartum indi- 1 viduals incarcerated in such facilities. The Attorney 2 General shall establish such programs in consulta- 3 tion with stakeholders such as— 4 (A) relevant community-based organiza- 5 tions, particularly organizations that represent 6 incarcerated and formerly incarcerated individ- 7 uals and organizations that seek to improve ma- 8 ternal health outcomes for pregnant and 9 postpartum individuals from racial and ethnic 10 minority groups; 11 (B) relevant organizations representing pa- 12 tients, with a particular focus on patients from 13 racial and ethnic minority groups; 14 (C) organizations representing maternity 15 care providers and maternal health care edu- 16 cation programs; 17 (D) perinatal health workers; and 18 (E) researchers and policy experts in fields 19 related to maternal health care for incarcerated 20 individuals. 21 (2) START DATE.—Each selected facility shall 22 begin facility programs not later than 18 months 23 after the date of enactment of this Act. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 596 •HR 7585 IH (3) FACILITY PRIORITY.—In carrying out para- 1 graph (1), the Director shall give priority to a facil- 2 ity based on— 3 (A) the number of pregnant and 4 postpartum individuals incarcerated in such fa- 5 cility and, among such individuals, the number 6 of pregnant and postpartum individuals from 7 racial and ethnic minority groups; and 8 (B) the extent to which the leaders of such 9 facility have demonstrated a commitment to de- 10 veloping exemplary programs for pregnant and 11 postpartum individuals incarcerated in such fa- 12 cility. 13 (4) PROGRAM DURATION.—The programs es- 14 tablished under this subsection shall be for a 5-year 15 period. 16 (5) PROGRAMS.—Bureau of Prisons facilities 17 selected by the Director shall establish programs for 18 pregnant and postpartum incarcerated individuals, 19 and such programs may— 20 (A) provide access to perinatal health 21 workers from pregnancy through the 22 postpartum period; 23 (B) provide access to healthy foods and 24 counseling on nutrition, recommended activity 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 597 •HR 7585 IH levels, and safety measures throughout preg- 1 nancy; 2 (C) train correctional officers to ensure 3 that pregnant incarcerated individuals receive 4 safe and respectful treatment; 5 (D) train medical personnel to ensure that 6 pregnant incarcerated individuals receive trau- 7 ma-informed, culturally congruent care that 8 promotes the health and safety of the pregnant 9 individuals; 10 (E) provide counseling and treatment for 11 individuals who have suffered from— 12 (i) diagnosed mental or behavioral 13 health conditions, including trauma and 14 substance use disorders; 15 (ii) trauma or violence, including do- 16 mestic violence; 17 (iii) human immunodeficiency virus; 18 (iv) sexual abuse; 19 (v) pregnancy or infant loss; or 20 (vi) chronic conditions; 21 (F) provide evidence-based pregnancy and 22 childbirth education, parenting support, and 23 other relevant forms of health literacy; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 598 •HR 7585 IH (G) provide clinical education opportunities 1 to maternity care providers in training to ex- 2 pand pathways into maternal health care ca- 3 reers serving incarcerated individuals; 4 (H) offer opportunities for postpartum in- 5 dividuals to maintain contact with the individ- 6 ual’s newborn child to promote bonding, includ- 7 ing enhanced visitation policies, access to prison 8 nursery programs, or breastfeeding support; 9 (I) provide reentry assistance, particularly 10 to— 11 (i) ensure access to health insurance 12 coverage and transfer of health records to 13 community providers if an incarcerated in- 14 dividual exits the criminal justice system 15 during such individual’s pregnancy or in 16 the postpartum period; and 17 (ii) connect individuals exiting the 18 criminal justice system during pregnancy 19 or in the postpartum period to community- 20 based resources, such as referrals to health 21 care providers, substance use disorder 22 treatments, and social services that ad- 23 dress social determinants of maternal 24 health; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 599 •HR 7585 IH (J) establish partnerships with local public 1 entities, private community entities, community- 2 based organizations, Indian Tribes and tribal 3 organizations (as such terms are defined in sec- 4 tion 4 of the Indian Self-Determination and 5 Education Assistance Act (25 U.S.C. 5304)), 6 and urban Indian organizations (as such term 7 is defined in section 4 of the Indian Health 8 Care Improvement Act (25 U.S.C. 1603)) to es- 9 tablish or expand pretrial diversion programs as 10 an alternative to incarceration for pregnant and 11 postpartum individuals, including— 12 (i) evidence-based childbirth education 13 or parenting classes; 14 (ii) prenatal health coordination; 15 (iii) family and individual counseling; 16 (iv) evidence-based screenings, edu- 17 cation, and, as needed, treatment for men- 18 tal and behavioral health conditions, in- 19 cluding drug and alcohol treatments; 20 (v) family case management services; 21 (vi) domestic violence education and 22 prevention; 23 (vii) physical and sexual abuse coun- 24 seling; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 600 •HR 7585 IH (viii) programs to address social de- 1 terminants of health such as employment, 2 housing, education, transportation, and nu- 3 trition. 4 (6) IMPLEMENTATION AND REPORTING.—A se- 5 lected facility shall be responsible for— 6 (A) implementing programs, which may in- 7 clude the programs described in paragraph (5); 8 and 9 (B) not later than 3 years after the date 10 of enactment of this Act, and 6 years after the 11 date of enactment of this Act, reporting results 12 of the programs to the Director, including in- 13 formation describing— 14 (i) relevant quantitative indicators of 15 success in improving the standard of care 16 and health outcomes for pregnant and 17 postpartum incarcerated individuals in the 18 facility, including data stratified by race, 19 ethnicity, sex, gender, age, geography, dis- 20 ability status, the category of the criminal 21 charge against such individual, rates of 22 pregnancy-related deaths, pregnancy-asso- 23 ciated deaths, cases of infant mortality and 24 morbidity, rates of pre-term births and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 601 •HR 7585 IH low-birthweight births, cases of severe ma- 1 ternal morbidity, cases of violence against 2 pregnant or postpartum individuals, diag- 3 noses of maternal mental or behavioral 4 health conditions, and other such informa- 5 tion as appropriate; 6 (ii) relevant qualitative and quan- 7 titative evaluations from pregnant and 8 postpartum incarcerated individuals who 9 participated in such programs, including 10 measures of patient-reported experience of 11 care; and 12 (iii) strategies to sustain such pro- 13 grams after fiscal year 2027 and expand 14 such programs to other facilities. 15 (7) REPORT.—Not later than 6 years after the 16 date of enactment of this Act, the Director shall 17 submit to the Attorney General and to the Congress 18 a report describing the results of the programs fund- 19 ed under this subsection. 20 (8) OVERSIGHT.—Not later than 1 year after 21 the date of enactment of this Act, the Attorney Gen- 22 eral shall award a contract to an independent orga- 23 nization or independent organizations to conduct 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 602 •HR 7585 IH oversight of the programs described in paragraph 1 (5). 2 (9) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this subsection $10,000,000 for each of fiscal years 5 2023 through 2027. 6 (d) GRANT PROGRAM TO IMPROVE MATERNAL 7 HEALTH OUTCOMES FOR INDIVIDUALS IN STATE AND 8 LOCAL PRISONS AND JAILS.— 9 (1) ESTABLISHMENT.—Not later than 1 year 10 after the date of enactment of this section, the At- 11 torney General, acting through the Director of the 12 Bureau of Justice Assistance (in this subsection re- 13 ferred to as the ‘‘Director’’), shall award Justice for 14 Incarcerated Moms grants to States to establish or 15 expand programs in State and local prisons and jails 16 for pregnant and postpartum incarcerated individ- 17 uals. The Attorney General shall award such grants 18 in consultation with stakeholders such as— 19 (A) relevant community-based organiza- 20 tions, particularly organizations that represent 21 incarcerated and formerly incarcerated individ- 22 uals and organizations that seek to improve ma- 23 ternal health outcomes for pregnant and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 603 •HR 7585 IH postpartum individuals from racial and ethnic 1 minority groups; 2 (B) relevant organizations representing pa- 3 tients, with a particular focus on patients from 4 racial and ethnic minority groups; 5 (C) organizations representing maternity 6 care providers and maternal health care edu- 7 cation programs; 8 (D) perinatal health workers; and 9 (E) researchers and policy experts in fields 10 related to maternal health care for incarcerated 11 individuals. 12 (2) APPLICATIONS.—Each applicant for a grant 13 under this subsection shall submit to the Director an 14 application at such time, in such manner, and con- 15 taining such information as the Director may re- 16 quire. 17 (3) USE OF FUNDS.—A State that is awarded 18 a grant under this subsection shall use such grant 19 to establish or expand programs for pregnant and 20 postpartum incarcerated individuals, and such pro- 21 grams may— 22 (A) provide access to perinatal health 23 workers from pregnancy through the 24 postpartum period; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 604 •HR 7585 IH (B) provide access to healthy foods and 1 counseling on nutrition, recommended activity 2 levels, and safety measures throughout preg- 3 nancy; 4 (C) train correctional officers to ensure 5 that pregnant incarcerated individuals receive 6 safe and respectful treatment; 7 (D) train medical personnel to ensure that 8 pregnant incarcerated individuals receive trau- 9 ma-informed, culturally congruent care that 10 promotes the health and safety of the pregnant 11 individuals; 12 (E) provide counseling and treatment for 13 individuals who have suffered from— 14 (i) diagnosed mental or behavioral 15 health conditions, including trauma and 16 substance use disorders; 17 (ii) trauma or violence, including do- 18 mestic violence; 19 (iii) human immunodeficiency virus; 20 (iv) sexual abuse; 21 (v) pregnancy or infant loss; or 22 (vi) chronic conditions; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 605 •HR 7585 IH (F) provide evidence-based pregnancy and 1 childbirth education, parenting support, and 2 other relevant forms of health literacy; 3 (G) provide clinical education opportunities 4 to maternity care providers in training to ex- 5 pand pathways into maternal health care ca- 6 reers serving incarcerated individuals; 7 (H) offer opportunities for postpartum in- 8 dividuals to maintain contact with the individ- 9 ual’s newborn child to promote bonding, includ- 10 ing enhanced visitation policies, access to prison 11 nursery programs, or breastfeeding support; 12 (I) provide reentry assistance, particularly 13 to— 14 (i) ensure access to health insurance 15 coverage and transfer of health records to 16 community providers if an incarcerated in- 17 dividual exits the criminal justice system 18 during such individual’s pregnancy or in 19 the postpartum period; and 20 (ii) connect individuals exiting the 21 criminal justice system during pregnancy 22 or in the postpartum period to community- 23 based resources, such as referrals to health 24 care providers, substance use disorder 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 606 •HR 7585 IH treatments, and social services that ad- 1 dress social determinants of maternal 2 health; or 3 (J) establish partnerships with local public 4 entities, private community entities, community- 5 based organizations, Indian Tribes and tribal 6 organizations (as such terms are defined in sec- 7 tion 4 of the Indian Self-Determination and 8 Education Assistance Act (25 U.S.C. 5304)), 9 and urban Indian organizations (as such term 10 is defined in section 4 of the Indian Health 11 Care Improvement Act (25 U.S.C. 1603)) to es- 12 tablish or expand pretrial diversion programs as 13 an alternative to incarceration for pregnant and 14 postpartum individuals, including— 15 (i) evidence-based childbirth education 16 or parenting classes; 17 (ii) prenatal health coordination; 18 (iii) family and individual counseling; 19 (iv) evidence-based screenings, edu- 20 cation, and, as needed, treatment for men- 21 tal and behavioral health conditions, in- 22 cluding drug and alcohol treatments; 23 (v) family case management services; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 607 •HR 7585 IH (vi) domestic violence education and 1 prevention; 2 (vii) physical and sexual abuse coun- 3 seling; and 4 (viii) programs to address social de- 5 terminants of health such as employment, 6 housing, education, transportation, and nu- 7 trition. 8 (4) PRIORITY.—In awarding grants under this 9 subsection, the Director shall give priority to appli- 10 cants based on— 11 (A) the number of pregnant and 12 postpartum individuals incarcerated in the 13 State and, among such individuals, the number 14 of pregnant and postpartum individuals from 15 racial and ethnic minority groups; and 16 (B) the extent to which the State has dem- 17 onstrated a commitment to developing exem- 18 plary programs for pregnant and postpartum 19 individuals incarcerated in the prisons and jails 20 in such State. 21 (5) GRANT DURATION.—A grant awarded under 22 this subsection shall be for a 5-year period. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 608 •HR 7585 IH (6) IMPLEMENTING AND REPORTING.—A State 1 that receives a grant under this subsection shall be 2 responsible for— 3 (A) implementing the program funded by 4 the grant; and 5 (B) not later than 3 years after the date 6 of enactment of this section, and 6 years after 7 the date of enactment of this section, reporting 8 results of such program to the Attorney Gen- 9 eral, including information describing— 10 (i) relevant quantitative indicators of 11 the program’s success in improving the 12 standard of care and health outcomes for 13 pregnant and postpartum incarcerated in- 14 dividuals in the facility, including data 15 stratified by race, ethnicity, sex, gender, 16 age, geography, disability status, category 17 of the criminal charge against such indi- 18 vidual, incidence rates of pregnancy-related 19 deaths, pregnancy-associated deaths, cases 20 of infant mortality and morbidity, rates of 21 pre-term births and low-birthweight births, 22 cases of severe maternal morbidity, cases 23 of violence against pregnant or postpartum 24 individuals, diagnoses of maternal mental 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 609 •HR 7585 IH or behavioral health conditions, and other 1 such information as appropriate; 2 (ii) relevant qualitative and quan- 3 titative evaluations from pregnant and 4 postpartum incarcerated individuals who 5 participated in such programs, including 6 measures of patient-reported experience of 7 care; and 8 (iii) strategies to sustain such pro- 9 grams beyond the duration of the grant 10 and expand such programs to other facili- 11 ties. 12 (7) REPORT.—Not later than 6 years after the 13 date of enactment of this Act, the Attorney General 14 shall submit to the Congress a report describing the 15 results of such grant programs. 16 (8) OVERSIGHT.—Not later than 1 year after 17 the date of enactment of this Act, the Attorney Gen- 18 eral shall award a contract to an independent orga- 19 nization or independent organizations to conduct 20 oversight of the programs described in paragraph 21 (3). 22 (9) AUTHORIZATION OF APPROPRIATIONS.— 23 There is authorized to be appropriated to carry out 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 610 •HR 7585 IH this subsection $10,000,000 for each of fiscal years 1 2023 through 2027. 2 (e) GAO REPORT.— 3 (1) IN GENERAL.—Not later than 2 years after 4 the date of enactment of this section, the Comp- 5 troller General of the United States shall submit to 6 the Congress a report on adverse maternal and in- 7 fant health outcomes among incarcerated individuals 8 and infants born to such individuals, with a par- 9 ticular focus on racial and ethnic inequities in ma- 10 ternal and infant health outcomes for incarcerated 11 individuals. 12 (2) CONTENTS OF REPORT.—The report de- 13 scribed in this subsection shall include— 14 (A) to the extent practicable— 15 (i) the number of pregnant individuals 16 who are incarcerated in Bureau of Prisons 17 facilities; 18 (ii) the number of incarcerated indi- 19 viduals, including those incarcerated in 20 Federal, State, and local correctional facili- 21 ties, who have experienced a pregnancy-re- 22 lated death, pregnancy-associated death, or 23 the death of an infant in the most recent 24 10 years of available data; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 611 •HR 7585 IH (iii) the number of cases of severe ma- 1 ternal morbidity among incarcerated indi- 2 viduals, including those incarcerated in 3 Federal, State, and local detention facili- 4 ties, in the most recent 10 years of avail- 5 able data; 6 (iv) the number of pre-term and low- 7 birthweight births of infants born to incar- 8 cerated individuals, including those incar- 9 cerated in Federal, State, and local correc- 10 tional facilities, in the most recent 10 11 years of available data; and 12 (v) statistics on the racial and ethnic 13 inequities in maternal and infant health 14 outcomes and severe maternal morbidity 15 rates among incarcerated individuals, in- 16 cluding those incarcerated in Federal, 17 State, and local detention facilities; 18 (B) in the case that the Comptroller Gen- 19 eral of the United States is unable determine 20 the information required in clauses (i) through 21 (iii) of subparagraph (A), an assessment of the 22 barriers to determining such information and 23 recommendations for improvements in tracking 24 maternal health outcomes among incarcerated 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 612 •HR 7585 IH individuals, including those incarcerated in Fed- 1 eral, State, and local detention facilities; 2 (C) causes of adverse maternal health out- 3 comes that are unique to incarcerated individ- 4 uals, including those incarcerated in Federal, 5 State, and local detention facilities; 6 (D) causes of adverse maternal health out- 7 comes and severe maternal morbidity that are 8 unique to incarcerated individuals from racial 9 and ethnic minority groups; 10 (E) recommendations to reduce maternal 11 mortality and severe maternal morbidity among 12 incarcerated individuals and to address racial 13 and ethnic inequities in maternal health out- 14 comes for incarcerated individuals in Bureau of 15 Prisons facilities and State and local prisons 16 and jails; and 17 (F) such other information as may be ap- 18 propriate to reduce the occurrence of adverse 19 maternal health outcomes among incarcerated 20 individuals and to address racial and ethnic in- 21 equities in maternal health outcomes for such 22 individuals. 23 (f) MACPAC REPORT.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 613 •HR 7585 IH (1) IN GENERAL.—Not later than 2 years after 1 the date of enactment of this section, the Medicaid 2 and CHIP Payment and Access Commission (re- 3 ferred to in this subsection as ‘‘MACPAC’’) shall 4 publish a report on the implications of pregnant and 5 postpartum incarcerated individuals being ineligible 6 for medical assistance under a State plan under title 7 XIX of the Social Security Act (42 U.S.C. 1396 et 8 seq.) that contains the information described in 9 paragraph (2). 10 (2) INFORMATION DESCRIBED.—For purposes 11 of paragraph (1), the information described in this 12 paragraph includes— 13 (A) information on the effect of ineligibility 14 for medical assistance under a State plan under 15 title XIX of the Social Security Act (42 U.S.C. 16 1396 et seq.) on maternal health outcomes for 17 pregnant and postpartum incarcerated individ- 18 uals, concentrating on the effects of such ineli- 19 gibility for pregnant and postpartum individuals 20 from racial and ethnic minority groups; and 21 (B) the potential implications on maternal 22 health outcomes resulting from suspending eli- 23 gibility for medical assistance under a State 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 614 •HR 7585 IH plan under such title of such Act when a preg- 1 nant or postpartum individual is incarcerated. 2 (g) DEFINITIONS.—In this section: 3 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 4 turally congruent’’, with respect to care or maternity 5 care, means care that is in agreement with the pre- 6 ferred cultural values, beliefs, worldview, language, 7 and practices of the health care consumer and other 8 stakeholders. 9 (2) MATERNITY CARE PROVIDER.—The term 10 ‘‘maternity care provider’’ means a health care pro- 11 vider who— 12 (A) is a physician, physician assistant, 13 midwife who meets at a minimum the inter- 14 national definition of the midwife and global 15 standards for midwifery education as estab- 16 lished by the International Confederation of 17 Midwives, nurse practitioner, or clinical nurse 18 specialist; and 19 (B) has a focus on maternal or perinatal 20 health. 21 (3) MATERNAL MORTALITY.—The term ‘‘mater- 22 nal mortality’’ means a death occurring during or 23 within a one-year period after pregnancy, caused by 24 pregnancy-related or childbirth complications, in- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 615 •HR 7585 IH cluding a suicide, overdose, or other death resulting 1 from a mental health or substance use disorder at- 2 tributed to or aggravated by pregnancy-related or 3 childbirth complications. 4 (4) PERINATAL HEALTH WORKER.—The term 5 ‘‘perinatal health worker’’ means a doula, commu- 6 nity health worker, peer supporter, breastfeeding 7 and lactation educator or counselor, nutritionist or 8 dietitian, childbirth educator, social worker, home 9 visitor, language interpreter, or navigator. 10 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 11 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 12 refer to the 1-year period beginning on the last day 13 of the pregnancy of an individual. 14 (6) PREGNANCY-ASSOCIATED DEATH.—The 15 term ‘‘pregnancy-associated death’’ means a death of 16 a pregnant or postpartum individual, by any cause, 17 that occurs during, or within 1 year following, the 18 individual’s pregnancy, regardless of the outcome, 19 duration, or site of the pregnancy. 20 (7) PREGNANCY-RELATED DEATH.—The term 21 ‘‘pregnancy-related death’’ means a death of a preg- 22 nant or postpartum individual that occurs during, or 23 within 1 year following, the individual’s pregnancy, 24 from a pregnancy complication, a chain of events 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 616 •HR 7585 IH initiated by pregnancy, or the aggravation of an un- 1 related condition by the physiologic effects of preg- 2 nancy. 3 (8) RACIAL AND ETHNIC MINORITY GROUP.— 4 The term ‘‘racial and ethnic minority group’’ has the 5 meaning given such term in section 1707(g)(1) of 6 the Public Health Service Act (42 U.S.C. 300u– 7 6(g)(1)). 8 (9) SEVERE MATERNAL MORBIDITY.—The term 9 ‘‘severe maternal morbidity’’ means a health condi- 10 tion, including mental health conditions and sub- 11 stance use disorders, attributed to or aggravated by 12 pregnancy or childbirth that results in significant 13 short-term or long-term consequences to the health 14 of the individual who was pregnant. 15 (10) SOCIAL DETERMINANTS OF MATERNAL 16 HEALTH DEFINED.—The term ‘‘social determinants 17 of maternal health’’ means non-clinical factors that 18 impact maternal health outcomes, including— 19 (A) economic factors, which may include 20 poverty, employment, food security, support for 21 and access to lactation and other infant feeding 22 options, housing stability, and related factors; 23 (B) neighborhood factors, which may in- 24 clude quality of housing, access to transpor- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 617 •HR 7585 IH tation, access to child care, availability of 1 healthy foods and nutrition counseling, avail- 2 ability of clean water, air and water quality, 3 ambient temperatures, neighborhood crime and 4 violence, access to broadband, and related fac- 5 tors; 6 (C) social and community factors, which 7 may include systemic racism, gender discrimi- 8 nation or discrimination based on other pro- 9 tected classes, workplace conditions, incarcer- 10 ation, and related factors; 11 (D) household factors, which may include 12 ability to conduct lead testing and abatement, 13 car seat installation, indoor air temperatures, 14 and related factors; 15 (E) education access and quality factors, 16 which may include educational attainment, lan- 17 guage and literacy, and related factors; and 18 (F) health care access factors, including 19 health insurance coverage, access to culturally 20 congruent health care services, providers, and 21 non-clinical support, access to home visiting 22 services, access to wellness and stress manage- 23 ment programs, health literacy, access to tele- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 618 •HR 7585 IH health and items required to receive telehealth 1 services, and related factors. 2 SEC. 5204. IMPACT TO SAVE MOMS ACT. 3 (a) PERINATAL CARE ALTERNATIVE PAYMENT 4 MODEL DEMONSTRATION PROJECT.— 5 (1) IN GENERAL.—For the period of fiscal 6 years 2023 through 2027, the Secretary of Health 7 and Human Services (referred to in this subsection 8 as the ‘‘Secretary’’), acting through the Adminis- 9 trator of the Centers for Medicare & Medicaid Serv- 10 ices, shall establish and implement, in accordance 11 with the requirements of this subsection, a dem- 12 onstration project, to be known as the Perinatal 13 Care Alternative Payment Model Demonstration 14 Project (referred to in this subsection as the ‘‘Dem- 15 onstration Project’’), for purposes of allowing States 16 to test payment models under their State plans 17 under title XIX of the Social Security Act (42 18 U.S.C. 1396 et seq.) and State child health plans 19 under title XXI of such Act (42 U.S.C. 1397aa et 20 seq.) with respect to maternity care provided to 21 pregnant and postpartum individuals enrolled in 22 such State plans and State child health plans. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 619 •HR 7585 IH (2) COORDINATION.—In establishing the Dem- 1 onstration Project, the Secretary shall coordinate 2 with stakeholders such as— 3 (A) State Medicaid programs; 4 (B) relevant organizations representing 5 maternal health care providers; 6 (C) relevant organizations representing pa- 7 tients, with a particular focus on individuals 8 from demographic groups with disproportionate 9 rates of adverse maternal health outcomes; 10 (D) relevant community-based organiza- 11 tions, particularly organizations that seek to 12 improve maternal health outcomes for individ- 13 uals from demographic groups with dispropor- 14 tionate rates of adverse maternal health out- 15 comes; 16 (E) non-clinical perinatal health workers 17 such as doulas, community health workers, peer 18 supporters, certified lactation consultants, nu- 19 tritionists and dieticians, social workers, home 20 visitors, and navigators; 21 (F) relevant health insurance issuers; 22 (G) hospitals, health systems, freestanding 23 birth centers (as such term is defined in para- 24 graph (3)(B) of section 1905(l) of the Social 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 620 •HR 7585 IH Security Act (42 U.S.C. 1396d(l))), Federally- 1 qualified health centers (as such term is defined 2 in paragraph (2)(B) of such section), and rural 3 health clinics (as such term is defined in section 4 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 5 (H) researchers and policy experts in fields 6 related to maternity care payment models; and 7 (I) any other stakeholders as the Secretary 8 determines appropriate, with a particular focus 9 on stakeholders from demographic groups with 10 disproportionate rates of adverse maternal 11 health outcomes. 12 (3) CONSIDERATIONS.—In establishing the 13 Demonstration Project, the Secretary shall consider 14 each of the following: 15 (A) Findings from any evaluations of the 16 Strong Start for Mothers and Newborns initia- 17 tive carried out by the Centers for Medicare & 18 Medicaid Services, the Health Resources and 19 Services Administration, and the Administra- 20 tion on Children and Families. 21 (B) Any alternative payment model that— 22 (i) is designed to improve maternal 23 health outcomes for racial and ethnic 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 621 •HR 7585 IH groups with disproportionate rates of ad- 1 verse maternal health outcomes; 2 (ii) includes methods for stratifying 3 patients by pregnancy risk level and, as 4 appropriate, adjusting payments under 5 such model to take into account pregnancy 6 risk level; 7 (iii) establishes evidence-based quality 8 metrics for such payments; 9 (iv) includes consideration of non-hos- 10 pital birth settings such as freestanding 11 birth centers (as so defined); 12 (v) includes consideration of social de- 13 terminants of health that are relevant to 14 maternal health outcomes such as housing, 15 transportation, nutrition, and other non- 16 clinical factors that influence maternal 17 health outcomes; or 18 (vi) includes diverse maternity care 19 teams that include— 20 (I) maternity care providers, in- 21 cluding obstetrician-gynecologists, 22 family physicians, physician assist- 23 ants, midwives who meet, at a min- 24 imum, the international definition of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 622 •HR 7585 IH the term ‘‘midwife’’ and global stand- 1 ards for midwifery education (as es- 2 tablished by the International Confed- 3 eration of Midwives), and nurse prac- 4 titioners— 5 (aa) from racially, eth- 6 nically, and professionally diverse 7 backgrounds; 8 (bb) with experience prac- 9 ticing in racially and ethnically 10 diverse communities; or 11 (cc) who have undergone 12 trainings on racism, implicit bias, 13 and explicit bias; and 14 (II) non-clinical perinatal health 15 workers such as doulas, community 16 health workers, peer supporters, cer- 17 tified lactation consultants, nutrition- 18 ists and dieticians, social workers, 19 home visitors, and navigators. 20 (4) ELIGIBILITY.—To be eligible to participate 21 in the Demonstration Project, a State shall submit 22 an application to the Secretary at such time, in such 23 manner, and containing such information as the Sec- 24 retary may require. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 623 •HR 7585 IH (5) EVALUATION.—The Secretary shall conduct 1 an evaluation of the Demonstration Project to deter- 2 mine the impact of the Demonstration Project on— 3 (A) maternal health outcomes, with data 4 stratified by race, ethnicity, socioeconomic indi- 5 cators, and any other factors as the Secretary 6 determines appropriate; 7 (B) spending on maternity care by States 8 participating in the Demonstration Project; 9 (C) to the extent practicable, subjective 10 measures of patient experience; and 11 (D) any other areas of assessment that the 12 Secretary determines relevant. 13 (6) REPORT.—Not later than one year after the 14 completion or termination date of the Demonstration 15 Project, the Secretary shall submit to the Committee 16 on Energy and Commerce, the Committee on Ways 17 and Means, and the Committee on Education and 18 Labor of the House of Representatives and the Com- 19 mittee on Finance and the Committee on Health, 20 Education, Labor, and Pensions of the Senate, and 21 make publicly available, a report containing— 22 (A) the results of any evaluation conducted 23 under paragraph (5); and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 624 •HR 7585 IH (B) a recommendation regarding whether 1 the Demonstration Project should be continued 2 after fiscal year 2026 and expanded on a na- 3 tional basis. 4 (7) AUTHORIZATION OF APPROPRIATIONS.— 5 There are authorized to be appropriated such sums 6 as are necessary to carry out this subsection. 7 (8) DEFINITIONS.—In this subsection: 8 (A) ALTERNATIVE PAYMENT MODEL.—The 9 term ‘‘alternative payment model’’ has the 10 meaning given such term in section 11 1833(z)(3)(C) of the Social Security Act (42 12 U.S.C. 1395l(z)(3)(C)). 13 (B) PERINATAL.—The term ‘‘perinatal’’ 14 means the period beginning on the day a person 15 becomes pregnant and ending on the last day of 16 the 1-year period beginning on the last day of 17 such person’s pregnancy. 18 (b) MACPAC REPORT.— 19 (1) IN GENERAL.—Not later than two years 20 after the date of the enactment of this section, the 21 Medicaid and CHIP Payment and Access Commis- 22 sion shall publish a report on issues relating to the 23 continuity of coverage under State plans under title 24 XIX of the Social Security Act (42 U.S.C. 1396 et 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 625 •HR 7585 IH seq.) and State child health plans under title XXI of 1 such Act (42 U.S.C. 1397aa et seq.) for pregnant 2 and postpartum individuals. Such report shall, at a 3 minimum, include the following: 4 (A) An assessment of any existing policies 5 under such State plans and such State child 6 health plans regarding presumptive eligibility 7 for pregnant individuals while their application 8 for enrollment in such a State plan or such a 9 State child health plan is being processed. 10 (B) An assessment of any existing policies 11 under such State plans and such State child 12 health plans regarding measures to ensure con- 13 tinuity of coverage under such a State plan or 14 such a State child health plan for pregnant and 15 postpartum individuals, including such individ- 16 uals who need to change their health insurance 17 coverage during their pregnancy or the 18 postpartum period following their pregnancy. 19 (C) An assessment of any existing policies 20 under such State plans and such State child 21 health plans regarding measures to automati- 22 cally reenroll individuals who are eligible to en- 23 roll under such a State plan or such a State 24 child health plan as a parent. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 626 •HR 7585 IH (D) If determined appropriate by the Com- 1 mission, any recommendations for the Depart- 2 ment of Health and Human Services, or such 3 State plans and such State child health plans, 4 to ensure continuity of coverage under such a 5 State plan or such a State child health plan for 6 pregnant and postpartum people. 7 (2) POSTPARTUM DEFINED.—In this sub- 8 section, the term ‘‘postpartum’’ means the 1-year 9 period beginning on the last day of a person’s preg- 10 nancy. 11 SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLI- 12 MATE CHANGE. 13 (a) GRANT PROGRAM TO PROTECT VULNERABLE 14 MOTHERS AND BABIES FROM CLIMATE CHANGE 15 RISKS.— 16 (1) IN GENERAL.—Not later than 180 days 17 after the date of the enactment of this section, the 18 Secretary of Health and Human Services (in this 19 section referred to as the ‘‘Secretary’’) shall estab- 20 lish a grant program (in this subsection referred to 21 as the ‘‘Program’’) to protect vulnerable individuals 22 from risks associated with climate change. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 627 •HR 7585 IH (2) GRANT AUTHORITY.—In carrying out the 1 Program, the Secretary may award, on a competitive 2 basis, grants to 10 covered entities. 3 (3) APPLICATIONS.—To be eligible for a grant 4 under the Program, a covered entity shall submit to 5 the Secretary an application at such time, in such 6 form, and containing such information as the Sec- 7 retary may require, which shall include, at a min- 8 imum, a description of the following: 9 (A) Plans for the use of grant funds 10 awarded under the Program and how patients 11 and stakeholder organizations were involved in 12 the development of such plans. 13 (B) How such grant funds will be targeted 14 to geographic areas that have disproportionately 15 high levels of risks associated with climate 16 change for vulnerable individuals. 17 (C) How such grant funds will be used to 18 address racial and ethnic inequities in— 19 (i) adverse maternal and infant health 20 outcomes; and 21 (ii) exposure to risks associated with 22 climate change for vulnerable individuals. 23 (D) Strategies to prevent an initiative as- 24 sisted with such grant funds from causing— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 628 •HR 7585 IH (i) adverse environmental impacts; 1 (ii) displacement of residents and 2 businesses; 3 (iii) rent and housing price increases; 4 or 5 (iv) disproportionate adverse impacts 6 on racial and ethnic minority groups and 7 other underserved populations. 8 (4) SELECTION OF GRANT RECIPIENTS.— 9 (A) TIMING.—Not later than 270 days 10 after the date of the enactment of this Act, the 11 Secretary shall select the recipients of grants 12 under the Program. 13 (B) CONSULTATION.—In selecting covered 14 entities for grants under the Program, the Sec- 15 retary shall consult with— 16 (i) representatives of stakeholder or- 17 ganizations; 18 (ii) the Administrator of the Environ- 19 mental Protection Agency; 20 (iii) the Administrator of the National 21 Oceanic and Atmospheric Administration; 22 and 23 (iv) from the Department of Health 24 and Human Services— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 629 •HR 7585 IH (I) the Deputy Assistant Sec- 1 retary for Minority Health; 2 (II) the Administrator of the 3 Centers for Medicare & Medicaid 4 Services; 5 (III) the Administrator of the 6 Health Resources and Services Ad- 7 ministration; 8 (IV) the Director of the National 9 Institutes of Health; and 10 (V) the Director of the Centers 11 for Disease Control and Prevention. 12 (C) PRIORITY.—In selecting a covered en- 13 tity to be awarded a grant under the Program, 14 the Secretary shall give priority to covered enti- 15 ties that serve a county— 16 (i) designated, or located in an area 17 designated, as a nonattainment area pur- 18 suant to section 107 of the Clean Air Act 19 (42 U.S.C. 7407) for any air pollutant for 20 which air quality criteria have been issued 21 under section 108(a) of such Act (42 22 U.S.C. 7408(a)); 23 (ii) with a level of vulnerability of 24 moderate-to-high or higher, according to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 630 •HR 7585 IH the Social Vulnerability Index of the Cen- 1 ters for Disease Control and Prevention; or 2 (iii) with temperatures that pose a 3 risk to human health, as determined by the 4 Secretary, in consultation with the Admin- 5 istrator of the National Oceanic and At- 6 mospheric Administration and the Chair of 7 the United States Global Change Research 8 Program, based on the best available 9 science. 10 (D) LIMITATION.—A recipient of grant 11 funds under the Program may not use such 12 grant funds to serve a county that is served by 13 any other recipient of a grant under the Pro- 14 gram. 15 (5) USE OF FUNDS.—A covered entity awarded 16 grant funds under the Program may only use such 17 grant funds for the following: 18 (A) Initiatives to identify risks associated 19 with climate change for vulnerable individuals 20 and to provide services and support to such in- 21 dividuals that address such risks, which may in- 22 clude— 23 (i) training for health care providers, 24 doulas, and other employees in hospitals, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 631 •HR 7585 IH birth centers, midwifery practices, and 1 other health care practices that provide 2 prenatal or labor and delivery services to 3 vulnerable individuals on the identification 4 of, and patient counseling relating to, risks 5 associated with climate change for vulner- 6 able individuals; 7 (ii) hiring, training, or providing re- 8 sources to community health workers and 9 perinatal health workers who can help 10 identify risks associated with climate 11 change for vulnerable individuals, provide 12 patient counseling about such risks, and 13 carry out the distribution of relevant serv- 14 ices and support; 15 (iii) enhancing the monitoring of risks 16 associated with climate change for vulner- 17 able individuals, including by— 18 (I) collecting data on such risks 19 in specific census tracts, neighbor- 20 hoods, or other geographic areas; and 21 (II) sharing such data with local 22 health care providers, doulas, and 23 other employees in hospitals, birth 24 centers, midwifery practices, and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 632 •HR 7585 IH other health care practices that pro- 1 vide prenatal or labor and delivery 2 services to local vulnerable individuals; 3 and 4 (iv) providing vulnerable individuals— 5 (I) air conditioning units, resi- 6 dential weatherization support, filtra- 7 tion systems, household appliances, or 8 related items; 9 (II) direct financial assistance; 10 and 11 (III) services and support, in- 12 cluding housing and transportation 13 assistance, to prepare for or recover 14 from extreme weather events, which 15 may include floods, hurricanes, 16 wildfires, droughts, and related 17 events. 18 (B) Initiatives to mitigate levels of and ex- 19 posure to risks associated with climate change 20 for vulnerable individuals, which shall be based 21 on the best available science and which may in- 22 clude initiatives to— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 633 •HR 7585 IH (i) develop, maintain, or expand urban 1 or community forestry initiatives and tree 2 canopy coverage initiatives; 3 (ii) improve infrastructure, including 4 buildings and paved surfaces; 5 (iii) develop or improve community 6 outreach networks to provide culturally 7 and linguistically appropriate information 8 and notifications about risks associated 9 with climate change for vulnerable individ- 10 uals; and 11 (iv) provide enhanced services to ra- 12 cial and ethnic minority groups and other 13 underserved populations. 14 (6) LENGTH OF AWARD.—A grant under this 15 subsection shall be disbursed over 4 fiscal years. 16 (7) TECHNICAL ASSISTANCE.—The Secretary 17 shall provide technical assistance to a covered entity 18 awarded a grant under the Program to support the 19 development, implementation, and evaluation of ac- 20 tivities funded with such grant. 21 (8) REPORTS TO SECRETARY.— 22 (A) ANNUAL REPORT.—For each fiscal 23 year during which a covered entity is disbursed 24 grant funds under the Program, such covered 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 634 •HR 7585 IH entity shall submit to the Secretary a report 1 that summarizes the activities carried out by 2 such covered entity with such grant funds dur- 3 ing such fiscal year, which shall include a de- 4 scription of the following: 5 (i) The involvement of stakeholder or- 6 ganizations in the implementation of initia- 7 tives assisted with such grant funds. 8 (ii) Relevant health and environmental 9 data, disaggregated, to the extent prac- 10 ticable, by race, ethnicity, gender, and 11 pregnancy status. 12 (iii) Qualitative feedback received 13 from vulnerable individuals with respect to 14 initiatives assisted with such grant funds. 15 (iv) Criteria used in selecting the geo- 16 graphic areas assisted with such grant 17 funds. 18 (v) Efforts to address racial and eth- 19 nic inequities in adverse maternal and in- 20 fant health outcomes and in exposure to 21 risks associated with climate change for 22 vulnerable individuals. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 635 •HR 7585 IH (vi) Any negative and unintended im- 1 pacts of initiatives assisted with such grant 2 funds, including— 3 (I) adverse environmental im- 4 pacts; 5 (II) displacement of residents 6 and businesses; 7 (III) rent and housing price in- 8 creases; and 9 (IV) disproportionate adverse im- 10 pacts on racial and ethnic minority 11 groups and other underserved popu- 12 lations. 13 (vii) How the covered entity will ad- 14 dress and prevent any impacts described in 15 clause (vi). 16 (B) PUBLICATION.—Not later than 30 17 days after the date on which a report is sub- 18 mitted under subparagraph (A), the Secretary 19 shall publish such report on a public website of 20 the Department of Health and Human Services. 21 (9) REPORT TO CONGRESS.—Not later than the 22 date that is 5 years after the date on which the Pro- 23 gram is established, the Secretary shall submit to 24 Congress and publish on a public website of the De- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 636 •HR 7585 IH partment of Health and Human Services a report on 1 the results of the Program, including the following: 2 (A) Summaries of the annual reports sub- 3 mitted under paragraph (8). 4 (B) Evaluations of the initiatives assisted 5 with grant funds under the Program. 6 (C) An assessment of the effectiveness of 7 the Program in— 8 (i) identifying risks associated with 9 climate change for vulnerable individuals; 10 (ii) providing services and support to 11 such individuals; 12 (iii) mitigating levels of and exposure 13 to such risks; and 14 (iv) addressing racial and ethnic in- 15 equities in adverse maternal and infant 16 health outcomes and in exposure to such 17 risks. 18 (D) A description of how the Program 19 could be expanded, including— 20 (i) monitoring efforts or data collec- 21 tion that would be required to identify 22 areas with high levels of risks associated 23 with climate change for vulnerable individ- 24 uals; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 637 •HR 7585 IH (ii) how such areas could be identified 1 using the strategy developed under sub- 2 section (d); and 3 (iii) recommendations for additional 4 funding. 5 (10) COVERED ENTITY DEFINED.—In this sub- 6 section, the term ‘‘covered entity’’ means a consor- 7 tium of organizations serving a county that— 8 (A) shall include a community-based orga- 9 nization; and 10 (B) may include— 11 (i) another stakeholder organization; 12 (ii) the government of such county; 13 (iii) the governments of one or more 14 municipalities within such county; 15 (iv) a State or local public health de- 16 partment or emergency management agen- 17 cy; 18 (v) a local health care practice, which 19 may include a licensed and accredited hos- 20 pital, birth center, midwifery practice, or 21 other health care practice that provides 22 prenatal or labor and delivery services to 23 vulnerable individuals; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 638 •HR 7585 IH (vi) an Indian tribe or tribal organiza- 1 tion (as such terms are defined in section 2 4 of the Indian Self-Determination and 3 Education Assistance Act (25 U.S.C. 4 5304)); 5 (vii) an Urban Indian organization (as 6 defined in section 4 of the Indian Health 7 Care Improvement Act (25 U.S.C. 1603)); 8 and 9 (viii) an institution of higher edu- 10 cation. 11 (11) AUTHORIZATION OF APPROPRIATIONS.— 12 There is authorized to be appropriated to carry out 13 this subsection $100,000,000 for fiscal years 2023 14 through 2026. 15 (b) GRANT PROGRAM FOR EDUCATION AND TRAIN- 16 ING AT HEALTH PROFESSION SCHOOLS.— 17 (1) IN GENERAL.—Not later than 1 year after 18 the date of the enactment of this Act, the Secretary 19 shall establish a grant program (in this subsection 20 referred to as the ‘‘Program’’) to provide funds to 21 health profession schools to support the development 22 and integration of education and training programs 23 for identifying and addressing risks associated with 24 climate change for vulnerable individuals. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 639 •HR 7585 IH (2) GRANT AUTHORITY.—In carrying out the 1 Program, the Secretary may award, on a competitive 2 basis, grants to health profession schools. 3 (3) APPLICATION.—To be eligible for a grant 4 under the Program, a health profession school shall 5 submit to the Secretary an application at such time, 6 in such form, and containing such information as 7 the Secretary may require, which shall include, at a 8 minimum, a description of the following: 9 (A) How such health profession school will 10 engage with vulnerable individuals, and stake- 11 holder organizations representing such individ- 12 uals, in developing and implementing the edu- 13 cation and training programs supported by 14 grant funds awarded under the Program. 15 (B) How such health profession school will 16 ensure that such education and training pro- 17 grams will address racial and ethnic inequities 18 in exposure to, and the effects of, risks associ- 19 ated with climate change for vulnerable individ- 20 uals. 21 (4) USE OF FUNDS.—A health profession school 22 awarded a grant under the Program shall use the 23 grant funds to develop, and integrate into the cur- 24 riculum and continuing education of such health 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 640 •HR 7585 IH profession school, education and training on each of 1 the following: 2 (A) Identifying risks associated with cli- 3 mate change for vulnerable individuals and indi- 4 viduals with the intent to become pregnant. 5 (B) How risks associated with climate 6 change affect vulnerable individuals and individ- 7 uals with the intent to become pregnant. 8 (C) Racial and ethnic inequities in expo- 9 sure to, and the effects of, risks associated with 10 climate change for vulnerable individuals and 11 individuals with the intent to become pregnant. 12 (D) Patient counseling and mitigation 13 strategies relating to risks associated with cli- 14 mate change for vulnerable individuals. 15 (E) Relevant services and support for vul- 16 nerable individuals relating to risks associated 17 with climate change and strategies for ensuring 18 vulnerable individuals have access to such serv- 19 ices and support. 20 (F) Implicit and explicit bias, racism, and 21 discrimination. 22 (G) Related topics identified by such 23 health profession school based on the engage- 24 ment of such health profession school with vul- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 641 •HR 7585 IH nerable individuals and stakeholder organiza- 1 tions representing such individuals. 2 (5) PARTNERSHIPS.—In carrying out activities 3 with grant funds, a health profession school awarded 4 a grant under the Program may partner with one or 5 more of the following: 6 (A) A State or local public health depart- 7 ment. 8 (B) A health care professional membership 9 organization. 10 (C) A stakeholder organization. 11 (D) A health profession school. 12 (E) An institution of higher education. 13 (6) REPORTS TO SECRETARY.— 14 (A) ANNUAL REPORT.—For each fiscal 15 year during which a health profession school is 16 disbursed grant funds under the Program, such 17 health profession school shall submit to the Sec- 18 retary a report that describes the activities car- 19 ried out with such grant funds during such fis- 20 cal year. 21 (B) FINAL REPORT.—Not later than the 22 date that is 1 year after the end of the last fis- 23 cal year during which a health profession school 24 is disbursed grant funds under the Program, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 642 •HR 7585 IH the health profession school shall submit to the 1 Secretary a final report that summarizes the 2 activities carried out with such grant funds. 3 (7) REPORT TO CONGRESS.—Not later than the 4 date that is 6 years after the date on which the Pro- 5 gram is established, the Secretary shall submit to 6 Congress and publish on a public website of the De- 7 partment of Health and Human Services a report 8 that includes the following: 9 (A) A summary of the reports submitted 10 under paragraph (6). 11 (B) Recommendations to improve edu- 12 cation and training programs at health profes- 13 sion schools with respect to identifying and ad- 14 dressing risks associated with climate change 15 for vulnerable individuals. 16 (8) HEALTH PROFESSION SCHOOL DEFINED.— 17 In this subsection, the term ‘‘health profession 18 school’’ means an accredited— 19 (A) medical school; 20 (B) school of nursing; 21 (C) midwifery program; 22 (D) physician assistant education program; 23 (E) teaching hospital; 24 (F) residency or fellowship program; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 643 •HR 7585 IH (G) other school or program determined 1 appropriate by the Secretary. 2 (9) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this subsection $5,000,000 for fiscal years 2023 5 through 2026. 6 (c) NIH CONSORTIUM ON BIRTH AND CLIMATE 7 CHANGE RESEARCH.— 8 (1) ESTABLISHMENT.—Not later than 1 year 9 after the date of the enactment of this Act, the Di- 10 rector of the National Institutes of Health (in this 11 subsection referred to as the ‘‘Director of NIH’’) 12 shall establish the Consortium on Birth and Climate 13 Change Research (in this subsection referred to as 14 the ‘‘Consortium’’). 15 (2) DUTIES.— 16 (A) IN GENERAL.—The Consortium shall 17 coordinate, across the institutes, centers, and 18 offices of the National Institutes of Health, re- 19 search on the risks associated with climate 20 change for vulnerable individuals. 21 (B) REQUIRED ACTIVITIES.—In carrying 22 out subparagraph (A), the Consortium shall— 23 (i) establish research priorities, in- 24 cluding by prioritizing research that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 644 •HR 7585 IH (I) identifies the risks associated 1 with climate change for vulnerable in- 2 dividuals with a particular focus on 3 inequities in such risks among racial 4 and ethnic minority groups and other 5 underserved populations; and 6 (II) identifies strategies to reduce 7 levels of, and exposure to, such risks, 8 with a particular focus on risks 9 among racial and ethnic minority 10 groups and other underserved popu- 11 lations; 12 (ii) identify gaps in available data re- 13 lated to such risks; 14 (iii) identify gaps in, and opportuni- 15 ties for, research collaborations; 16 (iv) identify funding opportunities for 17 community-based organizations and re- 18 searchers from racially, ethnically, and 19 geographically diverse backgrounds; and 20 (v) publish annual reports on the 21 work and findings of the Consortium on a 22 public website of the National Institutes of 23 Health. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 645 •HR 7585 IH (3) MEMBERSHIP.—The Director of NIH shall 1 appoint to the Consortium representatives of such 2 institutes, centers, and offices of the National Insti- 3 tutes of Health as the Director of NIH considers ap- 4 propriate, including, at a minimum, representatives 5 of— 6 (A) the National Institute of Environ- 7 mental Health Sciences; 8 (B) the National Institute on Minority 9 Health and Health Disparities; 10 (C) the Eunice Kennedy Shriver National 11 Institute of Child Health and Human Develop- 12 ment; 13 (D) the National Institute of Nursing Re- 14 search; and 15 (E) the Office of Research on Women’s 16 Health. 17 (4) CHAIRPERSON.—The Chairperson of the 18 Consortium shall be designated by the Director of 19 NIH and selected from among the representatives 20 appointed under paragraph (3). 21 (5) CONSULTATION.—In carrying out the duties 22 described in paragraph (2), the Consortium shall 23 consult with— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 646 •HR 7585 IH (A) the heads of relevant Federal agencies, 1 including— 2 (i) the Environmental Protection 3 Agency; 4 (ii) the National Oceanic and Atmos- 5 pheric Administration; 6 (iii) the Occupational Safety and 7 Health Administration; and 8 (iv) from the Department of Health 9 and Human Services— 10 (I) the Office of Minority Health 11 in the Office of the Secretary; 12 (II) the Centers for Medicare & 13 Medicaid Services; 14 (III) the Health Resources and 15 Services Administration; 16 (IV) the Centers for Disease 17 Control and Prevention; 18 (V) the Indian Health Service; 19 and 20 (VI) the Administration for Chil- 21 dren and Families; and 22 (B) representatives of— 23 (i) stakeholder organizations; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 647 •HR 7585 IH (ii) health care providers and profes- 1 sional membership organizations with ex- 2 pertise in maternal health or environ- 3 mental justice; 4 (iii) State and local public health de- 5 partments; 6 (iv) licensed and accredited hospitals, 7 birth centers, midwifery practices, or other 8 health care practices that provide prenatal 9 or labor and delivery services to vulnerable 10 individuals; and 11 (v) institutions of higher education, 12 including such institutions that are minor- 13 ity-serving institutions or have expertise in 14 maternal health or environmental justice. 15 (d) STRATEGY FOR IDENTIFYING CLIMATE CHANGE 16 RISK ZONES FOR VULNERABLE MOTHERS AND BABIES.— 17 (1) IN GENERAL.—The Secretary, acting 18 through the Director of the Centers for Disease 19 Control and Prevention, shall develop a strategy (in 20 this subsection referred to as the ‘‘Strategy’’) for 21 designating areas that the Secretary determines to 22 have a high risk of adverse maternal and infant 23 health outcomes among vulnerable individuals as a 24 result of risks associated with climate change. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 648 •HR 7585 IH (2) STRATEGY REQUIREMENTS.— 1 (A) IN GENERAL.—In developing the 2 Strategy, the Secretary shall establish a process 3 to identify areas where vulnerable individuals 4 are exposed to a high risk of adverse maternal 5 and infant health outcomes as a result of risks 6 associated with climate change in conjunction 7 with other factors that can impact such health 8 outcomes, including— 9 (i) the incidence of diseases associated 10 with air pollution, extreme heat, and other 11 environmental factors; 12 (ii) the availability and accessibility of 13 maternal and infant health care providers; 14 (iii) English-language proficiency 15 among people of reproductive age; 16 (iv) the health insurance status of 17 people of reproductive age; 18 (v) the number of people of reproduc- 19 tive age who are members of racial or eth- 20 nic groups with disproportionately high 21 rates of adverse maternal and infant 22 health outcomes; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 649 •HR 7585 IH (vi) the socioeconomic status of people 1 of reproductive age, including with respect 2 to— 3 (I) poverty; 4 (II) unemployment; 5 (III) household income; and 6 (IV) educational attainment; and 7 (vii) access to quality housing, trans- 8 portation, and nutrition. 9 (B) RESOURCES.—In developing the Strat- 10 egy, the Secretary shall identify, and incor- 11 porate a description of, the following: 12 (i) Existing mapping tools or Federal 13 programs that identify— 14 (I) risks associated with climate 15 change for vulnerable individuals; and 16 (II) other factors that can influ- 17 ence maternal and infant health out- 18 comes, including the factors described 19 in subparagraph (A). 20 (ii) Environmental, health, socio- 21 economic, and demographic data relevant 22 to identifying risks associated with climate 23 change for vulnerable individuals. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 650 •HR 7585 IH (iii) Existing monitoring networks 1 that collect data described in clause (ii), 2 and any gaps in such networks. 3 (iv) Federal, State, and local stake- 4 holders involved in maintaining monitoring 5 networks identified under clause (iii), and 6 how such stakeholders are coordinating 7 their monitoring efforts. 8 (v) Additional monitoring networks, 9 and enhancements to existing monitoring 10 networks, that would be required to ad- 11 dress gaps identified under clause (iii), in- 12 cluding at the subcounty and census tract 13 level. 14 (vi) Funding amounts required to es- 15 tablish the monitoring networks identified 16 under clause (v) and recommendations for 17 Federal, State, and local coordination with 18 respect to such networks. 19 (vii) Potential uses for data collected 20 and generated as a result of the Strategy, 21 including how such data may be used in 22 determining recipients of grants under the 23 program established by subsection (a) or 24 other similar programs. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 651 •HR 7585 IH (viii) Other information the Secretary 1 considers relevant for the development of 2 the Strategy. 3 (3) COORDINATION AND CONSULTATION.—In 4 developing the Strategy, the Secretary shall— 5 (A) coordinate with the Administrator of 6 the Environmental Protection Agency and the 7 Administrator of the National Oceanic and At- 8 mospheric Administration; and 9 (B) consult with— 10 (i) stakeholder organizations; 11 (ii) health care providers and profes- 12 sional membership organizations with ex- 13 pertise in maternal health or environ- 14 mental justice; 15 (iii) State and local public health de- 16 partments; 17 (iv) licensed and accredited hospitals, 18 birth centers, midwifery practices, or other 19 health care providers that provide prenatal 20 or labor and delivery services to vulnerable 21 individuals; and 22 (v) institutions of higher education, 23 including such institutions that are minor- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 652 •HR 7585 IH ity-serving institutions or have expertise in 1 maternal health or environmental justice. 2 (4) NOTICE AND COMMENT.—At least 240 days 3 before the date on which the Strategy is published 4 in accordance with paragraph (5), the Secretary 5 shall provide— 6 (A) notice of the Strategy on a public 7 website of the Department of Health and 8 Human Services; and 9 (B) an opportunity for public comment of 10 at least 90 days. 11 (5) PUBLICATION.—Not later than 18 months 12 after the date of the enactment of this Act, the Sec- 13 retary shall publish on a public website of the De- 14 partment of Health and Human Services— 15 (A) the Strategy; 16 (B) the public comments received under 17 paragraph (4); and 18 (C) the responses of the Secretary to such 19 public comments. 20 (e) DEFINITIONS.—In this section, the following defi- 21 nitions apply: 22 (1) ADVERSE MATERNAL AND INFANT HEALTH 23 OUTCOMES.—The term ‘‘adverse maternal and in- 24 fant health outcomes’’ includes the outcomes of pre- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 653 •HR 7585 IH term birth, low birth weight, stillbirth, infant or ma- 1 ternal mortality, and severe maternal morbidity. 2 (2) INSTITUTION OF HIGHER EDUCATION.—The 3 term ‘‘institution of higher education’’ has the 4 meaning given such term in section 101 of the High- 5 er Education Act of 1965 (20 U.S.C. 1001). 6 (3) MINORITY-SERVING INSTITUTION.—The 7 term ‘‘minority-serving institution’’ means an entity 8 specified in any of paragraphs (1) through (7) of 9 section 371(a) of the Higher Education Act of 1965 10 (20 U.S.C. 1067q(a)). 11 (4) RACIAL AND ETHNIC MINORITY GROUP.— 12 The term ‘‘racial and ethnic minority group’’ has the 13 meaning given such term in section 1707(g) of the 14 Public Health Service Act (42 U.S.C. 300u–6(g)). 15 (5) RISKS ASSOCIATED WITH CLIMATE 16 CHANGE.—The term ‘‘risks associated with climate 17 change’’ includes risks associated with extreme heat, 18 air pollution, extreme weather events, and other en- 19 vironmental issues associated with climate change 20 that can result in adverse maternal and infant 21 health outcomes. 22 (6) STAKEHOLDER ORGANIZATION.—The term 23 ‘‘stakeholder organization’’ means— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 654 •HR 7585 IH (A) a community-based organization with 1 expertise in providing assistance to vulnerable 2 individuals; 3 (B) a nonprofit organization with expertise 4 in maternal or infant health or environmental 5 justice; and 6 (C) a patient advocacy organization rep- 7 resenting vulnerable individuals. 8 (7) VULNERABLE INDIVIDUAL.—The term ‘‘vul- 9 nerable individual’’ means— 10 (A) an individual who is pregnant; 11 (B) an individual who was pregnant during 12 any portion of the preceding 1-year period; and 13 (C) an individual under 3 years of age. 14 SEC. 5206. TECH TO SAVE MOMS. 15 (a) DEFINITIONS.—In this section: 16 (1) POSTPARTUM AND POSTPARTUM PERIOD.— 17 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 18 refer to the 1-year period beginning on the last day 19 of the pregnancy of an individual. 20 (2) RACIAL AND ETHNIC MINORITY GROUP.— 21 The term ‘‘racial and ethnic minority group’’ has the 22 meaning given such term in section 1707(g)(1) of 23 the Public Health Service Act (42 U.S.C. 300u– 24 6(g)(1)). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 655 •HR 7585 IH (3) SEVERE MATERNAL MORBIDITY.—The term 1 ‘‘severe maternal morbidity’’ means a health condi- 2 tion, including mental health conditions and sub- 3 stance use disorders, attributed to or aggravated by 4 pregnancy or childbirth that results in significant 5 short-term or long-term consequences to the health 6 of the individual who was pregnant. 7 (4) SOCIAL DETERMINANTS OF MATERNAL 8 HEALTH.—The term ‘‘social determinants of mater- 9 nal health’’ means non-clinical factors that impact 10 maternal health outcomes, including— 11 (A) economic factors, which may include 12 poverty, employment, food security, support for 13 and access to lactation and other infant feeding 14 options, housing stability, and related factors; 15 (B) neighborhood factors, which may in- 16 clude quality of housing, access to transpor- 17 tation, access to child care, availability of 18 healthy foods and nutrition counseling, avail- 19 ability of clean water, air and water quality, 20 ambient temperatures, neighborhood crime and 21 violence, access to broadband, and related fac- 22 tors; 23 (C) social and community factors, which 24 may include systemic racism, gender discrimi- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 656 •HR 7585 IH nation or discrimination based on other pro- 1 tected classes, workplace conditions, incarcer- 2 ation, and related factors; 3 (D) household factors, which may include 4 ability to conduct lead testing and abatement, 5 car seat installation, indoor air temperatures, 6 and related factors; 7 (E) education access and quality factors, 8 which may include educational attainment, lan- 9 guage and literacy, and related factors; and 10 (F) health care access factors, including 11 health insurance coverage, access to culturally 12 congruent health care services, providers, and 13 non-clinical support, access to home visiting 14 services, access to wellness and stress manage- 15 ment programs, health literacy, access to tele- 16 health and items required to receive telehealth 17 services, and related factors. 18 (b) INTEGRATED TELEHEALTH MODELS IN MATER- 19 NITY CARE SERVICES.— 20 (1) IN GENERAL.—Section 1115A(b)(2)(B) of 21 the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) 22 is amended by adding at the end the following: 23 ‘‘(xxviii) Focusing on title XIX, pro- 24 viding for the adoption of and use of tele- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 657 •HR 7585 IH health tools that allow for screening, moni- 1 toring, and management of common health 2 complications with respect to an individual 3 receiving medical assistance during such 4 individual’s pregnancy and for not more 5 than a 1-year period beginning on the last 6 day of the pregnancy.’’. 7 (2) EFFECTIVE DATE.—The amendment made 8 by paragraph (1) shall take effect 1 year after the 9 date of the enactment of this section. 10 (c) GRANTS TO EXPAND THE USE OF TECHNOLOGY- 11 ENABLED COLLABORATIVE LEARNING AND CAPACITY 12 MODELS FOR PREGNANT AND POSTPARTUM INDIVID- 13 UALS.—Title III of the Public Health Service Act is 14 amended by inserting after section 330N (42 U.S.C. 15 254c–20) the following new section: 16 ‘‘SEC. 330. EXPANDING CAPACITY FOR MATERNAL HEALTH 17 OUTCOMES. 18 ‘‘(a) ESTABLISHMENT.—Beginning not later than 1 19 year after the date of enactment of this section, the Sec- 20 retary shall award grants to eligible entities to evaluate, 21 develop, and expand the use of technology-enabled collabo- 22 rative learning and capacity building models and improve 23 maternal health outcomes— 24 ‘‘(1) in health professional shortage areas; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 658 •HR 7585 IH ‘‘(2) in areas with high rates of maternal mor- 1 tality and severe maternal morbidity; 2 ‘‘(3) in areas with significant racial and ethnic 3 inequities in maternal health outcomes; and 4 ‘‘(4) for medically underserved populations and 5 American Indians and Alaska Natives, including In- 6 dian Tribes, Tribal organizations, and Urban Indian 7 organizations. 8 ‘‘(b) USE OF FUNDS.— 9 ‘‘(1) REQUIRED USES.—Recipients of grants 10 under this section shall use the grants to— 11 ‘‘(A) train maternal health care providers, 12 students, and other similar professionals 13 through models that include— 14 ‘‘(i) methods to increase safety and 15 health care quality; 16 ‘‘(ii) training to increase awareness of, 17 and eliminate implicit bias, racism, and 18 discrimination in the provision of health 19 care; 20 ‘‘(iii) best practices in screening for 21 and, as needed, evaluating and treating 22 maternal mental health conditions and 23 substance use disorders; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 659 •HR 7585 IH ‘‘(iv) training on best practices in ma- 1 ternity care for pregnant and postpartum 2 individuals during the COVID–19 public 3 health emergency or future public health 4 emergencies; 5 ‘‘(v) methods to screen for social de- 6 terminants of maternal health risks in the 7 prenatal and postpartum periods; and 8 ‘‘(vi) the use of remote patient moni- 9 toring tools for pregnancy-related com- 10 plications described in section 11 1115A(b)(2)(B)(xxviii) of the Social Secu- 12 rity Act; 13 ‘‘(B) evaluate and collect information on 14 the effect of such models on— 15 ‘‘(i) access to, and quality of, care; 16 ‘‘(ii) outcomes with respect to the 17 health of an individual; and 18 ‘‘(iii) the experience of individuals who 19 receive pregnancy-related health care; 20 ‘‘(C) develop qualitative and quantitative 21 measures to identify best practices for the ex- 22 pansion and use of such models; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 660 •HR 7585 IH ‘‘(D) study the effect of such models on 1 patient outcomes and maternity care providers; 2 and 3 ‘‘(E) conduct any other activity, as deter- 4 mined by the Secretary. 5 ‘‘(2) PERMISSIBLE USES.—Recipients of grants 6 under this section may use grants to support— 7 ‘‘(A) the use and expansion of technology- 8 enabled collaborative learning and capacity 9 building models, including hardware and soft- 10 ware that— 11 ‘‘(i) enables distance learning and 12 technical support; and 13 ‘‘(ii) supports the secure exchange of 14 electronic health information; and 15 ‘‘(B) maternity care providers, students, 16 and other similar professionals in the provision 17 of maternity care through such models. 18 ‘‘(c) APPLICATION.— 19 ‘‘(1) IN GENERAL.—An eligible entity seeking a 20 grant under subsection (a) shall submit to the Sec- 21 retary an application, at such time, in such manner, 22 and containing such information as the Secretary 23 may require. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 661 •HR 7585 IH ‘‘(2) ASSURANCE.—An application under para- 1 graph (1) shall include an assurance that such entity 2 shall collect information on, and assess the effect of, 3 the use of technology-enabled collaborative learning 4 and capacity building models, including with respect 5 to— 6 ‘‘(A) maternal health outcomes; 7 ‘‘(B) access to maternal health care serv- 8 ices; 9 ‘‘(C) quality of maternal health care; and 10 ‘‘(D) retention of maternity care providers 11 serving areas and populations described in sub- 12 section (a). 13 ‘‘(d) LIMITATIONS.— 14 ‘‘(1) NUMBER.—The Secretary may not award 15 more than 1 grant under this section to an eligible 16 entity. 17 ‘‘(2) DURATION.—A grant awarded under this 18 section shall be for a 5-year period. 19 ‘‘(e) ACCESS TO BROADBAND.—In administering 20 grants under this section, the Secretary may coordinate 21 with other agencies to ensure that funding opportunities 22 are available to support access to reliable, high-speed 23 internet for grantees. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 662 •HR 7585 IH ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 1 provide (either directly or by contract) technical assistance 2 to eligible entities, including recipients of grants under 3 subsection (a), on the development, use, and sustainability 4 of technology-enabled collaborative learning and capacity 5 building models to expand access to maternal health care 6 services provided by such entities, including— 7 ‘‘(1) in health professional shortage areas; 8 ‘‘(2) in areas with high rates of maternal mor- 9 tality and severe maternal morbidity or significant 10 racial and ethnic inequities in maternal health out- 11 comes; and 12 ‘‘(3) for medically underserved populations or 13 American Indians and Alaska Natives. 14 ‘‘(g) RESEARCH AND EVALUATION.—The Secretary, 15 in consultation with experts, shall develop a strategic plan 16 to research and evaluate the evidence for such models. 17 ‘‘(h) REPORTING.— 18 ‘‘(1) ELIGIBLE ENTITIES.—An eligible entity 19 that receives a grant under subsection (a) shall sub- 20 mit to the Secretary a report, at such time, in such 21 manner, and containing such information as the Sec- 22 retary may require. 23 ‘‘(2) SECRETARY.—Not later than 4 years after 24 the date of enactment of this section, the Secretary 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 663 •HR 7585 IH shall submit to the Congress, and make available on 1 the website of the Department of Health and 2 Human Services, a report that includes— 3 ‘‘(A) a description of grants awarded 4 under subsection (a) and the purpose and 5 amounts of such grants; 6 ‘‘(B) a summary of— 7 ‘‘(i) the evaluations conducted under 8 subsection (b)(1)(B); 9 ‘‘(ii) any technical assistance provided 10 under subsection (g); and 11 ‘‘(iii) the activities conducted under 12 subsection (a); and 13 ‘‘(C) a description of any significant find- 14 ings with respect to— 15 ‘‘(i) patient outcomes; and 16 ‘‘(ii) best practices for expanding, 17 using, or evaluating technology-enabled col- 18 laborative learning and capacity building 19 models. 20 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated to carry out this section, 22 $6,000,000 for each of fiscal years 2023 through 2027. 23 ‘‘(j) DEFINITIONS.—In this section: 24 ‘‘(1) ELIGIBLE ENTITY.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 664 •HR 7585 IH ‘‘(A) IN GENERAL.—The term ‘eligible en- 1 tity’ means an entity that provides, or supports 2 the provision of, maternal health care services 3 or other evidence-based services for pregnant 4 and postpartum individuals— 5 ‘‘(i) in health professional shortage 6 areas; 7 ‘‘(ii) in areas with high rates of ad- 8 verse maternal health outcomes or signifi- 9 cant racial and ethnic inequities in mater- 10 nal health outcomes; or 11 ‘‘(iii) who are— 12 ‘‘(I) members of medically under- 13 served populations; or 14 ‘‘(II) American Indians and Alas- 15 ka Natives, including Indian Tribes, 16 Tribal organizations, and Urban In- 17 dian organizations. 18 ‘‘(B) INCLUSIONS.—An eligible entity may 19 include entities that lead, or are capable of 20 leading a technology-enabled collaborative learn- 21 ing and capacity building model. 22 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE 23 AREA.—The term ‘health professional shortage area’ 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 665 •HR 7585 IH means a health professional shortage area des- 1 ignated under section 332. 2 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 3 has the meaning given such term in section 4 of the 4 Indian Self-Determination and Education Assistance 5 Act. 6 ‘‘(4) MATERNAL MORTALITY.—The term ‘ma- 7 ternal mortality’ means a death occurring during or 8 within 1-year period after pregnancy caused by preg- 9 nancy-related or childbirth complications, including a 10 suicide, overdose, or other death resulting from a 11 mental health or substance use disorder attributed 12 to or aggravated by pregnancy or childbirth com- 13 plications. 14 ‘‘(5) MEDICALLY UNDERSERVED POPU- 15 LATION.—The term ‘medically underserved popu- 16 lation’ has the meaning given such term in section 17 330(b)(3). 18 ‘‘(6) POSTPARTUM.—The term ‘postpartum’ 19 means the 1-year period beginning on the last date 20 of an individual’s pregnancy. 21 ‘‘(7) SEVERE MATERNAL MORBIDITY.—The 22 term ‘severe maternal morbidity’ means a health 23 condition, including a mental health or substance 24 use disorder, attributed to or aggravated by preg- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 666 •HR 7585 IH nancy or childbirth that results in significant short- 1 term or long-term consequences to the health of the 2 individual who was pregnant. 3 ‘‘(8) TECHNOLOGY-ENABLED COLLABORATIVE 4 LEARNING AND CAPACITY BUILDING MODEL.—The 5 term ‘technology-enabled collaborative learning and 6 capacity building model’ means a distance health 7 education model that connects health care profes- 8 sionals, and other specialists, through simultaneous 9 interactive videoconferencing for the purpose of fa- 10 cilitating case-based learning, disseminating best 11 practices, and evaluating outcomes in the context of 12 maternal health care. 13 ‘‘(9) TRIBAL ORGANIZATION.—The term ‘Tribal 14 organization’ has the meaning given such term in 15 section 4 of the Indian Self-Determination and Edu- 16 cation Assistance Act. 17 ‘‘(10) URBAN INDIAN ORGANIZATION.—The 18 term ‘Urban Indian organization’ has the meaning 19 given such term in section 4 of the Indian Health 20 Care Improvement Act.’’. 21 (d) GRANTS TO PROMOTE EQUITY IN MATERNAL 22 HEALTH OUTCOMES THROUGH DIGITAL TOOLS.— 23 (1) IN GENERAL.—Beginning not later than 1 24 year after the date of the enactment of this Act, the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 667 •HR 7585 IH Secretary of Health and Human Services shall make 1 grants to eligible entities to reduce racial and ethnic 2 inequities in maternal health outcomes by increasing 3 access to digital tools related to maternal health 4 care. 5 (2) APPLICATIONS.—To be eligible to receive a 6 grant under this subsection, an eligible entity shall 7 submit to the Secretary an application at such time, 8 in such manner, and containing such information as 9 the Secretary may require. 10 (3) PRIORITIZATION.—In awarding grants 11 under this subsection, the Secretary shall prioritize 12 an eligible entity— 13 (A) in an area with high rates of adverse 14 maternal health outcomes or significant racial 15 and ethnic inequities in maternal health out- 16 comes; 17 (B) in a health professional shortage area 18 designated under section 332 of the Public 19 Health Service Act (42 U.S.C. 254e); and 20 (C) that promotes technology that address- 21 es racial and ethnic inequities in maternal 22 health outcomes. 23 (4) LIMITATIONS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 668 •HR 7585 IH (A) NUMBER.—The Secretary may award 1 not more than 1 grant under this subsection to 2 an eligible entity. 3 (B) DURATION.—A grant awarded under 4 this subsection shall be for a 5-year period. 5 (5) TECHNICAL ASSISTANCE.—The Secretary 6 shall provide technical assistance to an eligible entity 7 on the development, use, evaluation, and post-grant 8 sustainability of digital tools for purposes of pro- 9 moting equity in maternal health outcomes. 10 (6) REPORTING.— 11 (A) ELIGIBLE ENTITIES.—An eligible enti- 12 ty that receives a grant under paragraph (1) 13 shall submit to the Secretary a report, at such 14 time, in such manner, and containing such in- 15 formation as the Secretary may require. 16 (B) SECRETARY.—Not later than 4 years 17 after the date of the enactment of this Act, the 18 Secretary shall submit to Congress a report 19 that includes— 20 (i) an evaluation on the effectiveness 21 of grants awarded under this subsection to 22 improve health outcomes for pregnant and 23 postpartum individuals from racial and 24 ethnic minority groups; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 669 •HR 7585 IH (ii) recommendations on new grant 1 programs that promote the use of tech- 2 nology to improve such maternal health 3 outcomes; and 4 (iii) recommendations with respect 5 to— 6 (I) technology-based privacy and 7 security safeguards in maternal health 8 care; 9 (II) reimbursement rates for ma- 10 ternal telehealth services; 11 (III) the use of digital tools to 12 analyze large data sets to identify po- 13 tential pregnancy-related complica- 14 tions; 15 (IV) barriers that prevent mater- 16 nity care providers from providing 17 telehealth services across States; 18 (V) the use of consumer digital 19 tools such as mobile phone applica- 20 tions, patient portals, and wearable 21 technologies to improve maternal 22 health outcomes; 23 (VI) barriers that prevent access 24 to telehealth services, including a lack 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 670 •HR 7585 IH of access to reliable, high-speed inter- 1 net or electronic devices; 2 (VII) barriers to data sharing be- 3 tween the Special Supplemental Nu- 4 trition Program for Women, Infants, 5 and Children program and maternity 6 care providers, and recommendations 7 for addressing such barriers; and 8 (VIII) lessons learned from ex- 9 panded access to telehealth related to 10 maternity care during the COVID–19 11 public health emergency. 12 (7) AUTHORIZATION OF APPROPRIATIONS.— 13 There is authorized to be appropriated to carry out 14 this subsection $6,000,000 for each of fiscal years 15 2023 through 2027. 16 (e) REPORT ON THE USE OF TECHNOLOGY IN MA- 17 TERNITY CARE.— 18 (1) IN GENERAL.—Not later than 60 days after 19 the date of enactment of this Act, the Secretary of 20 Health and Human Services shall enter into an 21 agreement with the National Academies of Sciences, 22 Engineering, and Medicine (referred to in this sec- 23 tion as the ‘‘National Academies’’) under which the 24 National Academies shall conduct a study on the use 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 671 •HR 7585 IH of technology and patient monitoring devices in ma- 1 ternity care. 2 (2) CONTENT.—The agreement entered into 3 pursuant to paragraph (1) shall provide for the 4 study of the following: 5 (A) The use of innovative technology (in- 6 cluding artificial intelligence) in maternal 7 health care, including the extent to which such 8 technology has affected racial or ethnic biases 9 in maternal health care. 10 (B) The use of patient monitoring devices 11 (including pulse oximeter devices) in maternal 12 health care, including the extent to which such 13 devices have affected racial or ethnic biases in 14 maternal health care. 15 (C) Best practices for reducing and pre- 16 venting racial or ethnic biases in the use of in- 17 novative technology and patient monitoring de- 18 vices in maternity care. 19 (D) Best practices in the use of innovative 20 technology and patient monitoring devices for 21 pregnant and postpartum individuals from ra- 22 cial and ethnic minority groups. 23 (E) Best practices with respect to privacy 24 and security safeguards in such use. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 672 •HR 7585 IH (3) REPORT.—Not later than 24 months after 1 the date of enactment of this Act, the National 2 Academies shall complete the study under this sub- 3 section, and transmit a report the results of such 4 study to Congress. 5 SEC. 5207. SOCIAL DETERMINANTS FOR MOMS. 6 (a) TASK FORCE TO DEVELOP A STRATEGY TO AD- 7 DRESS SOCIAL DETERMINANTS OF MATERNAL 8 HEALTH.— 9 (1) IN GENERAL.—The Secretary of Health and 10 Human Services shall convene a task force (in this 11 subsection referred to as the ‘‘Task Force’’) to de- 12 velop a strategy to coordinate efforts between Fed- 13 eral agencies to address social determinants of ma- 14 ternal health with respect to pregnant and 15 postpartum individuals. 16 (2) EX OFFICIO MEMBERS.—The ex officio 17 members of the Task Force shall consist of the fol- 18 lowing: 19 (A) The Secretary of Health and Human 20 Services (or a designee thereof). 21 (B) The Secretary of Housing and Urban 22 Development (or a designee thereof). 23 (C) The Secretary of Transportation (or a 24 designee thereof). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 673 •HR 7585 IH (D) The Secretary of Agriculture (or a 1 designee thereof). 2 (E) The Secretary of Labor (or a designee 3 thereof). 4 (F) The Administrator of the Environ- 5 mental Protection Agency (or a designee there- 6 of). 7 (G) The Assistant Secretary for the Ad- 8 ministration for Children and Families (or a 9 designee thereof). 10 (H) The Administrator of the Centers for 11 Medicare & Medicaid Services (or a designee 12 thereof). 13 (I) The Director of the Indian Health 14 Service (or a designee thereof). 15 (J) The Director of the National Institutes 16 of Health (or a designee thereof). 17 (K) The Administrator of the Health Re- 18 sources and Services Administration (or a des- 19 ignee thereof). 20 (L) The Deputy Assistant Secretary for 21 Minority Health of the Department of Health 22 and Human Services (or a designee thereof). 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 674 •HR 7585 IH (M) The Deputy Assistant Secretary for 1 Women’s Health of the Department of Health 2 and Human Services (or a designee thereof). 3 (N) The Director of the Centers for Dis- 4 ease Control and Prevention (or a designee 5 thereof). 6 (O) The Director of the Office on Violence 7 Against Women at the Department of Justice 8 (or a designee thereof). 9 (3) APPOINTED MEMBERS.—In addition to the 10 ex officio members of the Task Force, the Secretary 11 of Health and Human Services shall appoint the fol- 12 lowing members of the Task Force: 13 (A) At least two representatives of pa- 14 tients, to include— 15 (i) a representative of patients who 16 have suffered from severe maternal mor- 17 bidity; or 18 (ii) a representative of patients who is 19 a family member of an individual who suf- 20 fered a pregnancy-related death. 21 (B) At least two leaders of community- 22 based organizations that address maternal mor- 23 tality and severe maternal morbidity with a spe- 24 cific focus on racial and ethnic inequities. In 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 675 •HR 7585 IH appointing such leaders under this subpara- 1 graph, the Secretary of Health and Human 2 Services shall give priority to individuals who 3 are leaders of organizations led by individuals 4 from racial and ethnic minority groups. 5 (C) At least two perinatal health workers. 6 (D) A professionally diverse panel of ma- 7 ternity care providers. 8 (4) CHAIR.—The Secretary of Health and 9 Human Services shall select the chair of the Task 10 Force from among the members of the Task Force. 11 (5) REPORT.—Not later than 2 years after the 12 date of the enactment of this Act, the Task Force 13 shall submit to Congress a report on— 14 (A) the strategy developed under para- 15 graph (1); 16 (B) recommendations on funding amounts 17 with respect to implementing such strategy; and 18 (C) recommendations for how to expand 19 coverage of social services to address social de- 20 terminants of maternal health under Medicaid 21 managed care organizations and State Medicaid 22 programs. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 676 •HR 7585 IH (6) TERMINATION.—Section 14 of the Federal 1 Advisory Committee Act (5 U.S.C. App.) shall not 2 apply to the Task Force with respect to termination. 3 (b) HOUSING FOR MOMS GRANT PROGRAM.— 4 (1) IN GENERAL.—The Secretary of Housing 5 and Urban Development shall establish a Housing 6 for Moms grant program under this subsection to 7 make grants to eligible entities to increase access to 8 safe, stable, affordable, and adequate housing for 9 pregnant and postpartum individuals and their fami- 10 lies. 11 (2) APPLICATION.—To be eligible to receive a 12 grant under this subsection, an eligible entity shall 13 submit to the Secretary an application at such time, 14 in such manner, and containing such information as 15 the Secretary may provide. 16 (3) PRIORITY.—In awarding grants under this 17 subsection, the Secretary shall give priority to an eli- 18 gible entity that— 19 (A) is a community-based organization or 20 will partner with a community-based organiza- 21 tion to implement initiatives to increase access 22 to safe, stable, affordable, and adequate hous- 23 ing for pregnant and postpartum individuals 24 and their families; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 677 •HR 7585 IH (B) is operating in an area with high rates 1 of adverse maternal health outcomes or signifi- 2 cant racial or ethnic inequities in maternal 3 health outcomes, to the extent such data are 4 available; and 5 (C) is operating in an area with a high 6 poverty rate or significant number of individ- 7 uals who lack consistent access to safe, stable, 8 affordable, and adequate housing. 9 (4) USE OF FUNDS.—An eligible entity that re- 10 ceives a grant under this subsection shall use funds 11 under the grant for the purposes of— 12 (A) identifying and conducting outreach to 13 pregnant and postpartum individuals who are 14 low-income and lack consistent access to safe, 15 stable, affordable, and adequate housing; 16 (B) providing safe, stable, affordable, and 17 adequate housing options to such individuals; 18 (C) connecting such individuals with local 19 organizations offering safe, stable, affordable, 20 and adequate housing options; 21 (D) providing application assistance to 22 such individuals seeking to enroll in programs 23 offering safe, stable, affordable, and adequate 24 housing options; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 678 •HR 7585 IH (E) providing direct financial assistance to 1 such individuals for the purposes of maintaining 2 safe, stable, and adequate housing for the dura- 3 tion of the individual’s pregnancy and 4 postpartum periods; and 5 (F) working with relevant stakeholders to 6 ensure that local housing and homeless shelter 7 infrastructure is supportive to pregnant and 8 postpartum individuals, including through— 9 (i) health-promoting housing codes; 10 (ii) enforcement of housing codes; 11 (iii) proactive rental inspection pro- 12 grams; 13 (iv) code enforcement officer training; 14 and 15 (v) partnerships between regional of- 16 fices of the Department of Housing and 17 Urban Development and community-based 18 organizations to ensure housing laws are 19 understood and violations are discovered. 20 (5) REPORTING.— 21 (A) ELIGIBLE ENTITIES.—The Secretary 22 shall require each eligible entity receiving a 23 grant under this subsection to annually submit 24 to the Secretary and make publicly available a 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 679 •HR 7585 IH report on the status of activities conducted 1 using the grant. 2 (B) SECRETARY.—Not later than the end 3 of each fiscal year in which grants are made 4 under this subsection, the Secretary shall sub- 5 mit to the Congress and make publicly available 6 a report that— 7 (i) summarizes the reports received 8 under subparagraph (A); 9 (ii) evaluates the effectiveness of 10 grants awarded under this subsection in 11 increasing access to safe, stable, afford- 12 able, and adequate housing for pregnant 13 and postpartum individuals and their fami- 14 lies; and 15 (iii) makes recommendations with re- 16 spect to ensuring activities described para- 17 graph (4) continue after grant amounts 18 made available under this subsection are 19 expended. 20 (6) DEFINITIONS.—In this subsection: 21 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 22 entity’’ means— 23 (i) a community-based organization; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 680 •HR 7585 IH (ii) a State or local governmental enti- 1 ty, including a State or local public health 2 department; 3 (iii) an Indian tribe or tribal organiza- 4 tion (as such terms are defined in section 5 4 of the Indian Self-Determination and 6 Education Assistance Act (25 U.S.C. 7 5304)); or 8 (iv) an Urban Indian organization (as 9 such term is defined in section 4 of the In- 10 dian Health Care Improvement Act (25 11 U.S.C. 1603)). 12 (B) SECRETARY.—The term ‘‘Secretary’’ 13 means the Secretary of Housing and Urban De- 14 velopment. 15 (7) AUTHORIZATION OF APPROPRIATIONS.— 16 There is authorized to be appropriated to carry out 17 this subsection $10,000,000 for fiscal year 2022, 18 which shall remain available until expended. 19 (c) DEPARTMENT OF TRANSPORTATION.— 20 (1) REPORT.—Not later than one year after the 21 date of enactment of this Act, the Secretary of 22 Transportation shall submit to Congress and make 23 publicly available a report containing— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 681 •HR 7585 IH (A) an assessment of transportation bar- 1 riers preventing individuals from attending pre- 2 natal and postpartum appointments, accessing 3 maternal health care services, or accessing serv- 4 ices and resources related to social deter- 5 minants maternal of health; 6 (B) recommendations on how to overcome 7 the barriers assessed under subparagraph (A); 8 and 9 (C) an assessment of transportation safety 10 risks for pregnant individuals and recommenda- 11 tions on how to mitigate such risks. 12 (2) CONSIDERATIONS.—In carrying out para- 13 graph (1), the Secretary shall give special consider- 14 ation to solutions for— 15 (A) pregnant and postpartum individuals 16 living in a health professional shortage area 17 designated under section 332 of the Public 18 Health Service Act (42 U.S.C. 254e); 19 (B) pregnant and postpartum individuals 20 living in areas with high maternal mortality or 21 severe morbidity rates or significant racial or 22 ethnic inequities in maternal health outcomes; 23 and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 682 •HR 7585 IH (C) pregnant and postpartum individuals 1 with a disability that impacts mobility. 2 (d) DEPARTMENT OF AGRICULTURE.— 3 (1) SPECIAL SUPPLEMENTAL NUTRITION PRO- 4 GRAM.— 5 (A) EXTENSION OF POSTPARTUM PE- 6 RIOD.—Section 17(b)(10) of the Child Nutri- 7 tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 8 amended by striking ‘‘six months’’ and insert- 9 ing ‘‘24 months’’. 10 (B) REPORT.—Not later than 2 years after 11 the date of the enactment of this subsection, 12 the Secretary shall submit to Congress a report 13 that includes an evaluation of the effect of each 14 of the amendments made by this paragraph 15 on— 16 (i) maternal and infant health out- 17 comes, including racial and ethnic inequi- 18 ties with respect to such outcomes; 19 (ii) breastfeeding rates among 20 postpartum individuals; 21 (iii) qualitative evaluations of family 22 experiences under the special supplemental 23 nutrition program under section 17 of the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 683 •HR 7585 IH Child Nutrition Act of 1966 (42 U.S.C. 1 1786); and 2 (iv) other relevant information as de- 3 termined by the Secretary. 4 (2) GRANT PROGRAM FOR HEALTHY FOOD AND 5 CLEAN WATER FOR PREGNANT AND POSTPARTUM 6 INDIVIDUALS.— 7 (A) IN GENERAL.—The Secretary shall es- 8 tablish a program to award grants, on a com- 9 petitive basis, to eligible entities to carry out 10 the activities described in subparagraph (D). 11 (B) APPLICATION.—To be eligible for a 12 grant under this paragraph, an eligible entity 13 shall submit to the Secretary an application at 14 such time, in such manner, and containing such 15 information as the Secretary determines appro- 16 priate. 17 (C) PRIORITY.—In awarding grants under 18 this paragraph, the Secretary shall give priority 19 to an eligible entity that— 20 (i) is, or will partner with, a commu- 21 nity-based organization; and 22 (ii) is operating in an area with high 23 rates of— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 684 •HR 7585 IH (I) adverse maternal health out- 1 comes; or 2 (II) significant racial or ethnic 3 inequities in maternal health out- 4 comes. 5 (D) USE OF FUNDS.—An eligible entity 6 shall use grant funds awarded under this para- 7 graph to deliver healthy food, infant formula, 8 clean water, or diapers to pregnant and 9 postpartum individuals located in areas that are 10 food deserts, as determined by the Secretary 11 using data from the Food Access Research 12 Atlas of the Department of Agriculture. 13 (E) REPORTS.— 14 (i) ELIGIBLE ENTITY.—Not later than 15 1 year after an eligible entity first receives 16 a grant under this paragraph, and annu- 17 ally thereafter, an eligible entity shall sub- 18 mit to the Secretary a report on the status 19 of activities conducted using the grant, 20 which shall contain such information as 21 the Secretary may require. 22 (ii) SECRETARY.— 23 (I) IN GENERAL.—Not later than 24 2 years after the date on which the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 685 •HR 7585 IH first grant is awarded under this 1 paragraph, the Secretary shall submit 2 to Congress a report that includes— 3 (aa) a summary of the re- 4 ports submitted under clause (i); 5 (bb) an assessment of the 6 extent to which food distributed 7 through the grant program was 8 purchased from local and re- 9 gional food systems; 10 (cc) an evaluation of the ef- 11 fect of the grant program under 12 this paragraph on maternal and 13 infant health outcomes, including 14 racial and ethnic inequities with 15 respect to such outcomes; and 16 (dd) recommendations with 17 respect to ensuring the activities 18 described in subparagraph (D) 19 continue after the grant period 20 funding such activities expires. 21 (II) PUBLICATION.—The Sec- 22 retary shall make the report sub- 23 mitted under subclause (I) publicly 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 686 •HR 7585 IH available on the website of the De- 1 partment of Agriculture. 2 (F) AUTHORIZATION OF APPROPRIA- 3 TIONS.—There are authorized to be appro- 4 priated $5,000,000 to carry out this paragraph 5 for fiscal years 2022 through 2024. 6 (3) DEFINITIONS.—In this subsection: 7 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 8 entity’’ means— 9 (i) a community-based organization; 10 (ii) a State or local governmental enti- 11 ty, including a State or local public health 12 department; 13 (iii) an Indian Tribe or Tribal organi- 14 zation (as such terms are defined in sec- 15 tion 4 of the Indian Self-Determination 16 and Education Assistance Act (25 U.S.C. 17 5304)); or 18 (iv) an Urban Indian organization (as 19 such term is defined in section 4 of the In- 20 dian Health Care Improvement Act (25 21 U.S.C. 1603)). 22 (B) SECRETARY.—The term ‘‘Secretary’’ 23 means the Secretary of Agriculture. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 687 •HR 7585 IH (e) ENVIRONMENTAL STUDY THROUGH NATIONAL 1 ACADEMIES.— 2 (1) IN GENERAL.—The Administrator of the 3 Environmental Protection Agency shall seek to enter 4 an agreement, not later than 60 days after the date 5 of enactment of this Act, with the National Acad- 6 emies of Sciences, Engineering, and Medicine (re- 7 ferred to in this subsection as the ‘‘National Acad- 8 emies’’) under which the National Academies agree 9 to conduct a study on the impacts of water and air 10 quality, exposure to extreme temperatures, environ- 11 mental chemicals, environmental risks in the work- 12 place and the home, and pollution levels, on mater- 13 nal and infant health outcomes. 14 (2) STUDY REQUIREMENTS.—The agreement 15 under paragraph (1) shall direct the National Acad- 16 emies to make recommendations for— 17 (A) improving environmental conditions to 18 improve maternal and infant health outcomes; 19 and 20 (B) reducing or eliminating racial and eth- 21 nic inequities in such outcomes. 22 (3) REPORT.—The agreement under paragraph 23 (1) shall direct the National Academies to complete 24 the study under this subsection, and transmit to the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 688 •HR 7585 IH Congress and make publicly available a report on the 1 results of the study, not later than 12 months after 2 the date of enactment of this Act. 3 (f) CHILD CARE ACCESS.— 4 (1) GRANT PROGRAM.—The Secretary of 5 Health and Human Services (in this subsection re- 6 ferred to as the ‘‘Secretary’’) shall award grants to 7 eligible organizations to provide pregnant and 8 postpartum individuals with free and accessible 9 drop-in child care services during prenatal and 10 postpartum appointments. 11 (2) APPLICATION.—To be eligible to receive a 12 grant under this subsection, an eligible entity shall 13 submit to the Secretary an application at such time, 14 in such manner, and containing such information as 15 the Secretary may require. 16 (3) ELIGIBLE ORGANIZATIONS.— 17 (A) ELIGIBILITY.—To be eligible to receive 18 a grant under this subsection, an organization 19 shall be an organization that— 20 (i) provides child care services; and 21 (ii) can carry out programs providing 22 pregnant and postpartum individuals with 23 free and accessible drop-in child care serv- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 689 •HR 7585 IH ices during prenatal and postpartum ap- 1 pointments. 2 (B) PRIORITIZATION.—In selecting grant 3 recipients under this subsection, the Secretary 4 shall give priority to eligible organizations that 5 operate in an area, to the extent data with re- 6 spect to such an area are available— 7 (i) with high rates of adverse mater- 8 nal health outcomes; or 9 (ii) significant racial or ethnic inequi- 10 ties in maternal health outcomes. 11 (4) TIMING.—The Secretary shall commence 12 the grant program under paragraph (1) not later 13 than 1 year after the date of enactment of this Act. 14 (5) REPORTING.— 15 (A) GRANTEES.—Each recipient of a grant 16 under this subsection shall annually submit to 17 the Secretary and make publicly available a re- 18 port on the status of activities conducted using 19 the grant. Each such report shall include— 20 (i) an analysis of the effect of the 21 funded program on prenatal and 22 postpartum appointment attendance rates; 23 (ii) summaries of qualitative assess- 24 ments of the funded program from— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 690 •HR 7585 IH (I) pregnant and postpartum in- 1 dividuals participating in the pro- 2 gram; and 3 (II) the families of such individ- 4 uals; and 5 (iii) such additional information as 6 the Secretary may require. 7 (B) SECRETARY.—Not later than the end 8 of fiscal year 2024, the Secretary shall submit 9 to the Congress, and make publicly available, a 10 report containing the following: 11 (i) A summary of the reports received 12 under subparagraph (A). 13 (ii) An assessment of the effects, if 14 any, of the funded programs on maternal 15 health outcomes, with a specific focus on 16 racial and ethnic inequities in such out- 17 comes. 18 (iii) A description of actions the Sec- 19 retary can take to ensure that pregnant 20 and postpartum individuals eligible for 21 medical assistance under a State plan 22 under title XIX of the Social Security Act 23 (42 U.S.C. 1936 et seq.) have access to 24 free and accessible drop-in child care serv- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 691 •HR 7585 IH ices during prenatal and postpartum ap- 1 pointments, including identification of the 2 funding necessary to carry out such ac- 3 tions. 4 (6) DROP-IN CHILD CARE SERVICES DE- 5 FINED.—In this subsection, the term ‘‘drop-in child 6 care services’’ means child care and early childhood 7 education services that are— 8 (A) delivered at a facility that meets the 9 requirements of all applicable laws and regula- 10 tions of the State or local government in which 11 it is located, including the licensing of the facil- 12 ity as a child care facility; and 13 (B) provided in single encounters without 14 requiring full-time enrollment of a person in a 15 child care program. 16 (7) AUTHORIZATION OF APPROPRIATIONS.—To 17 carry out this subsection, there is authorized to be 18 appropriated $5,000,000 for the period of fiscal 19 years 2023 through 2025. 20 (g) GRANTS TO LOCAL ENTITIES ADDRESSING SO- 21 CIAL DETERMINANTS OF MATERNAL HEALTH.— 22 (1) IN GENERAL.—The Secretary of Health and 23 Human Services (in this subsection referred to as 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 692 •HR 7585 IH the ‘‘Secretary’’) shall award grants to eligible enti- 1 ties to— 2 (A) address social determinants of mater- 3 nal health for pregnant and postpartum individ- 4 uals; and 5 (B) eliminate racial and ethnic inequities 6 in maternal health outcomes. 7 (2) APPLICATION.—To be eligible to receive a 8 grant under this subsection an eligible entity shall 9 submit to the Secretary an application at such time, 10 in such manner, and containing such information as 11 the Secretary may provide. 12 (3) PRIORITIZATION.—In awarding grants 13 under paragraph (1), the Secretary shall give pri- 14 ority to an eligible entity that— 15 (A) is, or will partner with, a community- 16 based organization to carrying out the activities 17 under paragraph (4); 18 (B) is operating in an area with high rates 19 of adverse maternal health outcomes or signifi- 20 cant racial or ethnic inequities in maternal 21 health outcomes; and 22 (C) is operating in an area with a high 23 poverty rate. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 693 •HR 7585 IH (4) ACTIVITIES.—An eligible entity that re- 1 ceives a grant under this subsection may use funds 2 received through the grant to— 3 (A) hire and retain staff; 4 (B) develop and distribute a list of avail- 5 able resources with respect to social service pro- 6 grams in a community; 7 (C) establish a resource center that pro- 8 vides multiple social service programs in a sin- 9 gle location; 10 (D) offer programs and resources in the 11 communities in which the respective eligible en- 12 tities are located to address social determinants 13 of health for pregnant and postpartum individ- 14 uals; and 15 (E) consult with such pregnant and 16 postpartum individuals to conduct an assess- 17 ment of the activities under this paragraph. 18 (5) TECHNICAL ASSISTANCE.—The Secretary 19 shall provide to grant recipients under this sub- 20 section technical assistance to plan for sustaining 21 programs to address social determinants of maternal 22 health among pregnant and postpartum individuals 23 after the period of the grant. 24 (6) REPORTING.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 694 •HR 7585 IH (A) GRANTEES.—Not later than 1 year 1 after the date on which an eligible entity first 2 receives a grant under this subsection, and an- 3 nually thereafter, an eligible entity shall submit 4 to the Secretary, and make publicly available, a 5 report on the status of activities conducted 6 using the grant. Each such report shall include 7 data on the effects of such activities, 8 disaggregated by race, ethnicity, gender, and 9 other relevant factors. 10 (B) SECRETARY.—Not later than the end 11 of fiscal year 2026, the Secretary shall submit 12 to Congress a report that includes— 13 (i) a summary of the reports received 14 under subparagraph (A); and 15 (ii) recommendations for— 16 (I) improving maternal health 17 outcomes; and 18 (II) reducing or eliminating ra- 19 cial and ethnic inequities in maternal 20 health outcomes. 21 (7) AUTHORIZATION OF APPROPRIATIONS.— 22 There is authorized to be appropriated to carry out 23 this subsection $15,000,000 for each of fiscal years 24 2023 through 2027. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 695 •HR 7585 IH (h) DEFINITIONS.—In this section: 1 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 2 turally congruent’’, with respect to care or maternity 3 care provided to a health care consumer, means care 4 that is in agreement with the preferred cultural val- 5 ues, beliefs, worldview, language, and practices of 6 the health care consumer and other relevant stake- 7 holders. 8 (2) MATERNITY CARE PROVIDER.—The term 9 ‘‘maternity care provider’’ means a health care pro- 10 vider who— 11 (A) is a physician, physician assistant, 12 midwife who meets at a minimum the inter- 13 national definition of the midwife and global 14 standards for midwifery education as estab- 15 lished by the International Confederation of 16 Midwives, nurse practitioner, or clinical nurse 17 specialist; and 18 (B) has a focus on maternal or perinatal 19 health. 20 (3) MATERNAL MORTALITY.—The term ‘‘mater- 21 nal mortality’’ means a death occurring during or 22 within a one-year period after pregnancy, caused by 23 pregnancy-related or childbirth complications, in- 24 cluding a suicide, overdose, or other death resulting 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 696 •HR 7585 IH from a mental health or substance use disorder at- 1 tributed to or aggravated by pregnancy-related or 2 childbirth complications. 3 (4) PERINATAL HEALTH WORKER.—The term 4 ‘‘perinatal health worker’’ means a doula, commu- 5 nity health worker, peer supporter, breastfeeding 6 and lactation educator or counselor, nutritionist or 7 dietitian, childbirth educator, social worker, home 8 visitor, language interpreter, or navigator. 9 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 10 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 11 refer to the 1-year period beginning on the last day 12 of the pregnancy of an individual. 13 (6) RACIAL AND ETHNIC MINORITY GROUP.— 14 The term ‘‘racial and ethnic minority group’’ has the 15 meaning given such term in section 1707(g)(1) of 16 the Public Health Service Act (42 U.S.C. 300u– 17 6(g)(1)). 18 (7) SEVERE MATERNAL MORBIDITY.—The term 19 ‘‘severe maternal morbidity’’ means a health condi- 20 tion, including mental health conditions and sub- 21 stance use disorders, attributed to or aggravated by 22 pregnancy or childbirth that results in significant 23 short-term or long-term consequences to the health 24 of the individual who was pregnant. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 697 •HR 7585 IH (8) SOCIAL DETERMINANTS OF MATERNAL 1 HEALTH DEFINED.—The term ‘‘social determinants 2 of maternal health’’ means non-clinical factors that 3 impact maternal health outcomes, including— 4 (A) economic factors, which may include 5 poverty, employment, food security, support for 6 and access to lactation and other infant feeding 7 options, housing stability, and related factors; 8 (B) neighborhood factors, which may in- 9 clude quality of housing, access to transpor- 10 tation, access to child care, availability of 11 healthy foods and nutrition counseling, avail- 12 ability of clean water, air and water quality, 13 ambient temperatures, neighborhood crime and 14 violence, access to broadband, and related fac- 15 tors; 16 (C) social and community factors, which 17 may include systemic racism, gender discrimi- 18 nation or discrimination based on other pro- 19 tected classes, workplace conditions, incarcer- 20 ation, and related factors; 21 (D) household factors, which may include 22 ability to conduct lead testing and abatement, 23 car seat installation, indoor air temperatures, 24 and related factors; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 698 •HR 7585 IH (E) education access and quality factors, 1 which may include educational attainment, lan- 2 guage and literacy, and related factors; and 3 (F) health care access factors, including 4 health insurance coverage, access to culturally 5 congruent health care services, providers, and 6 non-clinical support, access to home visiting 7 services, access to wellness and stress manage- 8 ment programs, health literacy, access to tele- 9 health and items required to receive telehealth 10 services, and related factors. 11 SEC. 5208. DATA TO SAVE MOMS. 12 (a) SHORT TITLE.—This section may be cited as the 13 ‘‘Data to Save Moms Act’’. 14 (b) FUNDING FOR MATERNAL MORTALITY REVIEW 15 COMMITTEES TO PROMOTE REPRESENTATIVE COMMU- 16 NITY ENGAGEMENT.— 17 (1) IN GENERAL.—Section 317K(d) of the Pub- 18 lic Health Service Act (42 U.S.C. 247b–12(d)) is 19 amended by adding at the end the following: 20 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE 21 COMMUNITY ENGAGEMENT IN MATERNAL MOR- 22 TALITY REVIEW COMMITTEES.— 23 ‘‘(A) IN GENERAL.—The Secretary may, 24 using funds made available pursuant to sub- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 699 •HR 7585 IH paragraph (C), provide assistance to an applica- 1 ble maternal mortality review committee of a 2 State, Indian tribe, tribal organization, or 3 Urban Indian organization (as such term is de- 4 fined in section 4 of the Indian Health Care 5 Improvement Act (25 U.S.C. 1603))— 6 ‘‘(i) to select for inclusion in the mem- 7 bership of such a committee community 8 members from the State, Indian tribe, trib- 9 al organization, or Urban Indian organiza- 10 tion by— 11 ‘‘(I) prioritizing community mem- 12 bers who can increase the diversity of 13 the committee’s membership with re- 14 spect to race and ethnicity, location, 15 and professional background, includ- 16 ing members with non-clinical experi- 17 ences; and 18 ‘‘(II) to the extent applicable, 19 using funds reserved under subsection 20 (f), to address barriers to maternal 21 mortality review committee participa- 22 tion for community members, includ- 23 ing through providing required train- 24 ing, reducing transportation barriers, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 700 •HR 7585 IH providing compensation, and providing 1 other supports as may be necessary; 2 ‘‘(ii) to establish initiatives to conduct 3 outreach and community engagement ef- 4 forts within communities throughout the 5 State or Tribe to seek input from commu- 6 nity members on the work of such mater- 7 nal mortality review committee, with a par- 8 ticular focus on outreach to people who are 9 members of minority groups; and 10 ‘‘(iii) to release public reports assess- 11 ing— 12 ‘‘(I) the pregnancy-related death 13 and pregnancy-associated death review 14 processes of the maternal mortality 15 review committee, with a particular 16 focus on the maternal mortality re- 17 view committee’s sensitivity to the 18 unique circumstances of pregnant and 19 postpartum individuals from racial 20 and ethnic minority groups (as such 21 term is defined in section 1707(g)(1)) 22 who have suffered pregnancy-related 23 deaths; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 701 •HR 7585 IH ‘‘(II) the impact of the use of 1 funds made available pursuant to 2 paragraph (C) on increasing the diver- 3 sity of the maternal mortality review 4 committee membership and promoting 5 community engagement efforts 6 throughout the State or Tribe. 7 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec- 8 retary shall provide (either directly through the 9 Department of Health and Human Services or 10 by contract) technical assistance to any mater- 11 nal mortality review committee receiving a 12 grant under this paragraph on best practices 13 for increasing the diversity of the maternal 14 mortality review committee’s membership and 15 for conducting effective community engagement 16 throughout the State or Tribe. 17 ‘‘(C) AUTHORIZATION OF APPROPRIA- 18 TIONS.—In addition to any funds made avail- 19 able under subsection (f), there are authorized 20 to be appropriated to carry out this paragraph 21 $10,000,000 for each of fiscal years 2023 22 through 2027.’’. 23 (2) RESERVATION OF FUNDS.—Section 317K(f) 24 of the Public Health Service Act (42 U.S.C. 247b– 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 702 •HR 7585 IH 12(f)) is amended by adding at the end the fol- 1 lowing: ‘‘Of the amount made available under the 2 preceding sentence for a fiscal year, not less than 3 $1,500,000 shall be reserved for grants awarded 4 under subsection (d)(9) to Indian tribes, tribal orga- 5 nizations, or Urban Indian organizations (as those 6 terms are defined in section 4 of the Indian Health 7 Care Improvement Act (25 U.S.C. 1603)).’’. 8 (c) DATA COLLECTION AND REVIEW.—Section 9 317K(d)(3)(A)(i) of the Public Health Service Act (42 10 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 11 (1) by redesignating subclauses (II) and (III) 12 as subclauses (V) and (VI), respectively; and 13 (2) by inserting after subclause (I) the fol- 14 lowing: 15 ‘‘(II) to the extent practicable, 16 reviewing cases of severe maternal 17 morbidity, according to the most up- 18 to-date indicators; 19 ‘‘(III) to the extent practicable, 20 reviewing deaths during pregnancy or 21 up to 1 year after the end of a preg- 22 nancy from suicide, overdose, or other 23 death from a mental health condition 24 or substance use disorder attributed 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 703 •HR 7585 IH to, or aggravated by, pregnancy or 1 childbirth complications; 2 ‘‘(IV) to the extent practicable, 3 consulting with local community-based 4 organizations representing pregnant 5 and postpartum individuals from de- 6 mographic groups disproportionately 7 impacted by poor maternal health out- 8 comes to ensure that, in addition to 9 clinical factors, non-clinical factors 10 that might have contributed to a preg- 11 nancy-related death are appropriately 12 considered;’’. 13 (d) REVIEW OF MATERNAL HEALTH DATA COLLEC- 14 TION PROCESSES AND QUALITY MEASURES.— 15 (1) IN GENERAL.—The Secretary of Health and 16 Human Services, acting through the Administrator 17 for Centers for Medicare & Medicaid Serves and the 18 Director of the Agency for Healthcare Research and 19 Quality, shall consult with relevant stakeholders— 20 (A) to review existing maternal health data 21 collection processes and quality measures; and 22 (B) make recommendations to improve 23 such processes and measures, including topics 24 described under paragraph (3). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 704 •HR 7585 IH (2) COLLABORATION.—In carrying out this sub- 1 section, the Secretary shall consult with a diverse 2 group of maternal health stakeholders, which may 3 include— 4 (A) pregnant and postpartum individuals 5 and their family members, and nonprofit orga- 6 nizations representing such individuals, with a 7 particular focus on patients from racial and 8 ethnic minority groups; 9 (B) community-based organizations that 10 provide support for pregnant and postpartum 11 individuals, with a particular focus on patients 12 from racial and ethnic minority groups; 13 (C) membership organizations for mater- 14 nity care providers; 15 (D) organizations representing perinatal 16 health workers; 17 (E) organizations that focus on maternal 18 mental or behavioral health; 19 (F) organizations that focus on intimate 20 partner violence; 21 (G) institutions of higher education, with a 22 particular focus on minority-serving institu- 23 tions; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 705 •HR 7585 IH (H) licensed and accredited hospitals, birth 1 centers, midwifery practices, or other medical 2 practices that provide maternal health care 3 services to pregnant and postpartum patients; 4 (I) relevant State and local public agencies, 5 including State maternal mortality review com- 6 mittees; and 7 (J) the National Quality Forum, or such 8 other standard-setting organizations specified 9 by the Secretary. 10 (3) TOPICS.—The review of maternal health 11 data collection processes and recommendations to 12 improve such processes and measures required under 13 paragraph (1) shall assess all available relevant in- 14 formation, including information from State-level 15 sources, and shall consider at least the following: 16 (A) Current State and Tribal practices for 17 maternal health, maternal mortality, and severe 18 maternal morbidity data collection and dissemi- 19 nation, including consideration of— 20 (i) the timeliness of processes for 21 amending a death certificate when new in- 22 formation pertaining to the death becomes 23 available to reflect whether the death was 24 a pregnancy-related death; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 706 •HR 7585 IH (ii) relevant data collected with elec- 1 tronic health records, including data on 2 race, ethnicity, socioeconomic status, insur- 3 ance type, and other relevant demographic 4 information; 5 (iii) maternal health data collected 6 and publicly reported by hospitals, health 7 systems, midwifery practices, and birth 8 centers; 9 (iv) the barriers preventing States 10 from correlating maternal outcome data 11 with race and ethnicity data; 12 (v) processes for determining the 13 cause of a pregnancy-associated death in 14 States that do not have a maternal mor- 15 tality review committee; 16 (vi) whether maternal mortality review 17 committees include multidisciplinary and 18 diverse membership (as described in sec- 19 tion 317K(d)(1)(A) of the Public Health 20 Service Act (42 U.S.C. 247b– 21 12(d)(1)(A))); 22 (vii) whether members of maternal 23 mortality review committees participate in 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 707 •HR 7585 IH trainings on bias, racism, or discrimina- 1 tion, and the quality of such trainings; 2 (viii) the extent to which States have 3 implemented systematic processes of listen- 4 ing to the stories of pregnant and 5 postpartum individuals and their family 6 members, with a particular focus on preg- 7 nant and postpartum individuals from ra- 8 cial and ethnic minority groups (as such 9 term is defined in section 1707(g)(1) of 10 the Public Health Service Act (42 U.S.C. 11 300u–6(g)(1))) and their family members, 12 to fully understand the causes of, and in- 13 form potential solutions to, the maternal 14 mortality and severe maternal morbidity 15 crisis within their respective States; 16 (ix) the extent to which maternal mor- 17 tality review committees are considering 18 social determinants of maternal health 19 when examining the causes of pregnancy- 20 associated and pregnancy-related deaths; 21 (x) the extent to which maternal mor- 22 tality review committees are making ac- 23 tionable recommendations based on their 24 reviews of adverse maternal health out- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 708 •HR 7585 IH comes and the extent to which such rec- 1 ommendations are being implemented by 2 appropriate stakeholders; 3 (xi) the legal and administrative bar- 4 riers preventing the collection, collation, 5 and dissemination of State maternity care 6 data; 7 (xii) the effectiveness of data collec- 8 tion and reporting processes in separating 9 pregnancy-associated deaths from preg- 10 nancy-related deaths; and 11 (xiii) the current Federal, State, local, 12 and Tribal funding support for the activi- 13 ties referred to in clauses (i) through (xii). 14 (B) Whether the funding support referred 15 to in subparagraph (A)(xiii) is adequate for 16 States to carry out optimal data collection and 17 dissemination processes with respect to mater- 18 nal health, maternal mortality, and severe ma- 19 ternal morbidity. 20 (C) Current quality measures for mater- 21 nity care, including prenatal measures, labor 22 and delivery measures, and postpartum meas- 23 ures, including topics such as— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 709 •HR 7585 IH (i) effective quality measures for ma- 1 ternity care used by hospitals, health sys- 2 tems, midwifery practices, birth centers, 3 health plans, and other relevant entities; 4 (ii) the sufficiency of current outcome 5 measures used to evaluate maternity care 6 for driving improved care, experiences, and 7 outcomes in maternity care payment and 8 delivery system models; 9 (iii) maternal health quality measures 10 that other countries effectively use; 11 (iv) validated measures that have been 12 used for research purposes that could be 13 tested, refined, and submitted for national 14 endorsement; 15 (v) barriers preventing maternity care 16 providers and insurers from implementing 17 quality measures that are aligned with best 18 practices; 19 (vi) the frequency with which mater- 20 nity care quality measures are reviewed 21 and revised; 22 (vii) the strengths and weaknesses of 23 the Prenatal and Postpartum Care meas- 24 ures of the Health Plan Employer Data 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 710 •HR 7585 IH and Information Set measures established 1 by the National Committee for Quality As- 2 surance; 3 (viii) the strengths and weaknesses of 4 maternity care quality measures under the 5 Medicaid program under title XIX of the 6 Social Security Act (42 U.S.C. 1396 et 7 seq.) and the Children’s Health Insurance 8 Program under title XXI of such Act (42 9 U.S.C. 1397 et seq.), including the extent 10 to which States voluntarily report relevant 11 measures; 12 (ix) the extent to which maternity 13 care quality measures are informed by pa- 14 tient experiences that include measures of 15 patient-reported experience of care; 16 (x) the current processes for collecting 17 stratified data on the race and ethnicity of 18 pregnant and postpartum individuals in 19 hospitals, health systems, midwifery prac- 20 tices, and birth centers, and for incor- 21 porating such racially and ethnically strati- 22 fied data in maternity care quality meas- 23 ures; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 711 •HR 7585 IH (xi) the extent to which maternity 1 care quality measures account for the 2 unique experiences of pregnant and 3 postpartum individuals from racial and 4 ethnic minority groups (as such term is de- 5 fined in section 1707(g)(1) of the Public 6 Health Service Act (42 U.S.C. 300u– 7 6(g)(1))); and 8 (xii) the extent to which hospitals, 9 health systems, midwifery practices, and 10 birth centers are implementing existing 11 maternity care quality measures. 12 (D) Recommendations on authorizing addi- 13 tional funds and providing additional technical 14 assistance to improve maternal mortality review 15 committees and State and Tribal maternal 16 health data collection and reporting processes. 17 (E) Recommendations for new authorities 18 that may be granted to maternal mortality re- 19 view committees to be able to— 20 (i) access records from other Federal 21 and State agencies and departments that 22 may be necessary to identify causes of 23 pregnancy-associated and pregnancy-re- 24 lated deaths that are unique to pregnant 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 712 •HR 7585 IH and postpartum individuals from specific 1 populations, such as veterans and individ- 2 uals who are incarcerated; and 3 (ii) work with relevant experts who 4 are not members of the maternal mortality 5 review committee to assist in the review of 6 pregnancy-associated deaths of pregnant 7 and postpartum individuals from specific 8 populations, such as veterans and individ- 9 uals who are incarcerated. 10 (F) Recommendations to improve and 11 standardize current quality measures for mater- 12 nity care, with a particular focus on racial and 13 ethnic inequities in maternal health outcomes. 14 (G) Recommendations to improve the co- 15 ordination by the Department of Health and 16 Human Services of the efforts undertaken by 17 the agencies and organizations within the De- 18 partment related to maternal health data and 19 quality measures. 20 (4) REPORT.—Not later than 1 year after the 21 date of the enactment of this Act, the Secretary 22 shall submit to the Congress, and make publicly 23 available, a report on the results of the review of 24 maternal health data collection processes and quality 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 713 •HR 7585 IH measures and recommendations to improve such 1 processes and measures required under paragraph 2 (1). 3 (5) DEFINITIONS.—In this subsection: 4 (A) MATERNAL MORTALITY REVIEW COM- 5 MITTEE.—The term ‘‘maternal mortality review 6 committee’’ means a maternal mortality review 7 committee duly authorized by a State and re- 8 ceiving funding under section 317k(a)(2)(D) of 9 the Public Health Service Act (42 U.S.C. 247b– 10 12(a)(2)(D)). 11 (B) PREGNANCY-ASSOCIATED DEATH.— 12 The term ‘‘pregnancy-associated’’, with respect 13 to a death, means a death of a pregnant or 14 postpartum individual, by any cause, that oc- 15 curs during, or within 1 year following, the in- 16 dividual’s pregnancy, regardless of the outcome, 17 duration, or site of the pregnancy. 18 (C) PREGNANCY-RELATED DEATH.—The 19 term ‘‘pregnancy-related’’, with respect to a 20 death, means a death of a pregnant or 21 postpartum individual that occurs during, or 22 within 1 year following, the individual’s preg- 23 nancy, from a pregnancy complication, a chain 24 of events initiated by pregnancy, or the aggra- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 714 •HR 7585 IH vation of an unrelated condition by the physio- 1 logic effects of pregnancy. 2 (6) AUTHORIZATION OF APPROPRIATIONS.— 3 There are authorized to be appropriated such sums 4 as may be necessary to carry out this subsection for 5 each of fiscal years 2023 through 2027. 6 (e) INDIAN HEALTH SERVICE STUDY ON MATERNAL 7 MORTALITY AND SEVERE MATERNAL MORBIDITY.— 8 (1) IN GENERAL.—The Director of the Indian 9 Health Service (referred to in this subsection as the 10 ‘‘Director’’) shall, in coordination with entities de- 11 scribed in paragraph (2)— 12 (A) not later than 90 days after the enact- 13 ment of this Act, enter into a contract with an 14 independent research organization or Tribal 15 Epidemiology Center to conduct a comprehen- 16 sive study on maternal mortality and severe 17 maternal morbidity in the populations of Amer- 18 ican Indian and Alaska Native individuals; and 19 (B) not later than 3 years after the date 20 of the enactment of this Act, submit to Con- 21 gress a report on such study that contains rec- 22 ommendations for policies and practices that 23 can be adopted to improve maternal health out- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 715 •HR 7585 IH comes for pregnant and postpartum American 1 Indian and Alaska Native individuals. 2 (2) PARTICIPATING ENTITIES.—The entities de- 3 scribed in this paragraph shall consist of 12 mem- 4 bers, selected by the Director from among individ- 5 uals nominated by Indian Tribes and Tribal organi- 6 zations (as such terms are defined in section 4 of 7 the Indian Self-Determination and Education Assist- 8 ance Act (25 U.S.C. 5304)), and Urban Indian or- 9 ganizations (as such term is defined in section 4 of 10 the Indian Health Care Improvement Act (25 U.S.C. 11 1603)). In selecting such members, the Director 12 shall ensure that each of the 12 service areas of the 13 Indian Health Service is represented. 14 (3) CONTENTS OF STUDY.—The study con- 15 ducted pursuant to paragraph (1) shall— 16 (A) examine the causes of maternal mor- 17 tality and severe maternal morbidity that are 18 unique to American Indian and Alaska Native 19 individuals; 20 (B) include a systematic process of listen- 21 ing to the stories of American Indian and Alas- 22 ka Native pregnant and postpartum individuals 23 to fully understand the causes of, and inform 24 potential solutions to, the maternal mortality 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 716 •HR 7585 IH and severe maternal morbidity crisis within 1 their respective communities; 2 (C) distinguish between the causes of, 3 landscape of maternity care at, and rec- 4 ommendations to improve maternal health out- 5 comes within, the different settings in which 6 American Indian and Alaska Native pregnant 7 and postpartum individuals receive maternity 8 care, such as— 9 (i) facilities operated by the Indian 10 Health Service; 11 (ii) an Indian health program oper- 12 ated by an Indian Tribe or Tribal organi- 13 zation pursuant to a contract, grant, coop- 14 erative agreement, or compact with the In- 15 dian Health Service pursuant to the Indian 16 Self-Determination Act; and 17 (iii) an Urban Indian health program 18 operated by an Urban Indian organization 19 pursuant to a grant or contract with the 20 Indian Health Service pursuant to title V 21 of the Indian Health Care Improvement 22 Act; 23 (D) review processes for coordinating pro- 24 grams of the Indian Health Service with social 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 717 •HR 7585 IH services provided through other programs ad- 1 ministered by the Secretary of Health and 2 Human Services (other than the Medicare pro- 3 gram under title XVIII of the Social Security 4 Act (42 U.S.C. 1395 et seq.), the Medicaid pro- 5 gram under title XIX of such Act (42 U.S.C. 6 1396 et seq.), and the Children’s Health Insur- 7 ance Program under title XXI of such Act (42 8 U.S.C. 1397aa et seq.)); 9 (E) review current data collection and 10 quality measurement processes and practices; 11 (F) assess causes and frequency of mater- 12 nal mental health conditions and substance use 13 disorders; 14 (G) consider social determinants of health, 15 including poverty, lack of health insurance, un- 16 employment, sexual violence, and environmental 17 conditions in Tribal areas; 18 (H) consider the role that historical mis- 19 treatment of American Indian and Alaska Na- 20 tive people has played in causing currently high 21 rates of maternal mortality and severe maternal 22 morbidity; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 718 •HR 7585 IH (I) consider how current funding of the In- 1 dian Health Service affects the ability of the 2 Service to deliver quality maternity care; 3 (J) consider the extent to which the deliv- 4 ery of maternity care services is culturally ap- 5 propriate for American Indian and Alaska Na- 6 tive pregnant and postpartum individuals; 7 (K) make recommendations to reduce 8 misclassification of American Indian and Alaska 9 Native pregnant and postpartum individuals, 10 including consideration of best practices in 11 training for maternal mortality review com- 12 mittee members to be able to correctly classify 13 American Indian and Alaska Native individuals; 14 and 15 (L) make recommendations informed by 16 the stories shared by American Indian and 17 Alaska Native pregnant and postpartum indi- 18 viduals pursuant to subparagraph (B) to im- 19 prove maternal health outcomes for such indi- 20 viduals. 21 (4) REPORT.—The agreement entered into 22 under paragraph (1) with an independent research 23 organization or Tribal Epidemiology Center shall re- 24 quire that the organization or center transmit to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 719 •HR 7585 IH Congress a report on the results of the study con- 1 ducted pursuant to that agreement not later than 36 2 months after the date of the enactment of this Act. 3 (5) AUTHORIZATION OF APPROPRIATIONS.— 4 There is authorized to be appropriated to carry out 5 this subsection $2,000,000 for each of fiscal years 6 2023 through 2025. 7 (f) GRANTS TO MINORITY-SERVING INSTITUTIONS 8 TO STUDY MATERNAL MORTALITY, SEVERE MATERNAL 9 MORBIDITY, AND OTHER ADVERSE MATERNAL HEALTH 10 OUTCOMES.— 11 (1) IN GENERAL.—The Secretary of Health and 12 Human Services shall establish a program under 13 which the Secretary shall award grants to research 14 centers, health professions schools and programs, 15 and other entities at minority-serving institutions to 16 study specific aspects of the maternal health crisis 17 among pregnant and postpartum individuals from 18 racial and ethnic minority groups. Such research 19 may— 20 (A) include the development and imple- 21 mentation of systematic processes of listening 22 to the stories of pregnant and postpartum indi- 23 viduals from racial and ethnic minority groups, 24 and perinatal health workers supporting such 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 720 •HR 7585 IH individuals, to fully understand the causes of, 1 and inform potential solutions to, the maternal 2 mortality and severe maternal morbidity crisis 3 within their respective communities; 4 (B) assess the potential causes of relatively 5 low rates of maternal mortality among Hispanic 6 individuals, including potential racial 7 misclassification and other data collection and 8 reporting issues that might be misrepresenting 9 maternal mortality rates among Hispanic indi- 10 viduals in the United States; and 11 (C) assess differences in rates of adverse 12 maternal health outcomes among subgroups 13 identifying as Hispanic. 14 (2) APPLICATION.—To be eligible to receive a 15 grant under paragraph (1), an entity described in 16 such paragraph shall submit to the Secretary an ap- 17 plication at such time, in such manner, and con- 18 taining such information as the Secretary may re- 19 quire. 20 (3) TECHNICAL ASSISTANCE.—The Secretary 21 may use not more than 10 percent of the funds 22 made available under paragraph (7)— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 721 •HR 7585 IH (A) to conduct outreach to minority-serv- 1 ing institutions to raise awareness of the avail- 2 ability of grants under this paragraph (1); 3 (B) to provide technical assistance in the 4 application process for such a grant; and 5 (C) to promote capacity building, as need- 6 ed to enable entities described in such para- 7 graph to submit such an application. 8 (4) REPORTING REQUIREMENT.—Each entity 9 awarded a grant under this subsection shall periodi- 10 cally submit to the Secretary a report on the status 11 of activities conducted using the grant. 12 (5) EVALUATION.—Beginning one year after 13 the date on which the first grant is awarded under 14 this subsection, the Secretary shall submit to Con- 15 gress an annual report summarizing the findings of 16 research conducted using funds made available 17 under this subsection. 18 (6) MINORITY-SERVING INSTITUTIONS DE- 19 FINED.—In this subsection, the term ‘‘minority-serv- 20 ing institution’’ has the meaning given the term in 21 section 371(a) of the Higher Education Act of 1965 22 (20 U.S.C. 1067q(a)). 23 (7) AUTHORIZATION OF APPROPRIATIONS.— 24 There are authorized to be appropriated to carry out 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 722 •HR 7585 IH this subsection $10,000,000 for each of fiscal years 1 2023 through 2027. 2 (g) DEFINITIONS.—In this section: 3 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 4 turally congruent’’, with respect to care or maternity 5 care, means care that is in agreement with the pre- 6 ferred cultural values, beliefs, worldview, language, 7 and practices of the health care consumer and other 8 stakeholders. 9 (2) MATERNITY CARE PROVIDER.—The term 10 ‘‘maternity care provider’’ means a health care pro- 11 vider who— 12 (A) is a physician, physician assistant, 13 midwife who meets at a minimum the inter- 14 national definition of the midwife and global 15 standards for midwifery education as estab- 16 lished by the International Confederation of 17 Midwives, nurse practitioner, or clinical nurse 18 specialist; and 19 (B) has a focus on maternal or perinatal 20 health. 21 (3) MATERNAL MORTALITY.—The term ‘‘mater- 22 nal mortality’’ means a death occurring during or 23 within a one-year period after pregnancy, caused by 24 pregnancy-related or childbirth complications, in- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 723 •HR 7585 IH cluding a suicide, overdose, or other death resulting 1 from a mental health or substance use disorder at- 2 tributed to or aggravated by pregnancy-related or 3 childbirth complications. 4 (4) PERINATAL HEALTH WORKER.—The term 5 ‘‘perinatal health worker’’ means a doula, commu- 6 nity health worker, peer supporter, breastfeeding 7 and lactation educator or counselor, nutritionist or 8 dietitian, childbirth educator, social worker, home 9 visitor, language interpreter, or navigator. 10 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 11 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 12 refer to the 1-year period beginning on the last day 13 of the pregnancy of an individual. 14 (6) PREGNANCY-ASSOCIATED DEATH.—The 15 term ‘‘pregnancy-associated death’’ means a death of 16 a pregnant or postpartum individual, by any cause, 17 that occurs during, or within 1 year following, the 18 individual’s pregnancy, regardless of the outcome, 19 duration, or site of the pregnancy. 20 (7) PREGNANCY-RELATED DEATH.—The term 21 ‘‘pregnancy-related death’’ means a death of a preg- 22 nant or postpartum individual that occurs during, or 23 within 1 year following, the individual’s pregnancy, 24 from a pregnancy complication, a chain of events 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 724 •HR 7585 IH initiated by pregnancy, or the aggravation of an un- 1 related condition by the physiologic effects of preg- 2 nancy. 3 (8) RACIAL AND ETHNIC MINORITY GROUP.— 4 The term ‘‘racial and ethnic minority group’’ has the 5 meaning given such term in section 1707(g)(1) of 6 the Public Health Service Act (42 U.S.C. 300u– 7 6(g)(1)). 8 (9) SEVERE MATERNAL MORBIDITY.—The term 9 ‘‘severe maternal morbidity’’ means a health condi- 10 tion, including mental health conditions and sub- 11 stance use disorders, attributed to or aggravated by 12 pregnancy or childbirth that results in significant 13 short-term or long-term consequences to the health 14 of the individual who was pregnant. 15 (10) SOCIAL DETERMINANTS OF MATERNAL 16 HEALTH DEFINED.—The term ‘‘social determinants 17 of maternal health’’ means non-clinical factors that 18 impact maternal health outcomes, including— 19 (A) economic factors, which may include 20 poverty, employment, food security, support for 21 and access to lactation and other infant feeding 22 options, housing stability, and related factors; 23 (B) neighborhood factors, which may in- 24 clude quality of housing, access to transpor- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 725 •HR 7585 IH tation, access to child care, availability of 1 healthy foods and nutrition counseling, avail- 2 ability of clean water, air and water quality, 3 ambient temperatures, neighborhood crime and 4 violence, access to broadband, and related fac- 5 tors; 6 (C) social and community factors, which 7 may include systemic racism, gender discrimi- 8 nation or discrimination based on other pro- 9 tected classes, workplace conditions, incarcer- 10 ation, and related factors; 11 (D) household factors, which may include 12 ability to conduct lead testing and abatement, 13 car seat installation, indoor air temperatures, 14 and related factors; 15 (E) education access and quality factors, 16 which may include educational attainment, lan- 17 guage and literacy, and related factors; and 18 (F) health care access factors, including 19 health insurance coverage, access to culturally 20 congruent health care services, providers, and 21 non-clinical support, access to home visiting 22 services, access to wellness and stress manage- 23 ment programs, health literacy, access to tele- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 726 •HR 7585 IH health and items required to receive telehealth 1 services, and related factors. 2 SEC. 5209. KIRA JOHNSON ACT. 3 (a) INVESTMENTS IN COMMUNITY-BASED ORGANIZA- 4 TIONS TO IMPROVE BLACK MATERNAL HEALTH OUT- 5 COMES.— 6 (1) AWARDS.—Following the 1-year period de- 7 scribed in paragraph (3), the Secretary of Health 8 and Human Services (in this subsection referred to 9 as the ‘‘Secretary’’) shall award grants to eligible 10 entities to establish or expand programs to prevent 11 maternal mortality and severe maternal morbidity 12 among Black pregnant and postpartum individuals. 13 (2) ELIGIBILITY.—To be eligible to seek a 14 grant under this subsection, an entity shall be a 15 community-based organization offering programs 16 and resources aligned with evidence-based practices 17 for improving maternal health outcomes for Black 18 pregnant and postpartum individuals. 19 (3) OUTREACH AND TECHNICAL ASSISTANCE 20 PERIOD.—During the 1-year period beginning on the 21 date of enactment of this Act, the Secretary shall— 22 (A) conduct outreach to encourage eligible 23 entities to apply for grants under this sub- 24 section; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 727 •HR 7585 IH (B) provide technical assistance to eligible 1 entities on best practices for applying for grants 2 under this subsection. 3 (4) SPECIAL CONSIDERATION.— 4 (A) OUTREACH.—In conducting outreach 5 under paragraph (3), the Secretary shall give 6 special consideration to eligible entities that— 7 (i) are based in, and provide support 8 for, communities with high rates of adverse 9 maternal health outcomes or significant ra- 10 cial and ethnic inequities in maternal 11 health outcomes, to the extent such data 12 are available; 13 (ii) are led by Black people; and 14 (iii) offer programs and resources that 15 are aligned with evidence-based practices 16 for improving maternal health outcomes 17 for Black pregnant and postpartum indi- 18 viduals. 19 (B) AWARDS.—In awarding grants under 20 this subsection, the Secretary shall give special 21 consideration to eligible entities that— 22 (i) are described in clauses (i), (ii), 23 and (iii) of subparagraph (A); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 728 •HR 7585 IH (ii) offer programs and resources de- 1 signed in consultation with and intended 2 for Black pregnant and postpartum indi- 3 viduals; and 4 (iii) offer programs and resources in 5 the communities in which the respective el- 6 igible entities are located that— 7 (I) promote maternal mental 8 health and maternal substance use 9 disorder treatments and supports that 10 are aligned with evidence-based prac- 11 tices for improving maternal mental 12 and behavioral health outcomes for 13 Black pregnant and postpartum indi- 14 viduals; 15 (II) address social determinants 16 of maternal health for pregnant and 17 postpartum individuals; 18 (III) promote evidence-based 19 health literacy and pregnancy, child- 20 birth, and parenting education for 21 pregnant and postpartum individuals; 22 (IV) provide support from 23 perinatal health workers to pregnant 24 and postpartum individuals; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 729 •HR 7585 IH (V) provide culturally congruent 1 training to perinatal health workers; 2 (VI) conduct or support research 3 on maternal health issues dispropor- 4 tionately impacting Black pregnant 5 and postpartum individuals; 6 (VII) provide support to family 7 members of individuals who suffered a 8 pregnancy-associated death or preg- 9 nancy-related death; or 10 (VIII) operate midwifery prac- 11 tices that provide culturally congruent 12 maternal health care and support, in- 13 cluding for the purposes of— 14 (aa) supporting additional 15 education, training, and certifi- 16 cation programs, including sup- 17 port for distance learning; 18 (bb) providing financial sup- 19 port to current and future mid- 20 wives to address education costs, 21 debts, and other needs; 22 (cc) clinical site investments; 23 (dd) supporting preceptor 24 development trainings; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 730 •HR 7585 IH (ee) expanding the mid- 1 wifery practice; or 2 (ff) related needs identified 3 by the midwifery practice and de- 4 scribed in the practice’s applica- 5 tion; or 6 (IX) have developed other pro- 7 grams and resources that address 8 community-specific needs for pregnant 9 and postpartum individuals and are 10 aligned with evidence-based practices 11 for improving maternal health out- 12 comes for Black pregnant and 13 postpartum individuals. 14 (5) TECHNICAL ASSISTANCE.—The Secretary 15 shall provide to grant recipients under this sub- 16 section technical assistance on— 17 (A) capacity building to establish or ex- 18 pand programs to prevent adverse maternal 19 health outcomes among Black pregnant and 20 postpartum individuals; 21 (B) best practices in data collection, meas- 22 urement, evaluation, and reporting; and 23 (C) planning for sustaining programs to 24 prevent maternal mortality and severe maternal 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 731 •HR 7585 IH morbidity among Black pregnant and 1 postpartum individuals after the period of the 2 grant. 3 (6) EVALUATION.—Not later than the end of 4 fiscal year 2026, the Secretary shall submit to the 5 Congress an evaluation of the grant program under 6 this subsection that— 7 (A) assesses the effectiveness of outreach 8 efforts during the application process in diversi- 9 fying the pool of grant recipients; 10 (B) makes recommendations for future 11 outreach efforts to diversify the pool of grant 12 recipients for Department of Health and 13 Human Services grant programs and funding 14 opportunities related to maternal health; 15 (C) assesses the effectiveness of programs 16 funded by grants under this subsection in im- 17 proving maternal health outcomes for Black 18 pregnant and postpartum individuals, to the ex- 19 tent practicable; and 20 (D) makes recommendations for future 21 Department of Health and Human Services 22 grant programs and funding opportunities that 23 deliver funding to community-based organiza- 24 tions that provide programs and resources that 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 732 •HR 7585 IH are aligned with evidence-based practices for 1 improving maternal health outcomes for Black 2 pregnant and postpartum individuals. 3 (7) AUTHORIZATION OF APPROPRIATIONS.—To 4 carry out this subsection, there is authorized to be 5 appropriated $10,000,000 for each of fiscal years 6 2023 through 2027. 7 (b) INVESTMENTS IN COMMUNITY-BASED ORGANIZA- 8 TIONS TO IMPROVE MATERNAL HEALTH OUTCOMES IN 9 UNDERSERVED COMMUNITIES.— 10 (1) AWARDS.—Following the 1-year period de- 11 scribed in paragraph (3), the Secretary of Health 12 and Human Services (in this subsection referred to 13 as the ‘‘Secretary’’) shall award grants to eligible 14 entities to establish or expand programs to prevent 15 maternal mortality and severe maternal morbidity 16 among underserved groups. 17 (2) ELIGIBILITY.—To be eligible to seek a 18 grant under this subsection, an entity shall be a 19 community-based organization offering programs 20 and resources aligned with evidence-based practices 21 for improving maternal health outcomes for preg- 22 nant and postpartum individuals. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 733 •HR 7585 IH (3) OUTREACH AND TECHNICAL ASSISTANCE 1 PERIOD.—During the 1-year period beginning on the 2 date of enactment of this Act, the Secretary shall— 3 (A) conduct outreach to encourage eligible 4 entities to apply for grants under this sub- 5 section; and 6 (B) provide technical assistance to eligible 7 entities on best practices for applying for grants 8 under this subsection. 9 (4) SPECIAL CONSIDERATION.— 10 (A) OUTREACH.—In conducting outreach 11 under paragraph (3), the Secretary shall give 12 special consideration to eligible entities that— 13 (i) are based in, and provide support 14 for, communities with high rates of adverse 15 maternal health outcomes or significant ra- 16 cial and ethnic inequities in maternal 17 health outcomes, to the extent such data 18 are available; 19 (ii) are led by individuals from ra- 20 cially, ethnically, and geographically di- 21 verse backgrounds; and 22 (iii) offer programs and resources that 23 are aligned with evidence-based practices 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 734 •HR 7585 IH for improving maternal health outcomes 1 for pregnant and postpartum individuals. 2 (B) AWARDS.—In awarding grants under 3 this subsection, the Secretary shall give special 4 consideration to eligible entities that— 5 (i) are described in clauses (i), (ii), 6 and (iii) of subparagraph (A); 7 (ii) offer programs and resources de- 8 signed in consultation with and intended 9 for pregnant and postpartum individuals 10 from underserved groups; and 11 (iii) offer programs and resources in 12 the communities in which the respective el- 13 igible entities are located that— 14 (I) promote maternal mental 15 health and maternal substance use 16 disorder treatments and support that 17 are aligned with evidence-based prac- 18 tices for improving maternal mental 19 and behavioral health outcomes for 20 pregnant and postpartum individuals; 21 (II) address social determinants 22 of maternal health for pregnant and 23 postpartum individuals; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 735 •HR 7585 IH (III) promote evidence-based 1 health literacy and pregnancy, child- 2 birth, and parenting education for 3 pregnant and postpartum individuals; 4 (IV) provide support from 5 perinatal health workers to pregnant 6 and postpartum individuals; 7 (V) provide culturally congruent 8 training to perinatal health workers; 9 (VI) conduct or support research 10 on maternal health outcomes and in- 11 equities; 12 (VII) provide support to family 13 members of individuals who suffered a 14 pregnancy-associated death or preg- 15 nancy-related death; or 16 (VIII) operate midwifery prac- 17 tices that provide culturally congruent 18 maternal health care and support, in- 19 cluding for the purposes of— 20 (aa) supporting additional 21 education, training, and certifi- 22 cation programs, including sup- 23 port for distance learning; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 736 •HR 7585 IH (bb) providing financial sup- 1 port to current and future mid- 2 wives to address education costs, 3 debts, and other needs; 4 (cc) clinical site investments; 5 (dd) supporting preceptor 6 development trainings; 7 (ee) expanding the mid- 8 wifery practice; or 9 (ff) related needs identified 10 by the midwifery practice and de- 11 scribed in the practice’s applica- 12 tion; or 13 (iv) have developed other programs 14 and resources that address community-spe- 15 cific needs for pregnant and postpartum 16 individuals and are aligned with evidence- 17 based practices for improving maternal 18 health outcomes for pregnant and 19 postpartum individuals. 20 (5) TECHNICAL ASSISTANCE.—The Secretary 21 shall provide to grant recipients under this sub- 22 section technical assistance on— 23 (A) capacity building to establish or ex- 24 pand programs to prevent adverse maternal 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 737 •HR 7585 IH health outcomes among pregnant and 1 postpartum individuals from underserved 2 groups; 3 (B) best practices in data collection, meas- 4 urement, evaluation, and reporting; and 5 (C) planning for sustaining programs to 6 prevent maternal mortality and severe maternal 7 morbidity among pregnant and postpartum in- 8 dividuals from underserved groups after the pe- 9 riod of the grant. 10 (6) EVALUATION.—Not later than the end of 11 fiscal year 2026, the Secretary shall submit to the 12 Congress an evaluation of the grant program under 13 this subsection that— 14 (A) assesses the effectiveness of outreach 15 efforts during the application process in diversi- 16 fying the pool of grant recipients; 17 (B) makes recommendations for future 18 outreach efforts to diversify the pool of grant 19 recipients for Department of Health and 20 Human Services grant programs and funding 21 opportunities related to maternal health; 22 (C) assesses the effectiveness of programs 23 funded by grants under this subsection in im- 24 proving maternal health outcomes for pregnant 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 738 •HR 7585 IH and postpartum individuals from underserved 1 groups, to the extent practicable; and 2 (D) makes recommendations for future 3 Department of Health and Human Services 4 grant programs and funding opportunities that 5 deliver funding to community-based organiza- 6 tions that provide programs and resources that 7 are aligned with evidence-based practices for 8 improving maternal health outcomes for preg- 9 nant and postpartum individuals. 10 (7) DEFINITION.—In this subsection, the term 11 ‘‘underserved groups’’ refers to pregnant and 12 postpartum individuals— 13 (A) from racial and ethnic minority groups 14 (as such term is defined in section 1707(g)(1) 15 of the Public Health Service Act (42 U.S.C. 16 300u–6(g)(1))); 17 (B) whose household income is equal to or 18 less than 150 percent of the Federal poverty 19 line; 20 (C) who live in health professional shortage 21 areas (as such term is defined in section 332 of 22 the Public Health Service Act (42 U.S.C. 23 254e)); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 739 •HR 7585 IH (D) who live in counties with no hospital 1 offering obstetric care, no birth center, and no 2 obstetric provider; or 3 (E) who live in counties with a level of vul- 4 nerability of moderate-to-high or higher, accord- 5 ing to the Social Vulnerability Index of the Cen- 6 ters for Disease Control and Prevention. 7 (8) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this subsection, there is authorized to be 9 appropriated $10,000,000 for each of fiscal years 10 2023 through 2027. 11 (c) RESPECTFUL MATERNITY CARE TRAINING FOR 12 ALL EMPLOYEES IN MATERNITY CARE SETTINGS.—Part 13 B of title VII of the Public Health Service Act (42 U.S.C. 14 293 et seq.) is amended by adding at the end the following 15 new section: 16 ‘‘SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR 17 ALL EMPLOYEES IN MATERNITY CARE SET- 18 TINGS. 19 ‘‘(a) GRANTS.—The Secretary shall award grants for 20 programs to reduce and prevent bias, racism, and dis- 21 crimination in maternity care settings and to advance re- 22 spectful, culturally congruent, trauma-informed care. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 740 •HR 7585 IH ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 1 under subsection (a), the Secretary shall give special con- 2 sideration to applications for programs that would— 3 ‘‘(1) apply to all maternity care providers and 4 any employees who interact with pregnant and 5 postpartum individuals in the provider setting, in- 6 cluding front desk employees, sonographers, sched- 7 ulers, health care professionals, hospital or health 8 system administrators, security staff, and other em- 9 ployees; 10 ‘‘(2) emphasize periodic, as opposed to one- 11 time, trainings for all birthing professionals and em- 12 ployees described in paragraph (1); 13 ‘‘(3) address implicit bias, racism, and cultural 14 humility; 15 ‘‘(4) be delivered in ongoing education settings 16 for providers maintaining their licenses, with a pref- 17 erence for trainings that provide continuing edu- 18 cation units; 19 ‘‘(5) include trauma-informed care best prac- 20 tices and an emphasis on shared decision making be- 21 tween providers and patients; 22 ‘‘(6) include antiracism training and programs; 23 ‘‘(7) be delivered in undergraduate programs 24 that funnel into health professions schools; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 741 •HR 7585 IH ‘‘(8) be delivered in settings that apply to pro- 1 viders of the special supplemental nutrition program 2 for women, infants, and children under section 17 of 3 the Child Nutrition Act of 1966; 4 ‘‘(9) integrate bias training in obstetric emer- 5 gency simulation trainings or related trainings; 6 ‘‘(10) include training for emergency depart- 7 ment employees and emergency medical technicians 8 on recognizing warning signs for severe pregnancy- 9 related complications; 10 ‘‘(11) offer training to all maternity care pro- 11 viders on the value of racially, ethnically, and profes- 12 sionally diverse maternity care teams to provide cul- 13 turally congruent care; or 14 ‘‘(12) be based on one or more programs de- 15 signed by a historically Black college or university or 16 other minority-serving institution. 17 ‘‘(c) APPLICATION.—To seek a grant under sub- 18 section (a), an entity shall submit an application at such 19 time, in such manner, and containing such information as 20 the Secretary may require. 21 ‘‘(d) REPORTING TO SECRETARY.—Each recipient of 22 a grant under this section shall annually submit to the 23 Secretary a report on the status of activities conducted 24 using the grant, including, as applicable, a description of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 742 •HR 7585 IH the impact of training provided through the grant on pa- 1 tient outcomes and patient experience for pregnant and 2 postpartum individuals from racial and ethnic minority 3 groups and their families. 4 ‘‘(e) DISSEMINATION OF FINDINGS.—Based on the 5 annual reports submitted pursuant to subsection (d), the 6 Secretary— 7 ‘‘(1) shall produce an annual report on the find- 8 ings resulting from programs funded through this 9 section; 10 ‘‘(2) shall disseminate such report to all recipi- 11 ents of grants under this section and to the public; 12 and 13 ‘‘(3) may include in such report findings on 14 best practices for improving patient outcomes and 15 patient experience for pregnant and postpartum in- 16 dividuals from racial and ethnic minority groups and 17 their families in maternity care settings. 18 ‘‘(f) DEFINITIONS.—In this section: 19 ‘‘(1) The term ‘postpartum’ means the one-year 20 period beginning on the last day of an individual’s 21 pregnancy. 22 ‘‘(2) The term ‘culturally congruent’ means in 23 agreement with the preferred cultural values, beliefs, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 743 •HR 7585 IH world view, language, and practices of the health 1 care consumer and other stakeholders. 2 ‘‘(3) The term ‘maternity care provider’ means 3 a health care provider who— 4 ‘‘(A) is a physician, physician assistant, 5 midwife who meets at a minimum the inter- 6 national definition of the midwife and global 7 standards for midwifery education as estab- 8 lished by the International Confederation of 9 Midwives, nurse practitioner, or clinical nurse 10 specialist; and 11 ‘‘(B) has a focus on maternal or perinatal 12 health. 13 ‘‘(4) The term ‘racial and ethnic minority 14 group’ has the meaning given such term in section 15 1707(g)(1). 16 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 17 carry out this section, there is authorized to be appro- 18 priated $5,000,000 for each of fiscal years 2023 through 19 2027.’’. 20 (d) STUDY ON REDUCING AND PREVENTING BIAS, 21 RACISM, AND DISCRIMINATION IN MATERNITY CARE SET- 22 TINGS.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services shall seek to enter into an agree- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 744 •HR 7585 IH ment, not later than 90 days after the date of enact- 1 ment of this Act, with the National Academies of 2 Sciences, Engineering, and Medicine (referred to in 3 this subsection as the ‘‘National Academies’’) under 4 which the National Academies agree to— 5 (A) conduct a study on the design and im- 6 plementation of programs to reduce and prevent 7 bias, racism, and discrimination in maternity 8 care settings and to advance respectful, cul- 9 turally congruent, trauma-informed care; and 10 (B) not later than 24 months after the 11 date of the enactment of this Act— 12 (i) complete the study; and 13 (ii) transmit a report on the results of 14 the study to the Congress. 15 (2) POSSIBLE TOPICS.—The agreement entered 16 into pursuant to paragraph (1) may provide for the 17 study of any of the following: 18 (A) The development of a scorecard or 19 other evaluation standards for programs de- 20 signed to reduce and prevent bias, racism, and 21 discrimination in maternity care settings to as- 22 sess the effectiveness of such programs in im- 23 proving patient outcomes and patient experi- 24 ence for pregnant and postpartum individuals 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 745 •HR 7585 IH from racial and ethnic minority groups and 1 their families. 2 (B) Determination of the types and fre- 3 quency of training to reduce and prevent bias, 4 racism, and discrimination in maternity care 5 settings that are demonstrated to improve pa- 6 tient outcomes or patient experience for preg- 7 nant and postpartum individuals from racial 8 and ethnic minority groups and their families. 9 (e) RESPECTFUL MATERNITY CARE COMPLIANCE 10 PROGRAM.— 11 (1) IN GENERAL.—The Secretary of Health and 12 Human Services (referred to in this subsection as 13 the ‘‘Secretary’’) shall award grants to accredited 14 hospitals, health systems, and other maternity care 15 settings to establish as an integral part of quality 16 implementation initiatives within one or more hos- 17 pitals or other birth settings a respectful maternity 18 care compliance program. 19 (2) PROGRAM REQUIREMENTS.—A respectful 20 maternity care compliance program funded through 21 a grant under this subsection shall— 22 (A) institutionalize mechanisms to allow 23 patients receiving maternity care services, the 24 families of such patients, or perinatal health 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 746 •HR 7585 IH workers supporting such patients to report in- 1 stances of racism or evidence of bias on the 2 basis of race, ethnicity, or another protected 3 class; 4 (B) institutionalize response mechanisms 5 through which representatives of the program 6 can directly follow up with the patient, if pos- 7 sible, and the patient’s family in a timely man- 8 ner; 9 (C) prepare, and make publicly available, a 10 hospital- or health system-wide strategy to re- 11 duce bias on the basis of race, ethnicity, or an- 12 other protected class in the delivery of mater- 13 nity care that includes— 14 (i) information on the training pro- 15 grams to reduce and prevent bias, racism, 16 and discrimination on the basis of race, 17 ethnicity, or another protected class for all 18 employees in maternity care settings; 19 (ii) information on the number of 20 cases reported to the compliance program; 21 and 22 (iii) the development of methods to 23 routinely assess the extent to which bias, 24 racism, or discrimination on the basis of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 747 •HR 7585 IH race, ethnicity, or another protected class 1 are present in the delivery of maternity 2 care to patients from racial and ethnic mi- 3 nority groups; and 4 (D) develop mechanisms to routinely col- 5 lect and publicly report hospital-level data re- 6 lated to patient-reported experience of care; and 7 (E) provide annual reports to the Sec- 8 retary with information about each case re- 9 ported to the compliance program over the 10 course of the year containing such information 11 as the Secretary may require, such as— 12 (i) de-identified demographic informa- 13 tion on the patient in the case, such as 14 race, ethnicity, gender identity, and pri- 15 mary language; 16 (ii) the content of the report from the 17 patient or the family of the patient to the 18 compliance program; 19 (iii) the response from the compliance 20 program; and 21 (iv) to the extent applicable, institu- 22 tional changes made as a result of the 23 case. 24 (3) SECRETARY REQUIREMENTS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 748 •HR 7585 IH (A) PROCESSES.—Not later than 180 days 1 after the date of the enactment of this Act, the 2 Secretary shall establish processes for— 3 (i) disseminating best practices for es- 4 tablishing and implementing a respectful 5 maternity care compliance program within 6 a hospital or other birth setting; 7 (ii) promoting coordination and col- 8 laboration between hospitals, health sys- 9 tems, and other maternity care delivery 10 settings on the establishment and imple- 11 mentation of respectful maternity care 12 compliance programs; and 13 (iii) evaluating the effectiveness of re- 14 spectful maternity care compliance pro- 15 grams on maternal health outcomes and 16 patient and family experiences, especially 17 for patients from racial and ethnic minor- 18 ity groups and their families. 19 (B) STUDY.— 20 (i) IN GENERAL.—Not later than 2 21 years after the date of the enactment of 22 this Act, the Secretary shall, through a 23 contract with an independent research or- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 749 •HR 7585 IH ganization, conduct a study on strategies 1 to address— 2 (I) racism or bias on the basis of 3 race, ethnicity, or another protected 4 class in the delivery of maternity care 5 services; and 6 (II) successful implementation of 7 respectful care initiatives. 8 (ii) COMPONENTS OF STUDY.—The 9 study shall include the following: 10 (I) An assessment of the reports 11 submitted to the Secretary from the 12 respectful maternity care compliance 13 programs pursuant to paragraph 14 (2)(E). 15 (II) Based on such assessment, 16 recommendations for potential ac- 17 countability mechanisms related to 18 cases of racism or bias on the basis of 19 race, ethnicity, or another protected 20 class in the delivery of maternity care 21 services at hospitals and other birth 22 settings. Such recommendations shall 23 take into consideration medical and 24 non-medical factors that contribute to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 750 •HR 7585 IH adverse patient experiences and ma- 1 ternal health outcomes. 2 (iii) REPORT.—The Secretary shall 3 submit to the Congress, and make publicly 4 available, a report on the results of the 5 study under this subparagraph. 6 (4) AUTHORIZATION OF APPROPRIATIONS.—To 7 carry out this subsection, there is authorized to be 8 appropriated such sums as may be necessary for fis- 9 cal years 2023 through 2028. 10 (f) GAO REPORT.— 11 (1) IN GENERAL.—Not later than 2 years after 12 the date of enactment of this Act and annually 13 thereafter, the Comptroller General of the United 14 States shall submit to the Congress, and make pub- 15 licly available, a report on the establishment of re- 16 spectful maternity care compliance programs within 17 hospitals, health systems, and other maternity care 18 settings. 19 (2) MATTERS INCLUDED.—The report under 20 paragraph (1) shall include the following: 21 (A) Information regarding the extent to 22 which hospitals, health systems, and other ma- 23 ternity care settings have elected to establish 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 751 •HR 7585 IH respectful maternity care compliance programs, 1 including— 2 (i) which hospitals and other birth 3 settings elect to establish compliance pro- 4 grams and when such programs are estab- 5 lished; 6 (ii) to the extent practicable, impacts 7 of the establishment of such programs on 8 maternal health outcomes and patient and 9 family experiences in the hospitals and 10 other birth settings that have established 11 such programs, especially for patients from 12 racial and ethnic minority groups and their 13 families; 14 (iii) information on geographic areas, 15 and types of hospitals or other birth set- 16 tings, where respectful maternity care com- 17 pliance programs are not being established 18 and information on factors contributing to 19 decisions to not establish such programs; 20 and 21 (iv) recommendations for establishing 22 respectful maternity care compliance pro- 23 grams in geographic areas, and types of 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 752 •HR 7585 IH hospitals or other birth settings, where 1 such programs are not being established. 2 (B) Whether the funding made available to 3 carry out this subsection has been sufficient 4 and, if applicable, recommendations for addi- 5 tional appropriations to carry out this sub- 6 section. 7 (C) Such other information as the Comp- 8 troller General determines appropriate. 9 (g) DEFINITIONS.—In this section: 10 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 11 turally congruent’’, with respect to care or maternity 12 care, means care that is in agreement with the pre- 13 ferred cultural values, beliefs, worldview, language, 14 and practices of the health care consumer and other 15 stakeholders. 16 (2) MATERNITY CARE PROVIDER.—The term 17 ‘‘maternity care provider’’ means a health care pro- 18 vider who— 19 (A) is a physician, physician assistant, 20 midwife who meets at a minimum the inter- 21 national definition of the midwife and global 22 standards for midwifery education as estab- 23 lished by the International Confederation of 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 753 •HR 7585 IH Midwives, nurse practitioner, or clinical nurse 1 specialist; and 2 (B) has a focus on maternal or perinatal 3 health. 4 (3) MATERNAL MORTALITY.—The term ‘‘mater- 5 nal mortality’’ means a death occurring during or 6 within a one-year period after pregnancy, caused by 7 pregnancy-related or childbirth complications, in- 8 cluding a suicide, overdose, or other death resulting 9 from a mental health or substance use disorder at- 10 tributed to or aggravated by pregnancy-related or 11 childbirth complications. 12 (4) PERINATAL HEALTH WORKER.—The term 13 ‘‘perinatal health worker’’ means a doula, commu- 14 nity health worker, peer supporter, breastfeeding 15 and lactation educator or counselor, nutritionist or 16 dietitian, childbirth educator, social worker, home 17 visitor, language interpreter, or navigator. 18 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 19 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 20 refer to the 1-year period beginning on the last day 21 of the pregnancy of an individual. 22 (6) PREGNANCY-ASSOCIATED DEATH.—The 23 term ‘‘pregnancy-associated death’’ means a death of 24 a pregnant or postpartum individual, by any cause, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 754 •HR 7585 IH that occurs during, or within 1 year following, the 1 individual’s pregnancy, regardless of the outcome, 2 duration, or site of the pregnancy. 3 (7) PREGNANCY-RELATED DEATH.—The term 4 ‘‘pregnancy-related death’’ means a death of a preg- 5 nant or postpartum individual that occurs during, or 6 within 1 year following, the individual’s pregnancy, 7 from a pregnancy complication, a chain of events 8 initiated by pregnancy, or the aggravation of an un- 9 related condition by the physiologic effects of preg- 10 nancy. 11 (8) RACIAL AND ETHNIC MINORITY GROUP.— 12 The term ‘‘racial and ethnic minority group’’ has the 13 meaning given such term in section 1707(g)(1) of 14 the Public Health Service Act (42 U.S.C. 300u– 15 6(g)(1)). 16 (9) SEVERE MATERNAL MORBIDITY.—The term 17 ‘‘severe maternal morbidity’’ means a health condi- 18 tion, including mental health conditions and sub- 19 stance use disorders, attributed to or aggravated by 20 pregnancy or childbirth that results in significant 21 short-term or long-term consequences to the health 22 of the individual who was pregnant. 23 (10) SOCIAL DETERMINANTS OF MATERNAL 24 HEALTH DEFINED.—The term ‘‘social determinants 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 755 •HR 7585 IH of maternal health’’ means non-clinical factors that 1 impact maternal health outcomes, including— 2 (A) economic factors, which may include 3 poverty, employment, food security, support for 4 and access to lactation and other infant feeding 5 options, housing stability, and related factors; 6 (B) neighborhood factors, which may in- 7 clude quality of housing, access to transpor- 8 tation, access to child care, availability of 9 healthy foods and nutrition counseling, avail- 10 ability of clean water, air and water quality, 11 ambient temperatures, neighborhood crime and 12 violence, access to broadband, and related fac- 13 tors; 14 (C) social and community factors, which 15 may include systemic racism, gender discrimi- 16 nation or discrimination based on other pro- 17 tected classes, workplace conditions, incarcer- 18 ation, and related factors; 19 (D) household factors, which may include 20 ability to conduct lead testing and abatement, 21 car seat installation, indoor air temperatures, 22 and related factors; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 756 •HR 7585 IH (E) education access and quality factors, 1 which may include educational attainment, lan- 2 guage and literacy, and related factors; and 3 (F) health care access factors, including 4 health insurance coverage, access to culturally 5 congruent health care services, providers, and 6 non-clinical support, access to home visiting 7 services, access to wellness and stress manage- 8 ment programs, health literacy, access to tele- 9 health and items required to receive telehealth 10 services, and related factors. 11 SEC. 5210. MOMS MATTER. 12 (a) MATERNAL MENTAL HEALTH EQUITY GRANT 13 PROGRAM.— 14 (1) IN GENERAL.—The Secretary of Health and 15 Human Services, acting through the Assistant Sec- 16 retary for Mental Health and Substance Use, shall 17 establish a program to award grants to eligible enti- 18 ties to address maternal mental health conditions 19 and substance use disorders with respect to preg- 20 nant and postpartum individuals, with a focus on ra- 21 cial and ethnic minority groups. 22 (2) APPLICATION.—To be eligible to receive a 23 grant under this subsection, an eligible entity shall 24 submit to the Secretary an application at such time, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 757 •HR 7585 IH in such manner, and containing such information as 1 the Secretary may provide, including how such entity 2 will use funds for activities described in paragraph 3 (4) that are culturally congruent. 4 (3) PRIORITY.—In awarding grants under this 5 subsection, the Secretary shall give priority to an eli- 6 gible entity that— 7 (A) is, or will partner with, a community- 8 based organization to address maternal mental 9 health conditions and substance use disorders 10 described in paragraph (1); 11 (B) is operating in an area with high rates 12 of— 13 (i) adverse maternal health outcomes; 14 or 15 (ii) significant racial or ethnic inequi- 16 ties in maternal health outcomes; and 17 (C) is operating in a health professional 18 shortage area designated under section 332 of 19 the Public Health Service Act (42 U.S.C. 20 254e). 21 (4) USE OF FUNDS.—An eligible entity that re- 22 ceives a grant under this subsection shall use funds 23 for the following: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 758 •HR 7585 IH (A) Establishing or expanding maternity 1 care programs to improve the integration of 2 maternal health and behavioral health care 3 services into primary care settings where preg- 4 nant individuals regularly receive health care 5 services. 6 (B) Establishing or expanding group pre- 7 natal care programs or postpartum care pro- 8 grams. 9 (C) Expanding existing programs that im- 10 prove maternal mental and behavioral health 11 during the prenatal and postpartum periods, 12 with a focus on individuals from racial and eth- 13 nic minority groups. 14 (D) Providing services and support for 15 pregnant and postpartum individuals with ma- 16 ternal mental health conditions and substance 17 use disorders, including referrals to addiction 18 treatment centers that offer evidence-based 19 treatment options. 20 (E) Addressing stigma associated with ma- 21 ternal mental health conditions and substance 22 use disorders, with a focus on racial and ethnic 23 minority groups. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 759 •HR 7585 IH (F) Raising awareness of warning signs of 1 maternal mental health conditions and sub- 2 stance use disorders, with a focus on pregnant 3 and postpartum individuals from racial and eth- 4 nic minority groups. 5 (G) Establishing or expanding programs to 6 prevent suicide or self-harm among pregnant 7 and postpartum individuals. 8 (H) Offering evidence-aligned programs at 9 freestanding birth centers that provide maternal 10 mental and behavioral health care education, 11 treatments, and services, and other services for 12 individuals throughout the prenatal and 13 postpartum period. 14 (I) Establishing or expanding programs to 15 provide education and training to maternity 16 care providers with respect to— 17 (i) identifying potential warning signs 18 for maternal mental health conditions or 19 substance use disorders in pregnant and 20 postpartum individuals, with a focus on in- 21 dividuals from racial and ethnic minority 22 groups; and 23 (ii) in the case where such providers 24 identify such warning signs, offering refer- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 760 •HR 7585 IH rals to mental and behavioral health care 1 professionals. 2 (J) Developing a website, or other source, 3 that includes information on health care pro- 4 viders who treat maternal mental health condi- 5 tions and substance use disorders. 6 (K) Establishing or expanding programs in 7 communities to improve coordination between 8 maternity care providers and mental and behav- 9 ioral health care providers who treat maternal 10 mental health conditions and substance use dis- 11 orders, including through the use of toll-free 12 hotlines. 13 (L) Carrying out other programs aligned 14 with evidence-based practices for addressing 15 maternal mental health conditions and sub- 16 stance use disorders for pregnant and 17 postpartum individuals from racial and ethnic 18 minority groups. 19 (5) REPORTING.— 20 (A) ELIGIBLE ENTITIES.—An eligible enti- 21 ty that receives a grant under paragraph (1) 22 shall submit annually to the Secretary, and 23 make publicly available, a report on the activi- 24 ties conducted using funds received through a 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 761 •HR 7585 IH grant under this subsection. Such reports shall 1 include quantitative and qualitative evaluations 2 of such activities, including the experience of in- 3 dividuals who received health care through such 4 grant. 5 (B) SECRETARY.—Not later than the end 6 of fiscal year 2024, the Secretary shall submit 7 to Congress a report that includes— 8 (i) a summary of the reports received 9 under subparagraph (A); 10 (ii) an evaluation of the effectiveness 11 of grants awarded under this subsection; 12 (iii) recommendations with respect to 13 expanding coverage of evidence-based 14 screenings and treatments for maternal 15 mental health conditions and substance use 16 disorders; and 17 (iv) recommendations with respect to 18 ensuring activities described under para- 19 graph (4) continue after the end of a grant 20 period. 21 (6) DEFINITIONS.—In this subsection: 22 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 23 entity’’ means— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 762 •HR 7585 IH (i) a community-based organization 1 serving pregnant and postpartum individ- 2 uals, including such organizations serving 3 individuals from racial and ethnic minority 4 groups and other underserved populations; 5 (ii) a nonprofit or patient advocacy 6 organization with expertise in maternal 7 mental and behavioral health; 8 (iii) a maternity care provider; 9 (iv) a mental or behavioral health care 10 provider who treats maternal mental health 11 conditions or substance use disorders; 12 (v) a State or local governmental enti- 13 ty, including a State or local public health 14 department; 15 (vi) an Indian Tribe or Tribal organi- 16 zation (as such terms are defined in sec- 17 tion 4 of the Indian Self-Determination 18 and Education Assistance Act (25 U.S.C. 19 5304)); and 20 (vii) an Urban Indian organization (as 21 such term is defined in section 4 of the In- 22 dian Health Care Improvement Act (25 23 U.S.C. 1603)). 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 763 •HR 7585 IH (B) CULTURALLY CONGRUENT.—The term 1 ‘‘culturally congruent’’, with respect to care or 2 maternity care, means care that is in agreement 3 with the preferred cultural values, beliefs, 4 worldview, language, and practices of the health 5 care consumer and other stakeholders. 6 (C) FREESTANDING BIRTH CENTER.—The 7 term ‘‘freestanding birth center’’ has the mean- 8 ing given that term under section 1905(l) of the 9 Social Security Act (42 U.S.C. 1396d(1)). 10 (D) MATERNITY CARE PROVIDER.—The 11 term ‘‘maternity care provider’’ means a health 12 care provider who— 13 (i) is a physician, physician assistant, 14 midwife who meets at a minimum the 15 international definition of the midwife and 16 global standards for midwifery education 17 as established by the International Confed- 18 eration of Midwives, nurse practitioner, or 19 clinical nurse specialist; and 20 (ii) has a focus on maternal or 21 perinatal health. 22 (E) SECRETARY.—The term ‘‘Secretary’’ 23 means the Secretary of Health and Human 24 Services. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 764 •HR 7585 IH (7) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this subsection, there is authorized to be 2 appropriated $25,000,000 for each of fiscal years 3 2023 through 2026. 4 (b) GRANTS TO GROW AND DIVERSIFY THE MATER- 5 NAL MENTAL AND BEHAVIORAL HEALTH CARE WORK- 6 FORCE.—Title VII of the Public Health Service Act is 7 amended by inserting after section 757 of such Act (42 8 U.S.C. 294f) the following new section: 9 ‘‘SEC. 758. MATERNAL MENTAL AND BEHAVIORAL HEALTH 10 CARE WORKFORCE GRANTS. 11 ‘‘(a) IN GENERAL.—The Secretary may award grants 12 to entities to establish or expand programs described in 13 subsection (b) to grow and diversify the maternal mental 14 and behavioral health care workforce. 15 ‘‘(b) USE OF FUNDS.—Recipients of grants under 16 this section shall use the grants to grow and diversify the 17 maternal mental and behavioral health care workforce 18 by— 19 ‘‘(1) establishing schools or programs that pro- 20 vide education and training to individuals seeking 21 appropriate licensing or certification as mental or 22 behavioral health care providers who will specialize 23 in maternal mental health conditions or substance 24 use disorders; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 765 •HR 7585 IH ‘‘(2) expanding the capacity of existing schools 1 or programs described in paragraph (1), for the pur- 2 poses of increasing the number of students enrolled 3 in such schools or programs, including by awarding 4 scholarships for students. 5 ‘‘(c) PRIORITIZATION.—In awarding grants under 6 this section, the Secretary shall give priority to any entity 7 that— 8 ‘‘(1) has demonstrated a commitment to re- 9 cruiting and retaining students and faculty from ra- 10 cial and ethnic minority groups; 11 ‘‘(2) has developed a strategy to recruit and re- 12 tain a diverse pool of students into the maternal 13 mental or behavioral health care workforce program 14 or school supported by funds received through the 15 grant, particularly from racial and ethnic minority 16 groups and other underserved populations; 17 ‘‘(3) has developed a strategy to recruit and re- 18 tain students who plan to practice in a health pro- 19 fessional shortage area designated under section 20 332; 21 ‘‘(4) has developed a strategy to recruit and re- 22 tain students who plan to practice in an area with 23 significant racial and ethnic inequities in maternal 24 health outcomes, to the extent practicable; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 766 •HR 7585 IH ‘‘(5) includes in the standard curriculum for all 1 students within the maternal mental or behavioral 2 health care workforce program or school a bias, rac- 3 ism, or discrimination training program that in- 4 cludes training on implicit bias and racism. 5 ‘‘(d) REPORTING.—As a condition on receipt of a 6 grant under this section for a maternal mental or behav- 7 ioral health care workforce program or school, an entity 8 shall agree to submit to the Secretary an annual report 9 on the activities conducted through the grant, including— 10 ‘‘(1) the number and demographics of students 11 participating in the program or school; 12 ‘‘(2) the extent to which students in the pro- 13 gram or school are entering careers in— 14 ‘‘(A) health professional shortage areas 15 designated under section 332; and 16 ‘‘(B) areas with significant racial and eth- 17 nic inequities in maternal health outcomes, to 18 the extent such data are available; and 19 ‘‘(3) whether the program or school has in- 20 cluded in the standard curriculum for all students a 21 bias, racism, or discrimination training program that 22 includes training on implicit bias and racism, and if 23 so the effectiveness of such training program. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 767 •HR 7585 IH ‘‘(e) PERIOD OF GRANTS.—The period of a grant 1 under this section shall be up to 5 years. 2 ‘‘(f) APPLICATION.—To seek a grant under this sec- 3 tion, an entity shall submit to the Secretary an application 4 at such time, in such manner, and containing such infor- 5 mation as the Secretary may require, including any infor- 6 mation necessary for prioritization under subsection (c). 7 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 8 provide, directly or by contract, technical assistance to en- 9 tities seeking or receiving a grant under this section on 10 the development, use, evaluation, and post-grant period 11 sustainability of the maternal mental or behavioral health 12 care workforce programs or schools proposed to be, or 13 being, established or expanded through the grant. 14 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 15 4 years after the date of enactment of this section, the 16 Secretary shall prepare and submit to the Congress, and 17 post on the internet website of the Department of Health 18 and Human Services, a report on the effectiveness of the 19 grant program under this section at— 20 ‘‘(1) recruiting students from racial and ethnic 21 minority groups and other underserved populations; 22 ‘‘(2) increasing the number of mental or behav- 23 ioral health care providers specializing in maternal 24 mental health conditions or substance use disorders 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 768 •HR 7585 IH from racial and ethnic minority groups and other 1 underserved populations; 2 ‘‘(3) increasing the number of mental or behav- 3 ioral health care providers specializing in maternal 4 mental health conditions or substance use disorders 5 working in health professional shortage areas des- 6 ignated under section 332; and 7 ‘‘(4) increasing the number of mental or behav- 8 ioral health care providers specializing in maternal 9 mental health conditions or substance use disorders 10 working in areas with significant racial and ethnic 11 inequities in maternal health outcomes, to the extent 12 such data are available. 13 ‘‘(i) DEFINITIONS.—In this section: 14 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.— 15 The term ‘racial and ethnic minority group’ has the 16 meaning given such term in section 1707(g)(1). 17 ‘‘(2) MENTAL OR BEHAVIORAL HEALTH CARE 18 PROVIDER.—The term ‘mental or behavioral health 19 care provider’ refers to a health care provider in the 20 field of mental and behavioral health, including sub- 21 stance use disorders, acting in accordance with State 22 law. 23 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 24 carry out this section, there is authorized to be appro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 769 •HR 7585 IH priated $15,000,000 for each of fiscal years 2023 through 1 2027.’’. 2 SEC. 5211. TASKFORCE RECOMMENDING IMPROVEMENTS 3 FOR UNADDRESSED MENTAL PERINATAL & 4 POSTPARTUM HEALTH (TRIUMPH) FOR NEW 5 MOMS. 6 Part B of title III of the Public Health Service Act 7 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 8 tion 317L–1 (42 U.S.C. 247b–13a) the following: 9 ‘‘SEC. 317L–2. TASK FORCE ON MATERNAL MENTAL 10 HEALTH. 11 ‘‘(a) ESTABLISHMENT.—Not later than 90 days after 12 the date of enactment of this section, the Secretary shall 13 establish a task force, to be known as the Task Force on 14 Maternal Mental Health (in this section referred to as the 15 ‘Task Force’) to identify, evaluate, and make rec- 16 ommendations to coordinate and improve, Federal re- 17 sponses to maternal mental health conditions. 18 ‘‘(b) MEMBERSHIP.— 19 ‘‘(1) COMPOSITION.—The Task Force shall be 20 composed of— 21 ‘‘(A) the Assistant Secretary for Health of 22 the Department of Health and Human Services 23 (or the Assistant Secretary’s designee) who 24 shall serve as the Chair of the Task Force; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 770 •HR 7585 IH ‘‘(B) the Federal members under para- 1 graph (2); and 2 ‘‘(C) the non-Federal members under para- 3 graph (3). 4 ‘‘(2) FEDERAL MEMBERS.—In addition to the 5 Assistant Secretary for Health, the Federal mem- 6 bers of the Task Force shall consist of the heads of 7 the following Federal departments and agencies (or 8 their designees): 9 ‘‘(A) The Administration for Children and 10 Families. 11 ‘‘(B) The Agency for Healthcare Research 12 and Quality. 13 ‘‘(C) The Centers for Disease Control and 14 Prevention. 15 ‘‘(D) The Centers for Medicare & Medicaid 16 Services. 17 ‘‘(E) The Health Resources and Services 18 Administration. 19 ‘‘(F) The Food and Drug Administration. 20 ‘‘(G) The Indian Health Service. 21 ‘‘(H) The Office of the Assistant Secretary 22 for Planning and Evaluation of the Department 23 of Health and Human Services. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 771 •HR 7585 IH ‘‘(I) The Office of Minority Health of the 1 Department of Health and Human Services. 2 ‘‘(J) The Office of the Surgeon General of 3 the Department of Health and Human Services. 4 ‘‘(K) The Office of Women’s Health of the 5 Department of Health and Human Services. 6 ‘‘(L) The National Institutes of Health. 7 ‘‘(M) The Substance Abuse and Mental 8 Health Services Administration. 9 ‘‘(N) Such other Federal departments and 10 agencies as the Secretary determines that serve 11 individuals with maternal mental health condi- 12 tions, such as the Department of Veterans Af- 13 fairs, the Department of Justice, the Depart- 14 ment of Labor, the Department of Housing and 15 Urban Development, and the Department of 16 Defense. 17 ‘‘(3) NON-FEDERAL MEMBERS.—The non-Fed- 18 eral members of the Task Force shall— 19 ‘‘(A) compose not more than one-half, and 20 not less than one-third, of the total membership 21 of the Task Force; 22 ‘‘(B) be appointed by the Secretary; and 23 ‘‘(C) include— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 772 •HR 7585 IH ‘‘(i) representatives of medical soci- 1 eties with expertise in maternal or mental 2 health; 3 ‘‘(ii) representatives of nonprofit orga- 4 nizations with expertise in maternal or 5 mental health; 6 ‘‘(iii) relevant industry representa- 7 tives; and 8 ‘‘(iv) other representatives, as appro- 9 priate. 10 ‘‘(4) DEADLINE FOR DESIGNATING DES- 11 IGNEES.—If the Assistant Secretary for Health, or 12 the head of a Federal department or agency serving 13 as a member of the Task Force under paragraph 14 (2), chooses to be represented on the Task Force by 15 a designee, the Assistant Secretary or head shall 16 designate such designee not later than 90 days after 17 the date of the enactment of this section. 18 ‘‘(c) DUTIES.—The Task Force shall— 19 ‘‘(1) create and regularly update a report that 20 identifies, analyzes, and evaluates the state of na- 21 tional maternal mental health policy and programs 22 at the Federal, State, and local levels, and identifies 23 best practices including— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 773 •HR 7585 IH ‘‘(A) a set of evidence-based, evidence-in- 1 formed, and promising practices with respect 2 to— 3 ‘‘(i) prevention strategies for individ- 4 uals at risk of experiencing a maternal 5 mental health condition, including strate- 6 gies and recommendations to address so- 7 cial determinants of health; 8 ‘‘(ii) the identification, screening, di- 9 agnosis, intervention, and treatment of in- 10 dividuals and families affected by a mater- 11 nal mental health condition; 12 ‘‘(iii) the expeditious referral to, and 13 implementation of, practices and supports 14 that prevent and mitigate the effects of a 15 maternal mental health condition, includ- 16 ing strategies and recommendations to 17 eliminate the racial and ethnic inequities 18 that exist in maternal mental health; and 19 ‘‘(iv) community-based or 20 multigenerational practices that support 21 individuals and families affected by a ma- 22 ternal mental health condition; and 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 774 •HR 7585 IH ‘‘(B) Federal and State programs and ac- 1 tivities to prevent, screen, diagnose, intervene, 2 and treat maternal mental health conditions; 3 ‘‘(2) develop and regularly update a national 4 strategy for maternal mental health, taking into con- 5 sideration the findings of the reports under para- 6 graph (1), on how the Task Force and Federal de- 7 partments and agencies represented on the Task 8 Force will prioritize options for, and implement a co- 9 ordinated approach to, addressing maternal mental 10 health conditions, including by— 11 ‘‘(A) increasing prevention, screening, di- 12 agnosis, intervention, treatment, and access to 13 care, including clinical and nonclinical care such 14 as peer-support and community health workers, 15 through the public and private sectors; 16 ‘‘(B) providing support for pregnant or 17 postpartum individuals who are at risk for or 18 experiencing a maternal mental health condi- 19 tion, and their families as appropriate; 20 ‘‘(C) reducing racial, ethnic, geographic, 21 and other health inequities for prevention, diag- 22 nosis, intervention, treatment, and access to 23 care; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 775 •HR 7585 IH ‘‘(D) identifying opportunities for local- 1 and State-level partnerships; 2 ‘‘(E) identifying options for modifying, 3 strengthening, and coordinating Federal pro- 4 grams and activities, including existing infant 5 and maternity programs, such as the Medicaid 6 program under title XIX of the Social Security 7 Act and the State Children’s Health Insurance 8 Program under title XXI of such Act, in order 9 to increase research, prevention, identification, 10 intervention, and treatment with respect to ma- 11 ternal mental health; 12 ‘‘(F) providing recommendations to ensure 13 research, services, supports, and prevention ac- 14 tivities are not unnecessarily duplicative; and 15 ‘‘(G) planning, data sharing, and commu- 16 nication within and across Federal depart- 17 ments, agencies, offices, and programs; 18 ‘‘(3) solicit public comments from stakeholders 19 for the report under paragraph (1) and the national 20 strategy under paragraph (2), including comments 21 from frontline service providers, mental health pro- 22 fessionals, researchers, experts in maternal mental 23 health, institutions of higher education, public health 24 agencies (including maternal and child health pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 776 •HR 7585 IH grams), and industry representatives, in order to in- 1 form the activities and reports of the Task Force; 2 and 3 ‘‘(4) disaggregate any data collected under this 4 section by race, ethnicity, geographical location, age, 5 marital status, socioeconomic level, and other factors 6 as determined appropriate by the Secretary. 7 ‘‘(d) MEETINGS.—The Task Force shall— 8 ‘‘(1) meet not less than two times each year; 9 and 10 ‘‘(2) convene public meetings, as appropriate, to 11 fulfill its duties under this section. 12 ‘‘(e) REPORTS TO PUBLIC AND FEDERAL LEAD- 13 ERS.—The Task Force shall make publicly available and 14 submit to the heads of relevant Federal departments and 15 agencies, the Committee on Energy and Commerce of the 16 House of Representatives, the Committee on Health, Edu- 17 cation, Labor, and Pensions of the Senate, and other rel- 18 evant congressional committees, the following: 19 ‘‘(1) Not later than 1 year after the first meet- 20 ing of the Task Force, an initial report under sub- 21 section (c)(1). 22 ‘‘(2) Not later than 2 years after the first meet- 23 ing of the Task Force, an initial national strategy 24 under subsection (c)(2). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 777 •HR 7585 IH ‘‘(3) Each year thereafter— 1 ‘‘(A) an updated report under subsection 2 (c)(1); 3 ‘‘(B) an updated national strategy under 4 subsection (c)(2); or 5 ‘‘(C) if no such update is made, a report 6 summarizing the activities of the Task Force. 7 ‘‘(f) REPORTS TO GOVERNORS.—Upon finalizing the 8 initial national strategy under subsection (c)(2), and upon 9 making relevant updates to such strategy, the Task Force 10 shall submit a report to the Governors of all States de- 11 scribing opportunities for local- and State-level partner- 12 ships identified under subsection (c)(2)(D). 13 ‘‘(g) SUNSET.—The Task Force shall terminate on 14 the date that is 6 years after the date on which the Task 15 Force is established under subsection (a).’’. 16 SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE. 17 (a) STUDY BY DEPARTMENT OF HEALTH AND 18 HUMAN SERVICES.— 19 (1) STUDY.—The Secretary, in collaboration 20 with the Health Resources and Services Administra- 21 tion, the Substance Abuse and Mental Health Serv- 22 ices Administration, and the Administration for 23 Children and Families, and in consultation with the 24 Attorney General of the United States, the Director 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 778 •HR 7585 IH of the Indian Health Service, and stakeholders (in- 1 cluding community-based organizations, culturally 2 specific organizations, and Tribal public health au- 3 thorities), shall conduct a study on the extent to 4 which individuals are more at risk of maternal mor- 5 tality or severe maternal morbidity as a result of 6 being a victim of domestic violence, dating violence, 7 sexual assault, stalking, human trafficking, sex traf- 8 ficking, child sexual abuse, or forced marriage. 9 (2) REPORTS.—Not later than 2 years after the 10 date of enactment of this Act, the Secretary shall 11 complete the study under paragraph (1) and submit 12 a report to the Congress on the results of such 13 study. Such report shall include— 14 (A) an analysis of the extent to which do- 15 mestic violence, dating violence, sexual assault, 16 stalking, human trafficking, sex trafficking, 17 child sexual abuse, and forced marriage con- 18 tribute to, or result in, maternal mortality; 19 (B) an analysis of the impact of domestic 20 violence, dating violence, sexual assault, stalk- 21 ing, human trafficking, sex trafficking, child 22 sexual abuse, and forced marriage on access to 23 health care (including mental health care) and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 779 •HR 7585 IH substance use disorder treatment and recovery 1 support; 2 (C) a breakdown (including by race and 3 ethnicity) of categories of individuals who are 4 disproportionately victims of domestic violence, 5 dating violence, sexual assault, stalking, human 6 trafficking, sex trafficking, child sexual abuse, 7 or forced marriage that contributes to, or re- 8 sults in, pregnancy-related death; 9 (D) an analysis of the impact on health, 10 mental health, and substance use resulting from 11 domestic violence, dating violence, sexual as- 12 sault, stalking, human trafficking, sex traf- 13 ficking, child sexual abuse, and forced marriage 14 among Alaskan Natives, Native Hawaiians, and 15 American Indians during the prenatal and 16 postpartum period; 17 (E) an assessment of the factors that in- 18 crease or decrease risks for maternal mortality 19 or severe maternal morbidity among victims of 20 domestic violence, dating violence, sexual as- 21 sault, stalking, human trafficking, sex traf- 22 ficking, child sexual abuse, or forced marriage; 23 (F) an assessment of increased risk of ma- 24 ternal mortality or severe maternal morbidity 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 780 •HR 7585 IH stemming from suicide, substance use disorders, 1 or drug overdose due to domestic violence, dat- 2 ing violence, sexual assault, stalking, human 3 trafficking, sex trafficking, child sexual abuse, 4 or forced marriage; 5 (G) recommendations for legislative or pol- 6 icy changes— 7 (i) to reduce maternal mortality rates; 8 and 9 (ii) to address health inequities that 10 contribute to inequities in such rates and 11 deaths; 12 (H) best practices to reduce maternal mor- 13 tality and severe maternal morbidity among vic- 14 tims of domestic violence, dating violence, sex- 15 ual assault, stalking, human trafficking, sex 16 trafficking, child sexual abuse, and forced mar- 17 riage, including— 18 (i) reducing reproductive coercion, 19 mental health conditions, and substance 20 use coercion; and 21 (ii) routinely assessing pregnant peo- 22 ple for domestic violence and other forms 23 of reproductive violence; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 781 •HR 7585 IH (I) any other information on maternal 1 mortality or severe maternal morbidity the Sec- 2 retary determines appropriate to include in the 3 report. 4 (b) STUDY BY NATIONAL ACADEMY OF MEDICINE.— 5 (1) IN GENERAL.—The Secretary shall seek to 6 enter into an arrangement with the National Acad- 7 emy of Medicine (or, if the Academy declines to 8 enter into such arrangement, another appropriate 9 entity) to study— 10 (A) the impact of domestic violence, dating 11 violence, sexual assault, stalking, human traf- 12 ficking, sex trafficking, child sexual abuse, and 13 forced marriage on an individual’s health; rel- 14 ative to 15 (B) maternal mortality and severe mater- 16 nal morbidity. 17 (2) TOPICS.—The study under paragraph (1) 18 shall— 19 (A) examine— 20 (i) whether domestic violence, dating 21 violence, sexual assault, stalking, human 22 trafficking, sex trafficking, child sexual 23 abuse, or forced marriage, or generational 24 intimate partner violence, trauma, and psy- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 782 •HR 7585 IH chiatric disorders, increase the risk of sui- 1 cide, substance use, and drug overdose 2 among pregnant and postpartum persons; 3 and 4 (ii) the intersection of domestic vio- 5 lence, dating violence, sexual assault, stalk- 6 ing, human trafficking, sex trafficking, 7 child sexual abuse, and forced marriage as 8 a social determinant of health; and 9 (B) give particular focus to impacts among 10 African American, American Indian, Native Ha- 11 waiian, Alaskan Native, and LGBTQ birthing 12 persons. 13 (c) GRANTS FOR INNOVATIVE APPROACHES.— 14 (1) IN GENERAL.—The Secretary, acting 15 through the Administrator of the Health Resources 16 and Services Administration, and in collaboration 17 with the Administration for Children and Families, 18 the Indian Health Service, and the Substance Abuse 19 and Mental Health Services Administration, shall 20 award grants to eligible entities for developing and 21 implementing innovative approaches to improve ma- 22 ternal and child health outcomes of victims of do- 23 mestic violence, dating violence, sexual assault, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 783 •HR 7585 IH stalking, human trafficking, sex trafficking, child 1 sexual abuse, or forced marriage. 2 (2) ELIGIBLE ENTITY.—To seek a grant under 3 this subsection, an entity shall be— 4 (A) a State, local, or federally recognized 5 Tribal government; 6 (B) a nonprofit organization or commu- 7 nity-based organization that provides prevention 8 or intervention services related to domestic vio- 9 lence, dating violence, sexual assault, stalking, 10 human trafficking, sex trafficking, child sexual 11 abuse, or forced marriage; 12 (C) a tribal organization or Urban Indian 13 organization (as such terms are defined in sec- 14 tion 4 of the Indian Health Care Improvement 15 Act (25 U.S.C. 1603)); 16 (D) an entity, the principal purpose of 17 which is to provide health care, such as a hos- 18 pital, clinic, health department, freestanding 19 birthing center, perinatal health worker, or ma- 20 ternity care provider; 21 (E) an institution of higher education; or 22 (F) a comprehensive substance use dis- 23 order parenting program. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 784 •HR 7585 IH (3) PRIORITY.—In awarding grants under this 1 subsection, the Secretary of Health and Human 2 Services shall give priority to applicants proposing to 3 address— 4 (A) mental health and substance use dis- 5 orders among pregnant persons; or 6 (B) pregnant and postpartum persons ex- 7 periencing intimate partner violence. 8 (4) FREESTANDING BIRTH CENTER DEFINED.— 9 In this subsection, the term ‘‘freestanding birth cen- 10 ter’’ has the meaning given that term in section 11 1905(l) of the Social Security Act (42 U.S.C. 12 1396d(1)). 13 (5) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this subsection, there is authorized to be 15 appropriated $25,000,000 for the period of fiscal 16 years 2023 through 2025. 17 (d) GUIDANCE.—Not later than 2 years after the 18 date of enactment of this Act, the Secretary shall issue 19 and disseminate guidance to States, Tribes, Territories, 20 maternity care providers, and managed care entities on— 21 (1) providing universal education on healthy re- 22 lationships and intimate partner violence; 23 (2) developing protocols on— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 785 •HR 7585 IH (A) routine assessment of intimate partner 1 violence; and 2 (B) health promotion and strategies for 3 trauma-informed care plans; and 4 (3) creating sustainable partnerships with com- 5 munity-based organizations that address domestic vi- 6 olence, dating violence, sexual assault, stalking, 7 human trafficking, sex trafficking, child sexual 8 abuse, or forced marriage. 9 (e) DEFINITIONS.—In this section: 10 (1) The term ‘‘maternal mortality’’— 11 (A) means death that— 12 (i) occurs during, or within the 1-year 13 period after, pregnancy; and 14 (ii) is attributed to or aggravated by 15 pregnancy-related or childbirth complica- 16 tions; and 17 (B) includes a suicide, drug overdose 18 death, homicide (including a domestic violence- 19 related homicide), or other death resulting from 20 a mental health or substance use disorder at- 21 tributed to or aggravated by pregnancy-related 22 or childbirth complications. 23 (2) The term ‘‘maternity care provider’’ means 24 a health care provider who— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 786 •HR 7585 IH (A) is a physician, physician assistant, 1 nurse, midwife who meets at a minimum the 2 international definition of the midwife and glob- 3 al standards for midwifery education as estab- 4 lished by the International Confederation of 5 Midwives, nurse practitioner, or clinical nurse 6 specialist; and 7 (B) has a focus on maternal or perinatal 8 health. 9 (3) The term ‘‘perinatal health worker’’ means 10 a worker who— 11 (A) is a doula, community health worker, 12 peer supporter, breastfeeding and lactation edu- 13 cator or counselor, nutritionist or dietitian, 14 childbirth educator, social worker, home visitor, 15 language interpreter, or navigator; and 16 (B) provides assistance with perinatal 17 health. 18 (4) The term ‘‘postpartum’’ refers to the 12- 19 month period following childbirth. 20 (5) The term ‘‘Secretary’’ means the Secretary 21 of Health and Human Services. 22 (6) The term ‘‘severe maternal morbidity’’ 23 means a health condition, including a mental health 24 condition or substance use disorder, that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 787 •HR 7585 IH (A) is attributed to or aggravated by preg- 1 nancy or childbirth; and 2 (B) results in significant short-term or 3 long-term consequences to the health of the in- 4 dividual who was pregnant. 5 SEC. 5213. PERINATAL WORKFORCE. 6 (a) HHS AGENCY DIRECTIVES.— 7 (1) GUIDANCE TO STATES.— 8 (A) IN GENERAL.—Not later than 2 years 9 after the date of enactment of this Act, the Sec- 10 retary of Health and Human Services shall 11 issue and disseminate guidance to States to 12 educate providers, managed care entities, and 13 other insurers about the value and process of 14 delivering respectful maternal health care 15 through diverse and multidisciplinary care pro- 16 vider models. 17 (B) CONTENTS.—The guidance required 18 by subparagraph (A) shall address how States 19 can encourage and incentivize hospitals, health 20 systems, midwifery practices, freestanding birth 21 centers, other maternity care provider groups, 22 managed care entities, and other insurers— 23 (i) to recruit and retain maternity 24 care providers, mental and behavioral 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 788 •HR 7585 IH health care providers acting in accordance 1 with State law, registered dietitians or nu- 2 trition professionals (as such term is de- 3 fined in section 1861(vv)(2) of the Social 4 Security Act (42 U.S.C. 1395x(vv)(2))), 5 and lactation consultants certified by the 6 International Board of Lactation Consult- 7 ants Examiners— 8 (I) from racially, ethnically, and 9 linguistically diverse backgrounds; 10 (II) with experience practicing in 11 racially and ethnically diverse commu- 12 nities; and 13 (III) who have undergone train- 14 ing on implicit bias and racism; 15 (ii) to incorporate into maternity care 16 teams— 17 (I) midwives who meet, at a min- 18 imum, the international definition of 19 the midwife and global standards for 20 midwifery education, as established by 21 the International Confederation of 22 Midwives; and 23 (II) perinatal health workers; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 789 •HR 7585 IH (iii) to provide collaborative, culturally 1 congruent care; and 2 (iv) to provide opportunities for indi- 3 viduals enrolled in accredited midwifery 4 education programs to participate in job 5 shadowing with maternity care teams in 6 hospitals, health systems, midwifery prac- 7 tices, and freestanding birth centers. 8 (2) STUDY ON RESPECTFUL AND CULTURALLY 9 CONGRUENT MATERNITY CARE.— 10 (A) STUDY.—The Secretary of Health and 11 Human Services, acting through the Director of 12 the National Institutes of Health (in this para- 13 graph referred to as the ‘‘Secretary’’), shall 14 conduct a study on best practices in respectful 15 and culturally congruent maternity care. 16 (B) REPORT.—Not later than 2 years after 17 the date of enactment of this Act, the Secretary 18 shall— 19 (i) complete the study required by 20 subparagraph (A); 21 (ii) submit to the Congress, and make 22 publicly available, a report on the results 23 of such study; and 24 (iii) include in such report— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 790 •HR 7585 IH (I) a compendium of examples of 1 hospitals, health systems, midwifery 2 practices, freestanding birth centers, 3 other maternity care provider groups, 4 managed care entities, and other in- 5 surers that are delivering respectful 6 and culturally congruent maternal 7 health care; 8 (II) a compendium of examples 9 of hospitals, health systems, midwifery 10 practices, freestanding birth centers, 11 other maternity care provider groups, 12 managed care entities, and other in- 13 surers that have made progress in re- 14 ducing inequities in maternal health 15 outcomes and improving birthing ex- 16 periences for pregnant and 17 postpartum individuals from racial 18 and ethnic minority groups; and 19 (III) recommendations to hos- 20 pitals, health systems, midwifery prac- 21 tices, freestanding birth centers, other 22 maternity care provider groups, man- 23 aged care entities, and other insurers, 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 791 •HR 7585 IH for best practices in respectful and 1 culturally congruent maternity care. 2 (b) GRANTS TO GROW AND DIVERSIFY THE 3 PERINATAL WORKFORCE.—Title VII of the Public Health 4 Service Act is amended by inserting after section 758, as 5 added by section 5210(b), the following new section: 6 ‘‘SEC. 758A. PERINATAL WORKFORCE GRANTS. 7 ‘‘(a) IN GENERAL.—The Secretary shall award 8 grants to entities to establish or expand programs de- 9 scribed in subsection (b) to grow and diversify the 10 perinatal workforce. 11 ‘‘(b) USE OF FUNDS.—Recipients of grants under 12 this section shall use the grants to grow and diversify the 13 perinatal workforce by— 14 ‘‘(1) establishing schools or programs that pro- 15 vide education and training to individuals seeking 16 appropriate licensing or certification as— 17 ‘‘(A) physician assistants who will complete 18 clinical training in the field of maternal and 19 perinatal health; or 20 ‘‘(B) perinatal health workers; and 21 ‘‘(2) expanding the capacity of existing schools 22 or programs described in paragraph (1), for the pur- 23 poses of increasing the number of students enrolled 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 792 •HR 7585 IH in such schools or programs, including by awarding 1 scholarships for students. 2 ‘‘(c) PRIORITIZATION.—In awarding grants under 3 this section, the Secretary shall give priority to any entity 4 that— 5 ‘‘(1) has demonstrated a commitment to re- 6 cruiting and retaining students and faculty from ra- 7 cial and ethnic minority groups; 8 ‘‘(2) has developed a strategy to recruit and re- 9 tain a diverse pool of students into the perinatal 10 workforce program or school supported by funds re- 11 ceived through the grant, particularly from racial 12 and ethnic minority groups and other underserved 13 populations; 14 ‘‘(3) has developed a strategy to recruit and re- 15 tain students who plan to practice in a health pro- 16 fessional shortage area designated under section 17 332; 18 ‘‘(4) has developed a strategy to recruit and re- 19 tain students who plan to practice in an area with 20 significant racial and ethnic inequities in maternal 21 health outcomes, to the extent practicable; and 22 ‘‘(5) includes in the standard curriculum for all 23 students within the perinatal workforce program or 24 school a bias, racism, or discrimination training pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 793 •HR 7585 IH gram that includes training on implicit bias and rac- 1 ism. 2 ‘‘(d) REPORTING.—As a condition on receipt of a 3 grant under this section for a perinatal workforce program 4 or school, an entity shall agree to submit to the Secretary 5 an annual report on the activities conducted through the 6 grant, including— 7 ‘‘(1) the number and demographics of students 8 participating in the program or school; 9 ‘‘(2) the extent to which students in the pro- 10 gram or school are entering careers in— 11 ‘‘(A) health professional shortage areas 12 designated under section 332; and 13 ‘‘(B) areas with significant racial and eth- 14 nic inequities in maternal health outcomes, to 15 the extent such data are available; and 16 ‘‘(3) whether the program or school has in- 17 cluded in the standard curriculum for all students a 18 bias, racism, or discrimination training program that 19 includes explicit and implicit bias, and if so the ef- 20 fectiveness of such training program. 21 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 22 under this section shall not exceed 5 years. 23 ‘‘(f) APPLICATION.—To seek a grant under this sec- 24 tion, an entity shall submit to the Secretary an application 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 794 •HR 7585 IH at such time, in such manner, and containing such infor- 1 mation as the Secretary may require, including any infor- 2 mation necessary for prioritization under subsection (c). 3 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 4 provide, directly or by contract, technical assistance to en- 5 tities seeking or receiving a grant under this section on 6 the development, use, evaluation, and post-grant period 7 sustainability of the perinatal workforce programs or 8 schools proposed to be, or being, established or expanded 9 through the grant. 10 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 11 4 years after the date of enactment of this section, the 12 Secretary shall prepare and submit to the Congress, and 13 post on the internet website of the Department of Health 14 and Human Services, a report on the effectiveness of the 15 grant program under this section at— 16 ‘‘(1) recruiting students from racial and ethnic 17 minority groups; 18 ‘‘(2) increasing the number of physician assist- 19 ants who will complete clinical training in the field 20 of maternal and perinatal health, and perinatal 21 health workers, from racial and ethnic minority 22 groups and other underserved populations; 23 ‘‘(3) increasing the number of physician assist- 24 ants who will complete clinical training in the field 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 795 •HR 7585 IH of maternal and perinatal health, and perinatal 1 health workers, working in health professional short- 2 age areas designated under section 332; and 3 ‘‘(4) increasing the number of physician assist- 4 ants who will complete clinical training in the field 5 of maternal and perinatal health, and perinatal 6 health workers, working in areas with significant ra- 7 cial and ethnic inequities in maternal health out- 8 comes, to the extent such data are available. 9 ‘‘(i) DEFINITION.—In this section, the term ‘racial 10 and ethnic minority group’ has the meaning given such 11 term in section 1707(g). 12 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this section, there is authorized to be appro- 14 priated $15,000,000 for each of fiscal years 2023 through 15 2027.’’. 16 (c) GRANTS TO GROW AND DIVERSIFY THE NURSING 17 WORKFORCE IN MATERNAL AND PERINATAL HEALTH.— 18 Title VIII of the Public Health Service Act is amended 19 by inserting after section 811 of that Act (42 U.S.C. 296j) 20 the following: 21 ‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 22 ‘‘(a) IN GENERAL.—The Secretary shall award 23 grants to schools of nursing to grow and diversify the 24 perinatal nursing workforce. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 796 •HR 7585 IH ‘‘(b) USE OF FUNDS.—Recipients of grants under 1 this section shall use the grants to grow and diversify the 2 perinatal nursing workforce by providing scholarships to 3 students seeking to become— 4 ‘‘(1) nurse practitioners whose education in- 5 cludes a focus on maternal and perinatal health; or 6 ‘‘(2) clinical nurse specialists whose education 7 includes a focus on maternal and perinatal health. 8 ‘‘(c) PRIORITIZATION.—In awarding grants under 9 this section, the Secretary shall give priority to any school 10 of nursing that— 11 ‘‘(1) has developed a strategy to recruit and re- 12 tain a diverse pool of students seeking to enter ca- 13 reers focused on maternal and perinatal health, par- 14 ticularly students from racial and ethnic minority 15 groups and other underserved populations; 16 ‘‘(2) has developed a partnership with a prac- 17 tice setting in a health professional shortage area 18 designated under section 332 for the clinical place- 19 ments of the school’s students; 20 ‘‘(3) has developed a strategy to recruit and re- 21 tain students who plan to practice in an area with 22 significant racial and ethnic inequities in maternal 23 health outcomes, to the extent practicable; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 797 •HR 7585 IH ‘‘(4) includes in the standard curriculum for all 1 students seeking to enter careers focused on mater- 2 nal and perinatal health a bias, racism, or discrimi- 3 nation training program that includes education on 4 implicit bias and racism. 5 ‘‘(d) REPORTING.—As a condition on receipt of a 6 grant under this section, a school of nursing shall agree 7 to submit to the Secretary an annual report on the activi- 8 ties conducted through the grant, including, to the extent 9 practicable— 10 ‘‘(1) the number and demographics of students 11 in the school of nursing seeking to enter careers fo- 12 cused on maternal and perinatal health; 13 ‘‘(2) the extent to which such students are pre- 14 paring to enter careers in— 15 ‘‘(A) health professional shortage areas 16 designated under section 332; and 17 ‘‘(B) areas with significant racial and eth- 18 nic inequities in maternal health outcomes, to 19 the extent such data are available; and 20 ‘‘(3) whether the standard curriculum for all 21 students seeking to enter careers focused on mater- 22 nal and perinatal health includes a bias, racism, or 23 discrimination training program that includes edu- 24 cation on implicit bias and racism. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 798 •HR 7585 IH ‘‘(e) PERIOD OF GRANTS.—The period of a grant 1 under this section shall be up to 5 years. 2 ‘‘(f) APPLICATION.—To seek a grant under this sec- 3 tion, an entity shall submit to the Secretary an applica- 4 tion, at such time, in such manner, and containing such 5 information as the Secretary may require, including any 6 information necessary for prioritization under subsection 7 (c). 8 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 9 provide, directly or by contract, technical assistance to 10 schools of nursing seeking or receiving a grant under this 11 section on the processes of awarding and evaluating schol- 12 arships through the grant. 13 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 14 4 years after the date of enactment of this section, the 15 Secretary shall prepare and submit to the Congress, and 16 post on the internet website of the Department of Health 17 and Human Services, a report on the effectiveness of the 18 grant program under this section at— 19 ‘‘(1) recruiting students from racial and ethnic 20 minority groups and other underserved populations; 21 ‘‘(2) increasing the number of nurse practi- 22 tioners and clinical nurse specialists entering careers 23 focused on maternal and perinatal health from racial 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 799 •HR 7585 IH and ethnic minority groups and other underserved 1 populations; 2 ‘‘(3) increasing the number of nurse practi- 3 tioners and clinical nurse specialists entering careers 4 focused on maternal and perinatal health working in 5 health professional shortage areas designated under 6 section 332; and 7 ‘‘(4) increasing the number of nurse practi- 8 tioners and clinical nurse specialists entering careers 9 focused on maternal and perinatal health working in 10 areas with significant racial and ethnic inequities in 11 maternal health outcomes, to the extent such data 12 are available. 13 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this section, there is authorized to be appro- 15 priated $15,000,000 for each of fiscal years 2023 through 16 2027.’’. 17 (d) GAO REPORT.— 18 (1) IN GENERAL.—Not later than 2 years after 19 the date of enactment of this Act, and every 5 years 20 thereafter, the Comptroller General of the United 21 States shall submit to Congress a report on barriers 22 to maternal health education and access to care in 23 the United States. Such report shall include the in- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 800 •HR 7585 IH formation and recommendations described in para- 1 graph (2). 2 (2) CONTENT OF REPORT.—The report under 3 paragraph (1) shall include— 4 (A) an assessment of current barriers to 5 entering accredited midwifery education pro- 6 grams, and recommendations for addressing 7 such barriers, particularly for low-income people 8 and people from racial and ethnic minority 9 groups; 10 (B) an assessment of current barriers to 11 entering and successfully completing accredited 12 education programs for other health profes- 13 sional careers related to maternity care, includ- 14 ing maternity care providers, mental and behav- 15 ioral health care providers acting in accordance 16 with State law, registered dietitians or nutrition 17 professionals (as such term is defined in section 18 1861(vv)(2) of the Social Security Act (42 19 U.S.C. 1395x(vv)(2))), and lactation consult- 20 ants certified by the International Board of 21 Lactation Consultants Examiners, particularly 22 for low-income people and people from racial 23 and ethnic minority groups; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 801 •HR 7585 IH (C) an assessment of current barriers that 1 prevent midwives from meeting the inter- 2 national definition of the midwife and global 3 standards for midwifery education as estab- 4 lished by the International Confederation of 5 Midwives, and recommendations for addressing 6 such barriers, particularly for low-income people 7 and people from racial and ethnic minority 8 groups; 9 (D) an assessment of inequities in access 10 to maternity care providers, mental or behav- 11 ioral health care providers acting in accordance 12 with State law, registered dietitians or nutrition 13 professionals (as such term is defined in section 14 1861(vv)(2) of the Social Security Act (42 15 U.S.C. 1395x(vv)(2))), lactation consultants 16 certified by the International Board of Lacta- 17 tion Consultants Examiners, and perinatal 18 health workers, stratified by race, ethnicity, 19 gender identity, geographic location, and insur- 20 ance type and recommendations to promote 21 greater access equity; and 22 (E) recommendations to promote greater 23 equity in compensation for perinatal health 24 workers under public and private insurers, par- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 802 •HR 7585 IH ticularly for such individuals from racially and 1 ethnically diverse backgrounds. 2 (e) DEFINITIONS.—In this section: 3 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 4 turally congruent’’, with respect to care or maternity 5 care, means care that is in agreement with the pre- 6 ferred cultural values, beliefs, worldview, language, 7 and practices of the health care consumer and other 8 stakeholders. 9 (2) MATERNITY CARE PROVIDER.—The term 10 ‘‘maternity care provider’’ means a health care pro- 11 vider who— 12 (A) is a physician, physician assistant, 13 midwife who meets at a minimum the inter- 14 national definition of the midwife and global 15 standards for midwifery education as estab- 16 lished by the International Confederation of 17 Midwives, nurse practitioner, or clinical nurse 18 specialist; and 19 (B) has a focus on maternal or perinatal 20 health. 21 (3) PERINATAL HEALTH WORKER.—The term 22 ‘‘perinatal health worker’’ means a doula, commu- 23 nity health worker, peer supporter, breastfeeding 24 and lactation educator or counselor, nutritionist or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 803 •HR 7585 IH dietitian, childbirth educator, social worker, home 1 visitor, language interpreter, or navigator. 2 (4) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (5) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘‘racial and ethnic minority group’’ has the 8 meaning given such term in section 1707(g)(1) of 9 the Public Health Service Act (42 U.S.C. 300u– 10 6(g)(1)). 11 SEC. 5214. MIDWIVES SCHOOLS AND PROGRAMS EXPAN- 12 SION. 13 (a) MIDWIFERY SCHOOLS AND PROGRAMS.— 14 (1) IN GENERAL.—Title VII of the Public 15 Health Service Act is amended by inserting after 16 section 760 of such Act (42 U.S.C. 294k) the fol- 17 lowing: 18 ‘‘SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS. 19 ‘‘(a) IN GENERAL.—The Secretary may award grants 20 to institutions of higher education (as defined in sub- 21 sections (a) and (b) of section 101 of the Higher Edu- 22 cation Act of 1965) for the following: 23 ‘‘(1) Direct support of students in an accredited 24 midwifery school or program. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 804 •HR 7585 IH ‘‘(2) Establishment or expansion of an accred- 1 ited midwifery school or program. 2 ‘‘(3) Securing, preparing, or providing support 3 for increasing the number of, qualified preceptors 4 for training the students of an accredited midwifery 5 school or program. 6 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 7 grants under subsection (a), the Secretary shall give spe- 8 cial consideration to any institution of higher education 9 that— 10 ‘‘(1) agrees to prioritize students who plan to 11 practice in a health professional shortage area des- 12 ignated under section 332; and 13 ‘‘(2) demonstrates a focus on increasing racial 14 and ethnic minority representation in midwifery edu- 15 cation. 16 ‘‘(c) RESTRICTION.—The Secretary shall not provide 17 any assistance under this section to be used with respect 18 to a midwifery school or program within a school of nurs- 19 ing (as defined in section 801). 20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 21 ‘‘(1) IN GENERAL.—There is authorized to be 22 appropriated to carry out this section $15,000,000 23 for the period of fiscal years 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 805 •HR 7585 IH ‘‘(2) ALLOCATION.—Of the amounts made 1 available to carry out this section for any fiscal year, 2 the Secretary shall use— 3 ‘‘(A) 50 percent to award grants for pur- 4 poses specified in subsection (a)(1); 5 ‘‘(B) 25 percent to award grants for pur- 6 poses specified in subsection (a)(2); and 7 ‘‘(C) 25 percent to award grants for pur- 8 poses specified in subsection (a)(3).’’. 9 (2) DEFINITIONS.— 10 (A) MIDWIFERY SCHOOL OR PROGRAM.— 11 Section 799B(1)(A) of the Public Health Serv- 12 ice Act (42 U.S.C. 295p(1)(A)) is amended— 13 (i) by inserting ‘‘ ‘midwifery school or 14 program’,’’ before ‘‘and ‘school of chiro- 15 practic’ ’’; 16 (ii) by inserting ‘‘a degree or certifi- 17 cate in midwifery or an equivalent degree 18 or certificate,’’ before ‘‘and a degree of 19 doctor of chiropractic or an equivalent de- 20 gree’’; and 21 (iii) by striking ‘‘any such school’’ and 22 inserting ‘‘any such school or program’’. 23 (B) ACCREDITED.—Section 799B(1)(E) of 24 the Public Health Service Act (42 U.S.C. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 806 •HR 7585 IH 295p(1)(E)) is amended by inserting ‘‘or a mid- 1 wifery school or program,’’ before ‘‘or a grad- 2 uate program in health administration’’. 3 (b) NURSE-MIDWIVES.—Title VIII of the Public 4 Health Service Act, as amended by section 5213, is fur- 5 ther amended by inserting after section 812 of that Act, 6 as added by section 5213, the following: 7 ‘‘SEC. 812A. MIDWIFERY EXPANSION PROGRAM. 8 ‘‘(a) IN GENERAL.—The Secretary may award grants 9 to schools of nursing for the following: 10 ‘‘(1) Direct support of students in an accredited 11 nurse-midwifery school or program. 12 ‘‘(2) Establishment or expansion of an accred- 13 ited nurse-midwifery school or program. 14 ‘‘(3) Securing, preparing, or providing support 15 for increasing the numbers of, preceptors at clinical 16 training sites to precept students training to become 17 certified nurse-midwives. 18 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 19 grants under subsection (a), the Secretary shall give spe- 20 cial consideration to any school of nursing that— 21 ‘‘(1) agrees to prioritize students who choose to 22 pursue an advanced education degree in nurse-mid- 23 wifery to practice in a health professional shortage 24 area designated under section 332; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 807 •HR 7585 IH ‘‘(2) demonstrates a focus on increasing racial 1 and ethnic minority representation in nurse-mid- 2 wifery education. 3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 4 ‘‘(1) IN GENERAL.—To carry out this section, 5 there is authorized to be appropriated $20,000,000 6 for the period of fiscal years 2023 through 2027. 7 ‘‘(2) ALLOCATION.—Of the amounts made 8 available to carry out this section for any fiscal year, 9 the Secretary shall use— 10 ‘‘(A) 50 percent to award grants for pur- 11 poses specified in subsection (a)(1); 12 ‘‘(B) 25 percent to award grants for pur- 13 poses specified in subsection (a)(2); and 14 ‘‘(C) 25 percent to award grants for pur- 15 poses specified in subsection (a)(3).’’. 16 SEC. 5215. GESTATIONAL DIABETES. 17 Part B of title III of the Public Health Service Act 18 (42 U.S.C. 243 et seq.) is amended by adding after section 19 317H the following: 20 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 21 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 22 TIONAL DIABETES.— 23 ‘‘(1) IN GENERAL.—The Secretary, acting 24 through the Director of the Centers for Disease 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 808 •HR 7585 IH Control and Prevention, in consultation with the Di- 1 abetes Mellitus Interagency Coordinating Committee 2 established under section 429 and representatives of 3 appropriate national health organizations, shall de- 4 velop a multisite gestational diabetes research 5 project within the diabetes program of the Centers 6 for Disease Control and Prevention to expand and 7 enhance surveillance data and public health research 8 on gestational diabetes. 9 ‘‘(2) AREAS TO BE ADDRESSED.—The research 10 project developed under paragraph (1) shall ad- 11 dress— 12 ‘‘(A) procedures to establish accurate and 13 efficient systems for the collection of gestational 14 diabetes data within each State and common- 15 wealth, territory, or possession of the United 16 States; 17 ‘‘(B) the progress of collaborative activities 18 with the National Vital Statistics System, the 19 National Center for Health Statistics, and 20 State health departments with respect to the 21 standard birth certificate, in order to improve 22 surveillance of gestational diabetes; 23 ‘‘(C) postpartum methods of tracking indi- 24 viduals with gestational diabetes after delivery 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 809 •HR 7585 IH as well as targeted interventions proven to 1 lower the incidence of type 2 diabetes in that 2 population; 3 ‘‘(D) variations in the distribution of diag- 4 nosed and undiagnosed gestational diabetes, 5 and of impaired fasting glucose tolerance and 6 impaired fasting glucose, within and among 7 groups of pregnant individuals; and 8 ‘‘(E) factors and culturally sensitive inter- 9 ventions that influence risks and reduce the in- 10 cidence of gestational diabetes and related com- 11 plications during childbirth, including cultural, 12 behavioral, racial, ethnic, geographic, demo- 13 graphic, socioeconomic, and genetic factors. 14 ‘‘(3) REPORT.—Not later than 2 years after the 15 date of the enactment of this section, and annually 16 thereafter, the Secretary shall generate a report on 17 the findings and recommendations of the research 18 project including prevalence of gestational diabetes 19 in the multisite area and disseminate the report to 20 the appropriate Federal and non-Federal agencies. 21 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 22 SEARCH.— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 810 •HR 7585 IH ‘‘(1) IN GENERAL.—The Secretary shall expand 1 and intensify public health research regarding gesta- 2 tional diabetes. Such research may include— 3 ‘‘(A) developing and testing novel ap- 4 proaches for improving postpartum diabetes 5 testing or screening and for preventing type 2 6 diabetes in individuals who can become preg- 7 nant with a history of gestational diabetes; and 8 ‘‘(B) conducting public health research to 9 further understanding of the epidemiologic, 10 socioenvironmental, behavioral, translation, and 11 biomedical factors and health systems that in- 12 fluence the risk of gestational diabetes and the 13 development of type 2 diabetes in individuals 14 who can become pregnant with a history of ges- 15 tational diabetes. 16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 17 There is authorized to be appropriated to carry out 18 this subsection $5,000,000 for each of fiscal years 19 2023 through 2027. 20 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 21 RATE OF GESTATIONAL DIABETES.— 22 ‘‘(1) IN GENERAL.—The Secretary, acting 23 through the Director of the Centers for Disease 24 Control and Prevention, shall award grants, on a 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 811 •HR 7585 IH competitive basis, to eligible entities for demonstra- 1 tion projects that implement evidence-based inter- 2 ventions to reduce the incidence of gestational diabe- 3 tes, the recurrence of gestational diabetes in subse- 4 quent pregnancies, and the development of type 2 di- 5 abetes in individuals who can become pregnant with 6 a history of gestational diabetes. 7 ‘‘(2) PRIORITY.—In making grants under this 8 subsection, the Secretary shall give priority to 9 projects focusing on— 10 ‘‘(A) helping individuals who can become 11 pregnant who have 1 or more risk factors for 12 developing gestational diabetes; 13 ‘‘(B) working with individuals who can be- 14 come pregnant with a history of gestational dia- 15 betes during a previous pregnancy; 16 ‘‘(C) providing postpartum care for indi- 17 viduals who can become pregnant with gesta- 18 tional diabetes; 19 ‘‘(D) tracking cases where individuals who 20 can become pregnant with a history of gesta- 21 tional diabetes developed type 2 diabetes; 22 ‘‘(E) educating mothers with a history of 23 gestational diabetes about the increased risk of 24 their child developing diabetes; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 812 •HR 7585 IH ‘‘(F) working to prevent gestational diabe- 1 tes and prevent or delay the development of 2 type 2 diabetes in individuals who can become 3 pregnant with a history of gestational diabetes; 4 and 5 ‘‘(G) achieving outcomes designed to assess 6 the efficacy and cost-effectiveness of interven- 7 tions that can inform decisions on long-term 8 sustainability, including third-party reimburse- 9 ment. 10 ‘‘(3) APPLICATION.—An eligible entity desiring 11 to receive a grant under this subsection shall submit 12 to the Secretary— 13 ‘‘(A) an application at such time, in such 14 manner, and containing such information as the 15 Secretary may require; and 16 ‘‘(B) a plan to— 17 ‘‘(i) lower the rate of gestational dia- 18 betes during pregnancy; or 19 ‘‘(ii) develop methods of tracking indi- 20 viduals who can become pregnant with a 21 history of gestational diabetes and develop 22 effective interventions to lower the inci- 23 dence of the recurrence of gestational dia- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 813 •HR 7585 IH betes in subsequent pregnancies and the 1 development of type 2 diabetes. 2 ‘‘(4) USES OF FUNDS.—An eligible entity re- 3 ceiving a grant under this subsection shall use the 4 grant funds to carry out demonstration projects de- 5 scribed in paragraph (1), including— 6 ‘‘(A) expanding community-based health 7 promotion education, activities, and incentives 8 focused on the prevention of gestational diabe- 9 tes and development of type 2 diabetes in indi- 10 viduals who can become pregnant with a history 11 of gestational diabetes; 12 ‘‘(B) aiding State- and Tribal-based diabe- 13 tes prevention and control programs to collect, 14 analyze, disseminate, and report surveillance 15 data on individuals who can become pregnant 16 with, and at risk for, gestational diabetes, the 17 recurrence of gestational diabetes in subsequent 18 pregnancies, and, for individuals who can be- 19 come pregnant with a history of gestational dia- 20 betes, the development of type 2 diabetes; and 21 ‘‘(C) training and encouraging health care 22 providers— 23 ‘‘(i) to promote risk assessment, high- 24 quality care, and self-management for ges- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 814 •HR 7585 IH tational diabetes and the recurrence of ges- 1 tational diabetes in subsequent preg- 2 nancies; and 3 ‘‘(ii) to prevent the development of 4 type 2 diabetes in individuals who can be- 5 come pregnant with a history of gesta- 6 tional diabetes, and its complications in the 7 practice settings of the health care pro- 8 viders. 9 ‘‘(5) REPORT.—Not later than 4 years after the 10 date of the enactment of this section, the Secretary 11 shall prepare and submit to the Congress a report 12 concerning the results of the demonstration projects 13 conducted through the grants awarded under this 14 subsection. 15 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 16 this subsection, the term ‘eligible entity’ means a 17 nonprofit organization (such as a nonprofit academic 18 center or community health center) or a State, Trib- 19 al, or local health agency. 20 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 21 There is authorized to be appropriated to carry out 22 this subsection $5,000,000 for each of fiscal years 23 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 815 •HR 7585 IH ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 1 TIONAL DIABETES.—The Secretary, acting through the 2 Director of the Centers for Disease Control and Preven- 3 tion, shall work with the State- and Tribal-based diabetes 4 prevention and control programs assisted by the Centers 5 to encourage postpartum followup after gestational diabe- 6 tes, as medically appropriate, for the purpose of reducing 7 the incidence of gestational diabetes, the recurrence of 8 gestational diabetes in subsequent pregnancies, the devel- 9 opment of type 2 diabetes in individuals with a history 10 of gestational diabetes, and related complications.’’. 11 SEC. 5216. CONSUMER EDUCATION CAMPAIGN. 12 Section 229(b) of the Public Health Service Act (42 13 U.S.C. 237a(b)), as 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: 19 ‘‘(8) not later than one year after the date of 20 the enactment of this paragraph, develop and imple- 21 ment a 4-year culturally and linguistically appro- 22 priate multimedia consumer education campaign 23 that is designed to promote understanding and ac- 24 ceptance of evidence-based maternity practices and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 816 •HR 7585 IH models of care for optimal maternity outcomes 1 among individuals of childbearing ages and families 2 of such individuals and that— 3 ‘‘(A) highlights the importance of pro- 4 tecting, promoting, and supporting the innate 5 capacities of childbearing individuals and their 6 newborns for childbirth, breastfeeding, and at- 7 tachment; 8 ‘‘(B) promotes understanding of the impor- 9 tance of using obstetric interventions when 10 medically necessary and when supported by 11 strong, high-quality evidence; 12 ‘‘(C) highlights the widespread overuse of 13 maternity practices that have been shown to 14 have benefit when used appropriately in situa- 15 tions of medical necessity, but which can expose 16 pregnant individuals, infants, or both to risk of 17 harm if used routinely and indiscriminately; 18 ‘‘(D) emphasizes the noninvasive maternity 19 practices that have proven correlation or may 20 be associated with improvement in outcomes 21 with no detrimental side effects, and are signifi- 22 cantly underused in the United States, includ- 23 ing smoking cessation programs in pregnancy, 24 group model prenatal care, continuous labor 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 817 •HR 7585 IH support, nonsupine positions for birth, and ex- 1 ternal version to turn breech babies at term; 2 ‘‘(E) educates consumers about— 3 ‘‘(i) the qualifications of licensed pro- 4 viders of maternity care, including obstetri- 5 cian-gynecologists, family physicians, cer- 6 tified nurse-midwives, certified midwives, 7 and certified professional midwives; and 8 ‘‘(ii) the best evidence about the safe- 9 ty, satisfaction, outcomes, and costs of 10 such providers; 11 ‘‘(F) informs consumers about the best 12 available research comparing birth center 13 births, planned home births, and hospital 14 births, including information about each set- 15 ting’s safety, satisfaction, outcomes, and costs; 16 ‘‘(G) fosters participation in high-quality, 17 evidence-based childbirth education that pro- 18 motes a healthy and safe approach to preg- 19 nancy, childbirth, and early parenting; is taught 20 by certified educators, peer counselors, and 21 health professionals; and promotes informed de- 22 cision making by childbearing individuals; 23 ‘‘(H) informs consumers about— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 818 •HR 7585 IH ‘‘(i) the effects of systemic, institu- 1 tional, and interpersonal racism on the 2 health, well-being, and outcomes of birth- 3 ing people; 4 ‘‘(ii) the importance of respectful, cul- 5 turally and linguistically appropriate, and 6 culturally congruent care; and 7 ‘‘(iii) the value of community-based 8 and community-led maternal care and sup- 9 port; and 10 ‘‘(I) is pilot tested for consumer com- 11 prehension, cultural sensitivity, and acceptance 12 of the messages across geographically, racially, 13 ethnically, and linguistically diverse popu- 14 lations;’’. 15 SEC. 5217. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 16 VIEWS FOR CARE OF CHILDBEARING INDI- 17 VIDUALS AND NEWBORNS. 18 (a) IN GENERAL.—Not later than one year after the 19 date of the enactment of this Act, the Secretary of Health 20 and Human Services, acting through the Director of the 21 Agency for Healthcare Research and Quality, shall— 22 (1) make publicly available an online biblio- 23 graphic database identifying systematic reviews, in- 24 cluding an explanation of the level and quality of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 819 •HR 7585 IH evidence, for care of childbearing individuals and 1 newborns; and 2 (2) initiate regular updates that incorporate 3 newly issued and updated systematic reviews. 4 (b) SOURCES.—To aim for a comprehensive inventory 5 of systematic reviews relevant to maternal and newborn 6 care, the database shall identify reviews from diverse 7 sources, including— 8 (1) scientific peer-reviewed journals; 9 (2) databases, including the Cochrane Database 10 of Systematic Reviews; and 11 (3) internet websites of agencies and organiza- 12 tions throughout the world that produce such sys- 13 tematic reviews. 14 (c) FEATURES.—The database shall— 15 (1) provide bibliographic citations for each 16 record within the database, and for each such cita- 17 tion include an explanation of the level and quality 18 of evidence; 19 (2) include abstracts, as available; 20 (3) provide reference to companion documents 21 as may exist for each review, such as evidence tables 22 and guidelines or consumer educational materials de- 23 veloped from the review; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 820 •HR 7585 IH (4) provide links to the source of the full review 1 and to any companion documents; 2 (5) provide links to the source of a previous 3 version or update of the review; 4 (6) be searchable by intervention or other topic 5 of the review, reported outcomes, author, title, and 6 source; and 7 (7) offer to users periodic electronic notification 8 of database updates relating to users’ topics of inter- 9 est. 10 (d) OUTREACH.—Not later than the first date the 11 database is made publicly available and periodically there- 12 after, the Secretary of Health and Human Services shall 13 publicize the availability, features, and uses of the data- 14 base under this section to the stakeholders described in 15 subsection (e). 16 (e) CONSULTATION.—For purposes of developing the 17 database under this section and maintaining and updating 18 such database, the Secretary of Health and Human Serv- 19 ices shall convene and consult with an advisory committee 20 composed of relevant stakeholders, including— 21 (1) Federal Medicaid administrators and State 22 agencies administrating State plans under title XIX 23 of the Social Security Act pursuant to section 24 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 821 •HR 7585 IH (2) providers of maternity and newborn care 1 from both academic and community-based settings, 2 including obstetrician-gynecologists, family physi- 3 cians, certified nurse midwives, certified midwives, 4 certified professional midwives, physician assistants, 5 perinatal nurses, pediatricians, and nurse practi- 6 tioners; 7 (3) maternal-fetal medicine specialists; 8 (4) neonatologists; 9 (5) childbearing individuals and advocates for 10 such individuals, including childbirth educators cer- 11 tified by a nationally accredited program, rep- 12 resenting communities that are diverse in terms of 13 race, ethnicity, indigenous status, and geographic 14 area; 15 (6) employers and purchasers; 16 (7) health facility and system leaders, including 17 both hospital and birth center facilities; 18 (8) journalists; and 19 (9) bibliographic informatics specialists. 20 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated $2,500,000 for each of the 22 fiscal years 2023 through 2025 for the purpose of devel- 23 oping the database and such sums as may be necessary 24 for each subsequent fiscal year for updating the database 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 822 •HR 7585 IH and providing outreach and notification to users, as de- 1 scribed in this section. 2 SEC. 5218. DEVELOPMENT OF INTERPROFESSIONAL MA- 3 TERNITY CARE EDUCATIONAL MODELS AND 4 TOOLS. 5 (a) IN GENERAL.—Not later than 6 months after the 6 date of the enactment of this Act, the Secretary of Health 7 and Human Services, acting in conjunction with the Ad- 8 ministrator of Health Resources and Services Administra- 9 tion, shall convene, for a 1-year period, an Interprofes- 10 sional Maternity Provider Education Commission (re- 11 ferred to in this section as the ‘‘Commission’’) to discuss 12 and make recommendations for— 13 (1) a consensus standard physiologic maternity 14 care curriculum that takes into account the core 15 competencies for basic midwifery practice such as 16 those developed by the American College of Nurse 17 Midwives and the North American Registry of Mid- 18 wives, and the educational objectives for physicians 19 practicing in obstetrics and gynecology as deter- 20 mined by the Council on Resident Education in Ob- 21 stetrics and Gynecology; 22 (2) suggestions for multidisciplinary use of the 23 consensus physiologic curriculum; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 823 •HR 7585 IH (3) strategies to integrate and coordinate edu- 1 cation across maternity care disciplines, including 2 recommendations to increase medical and midwifery 3 student exposure to out-of-hospital birth; 4 (4) curriculum and strategies for continuing 5 education of practicing perinatal professionals who 6 have completed their undergraduate and graduate 7 education; and 8 (5) pilot demonstrations of interprofessional 9 educational models. 10 (b) PARTICIPANTS.— 11 (1) PROFESSIONS.—The Commission shall in- 12 clude maternity care educators, curriculum devel- 13 opers, service leaders, certification leaders, and ac- 14 creditation leaders from the various professions that 15 provide or support maternity care in the United 16 States. Such professions shall include obstetrician 17 gynecologists, certified nurse midwives or certified 18 midwives, family practice physicians, nurse practi- 19 tioners, physician assistants, certified professional 20 midwives, perinatal nurses, doulas, lactation per- 21 sonnel, and community health workers. 22 (2) CONSUMER ADVOCATES.—The Commission 23 shall also include representation from maternity care 24 consumer advocates. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 824 •HR 7585 IH (c) CURRICULUM.—The consensus standard physio- 1 logic maternity care curriculum described in subsection 2 (a)(1) shall— 3 (1) have a public health focus with a foundation 4 in health promotion and disease prevention; 5 (2) foster physiologic childbearing and person 6 and family centered care; 7 (3) reflect the extensive, growing research evi- 8 dence about— 9 (A) the innate abilities and processes of 10 the birthing person and the fetus or newborn 11 for labor, birth, postpartum transition, 12 breastfeeding, and attachment, when promoted, 13 supported, and protected; and 14 (B) the effects of factors that disturb and 15 disrupt these processes; 16 (4) integrate strategies to reduce maternal and 17 infant morbidity and mortality; 18 (5) incorporate recommendations to ensure re- 19 spectful, safe, and seamless consultation, referral, 20 transport, and transfer of care when necessary; 21 (6) include cultural sensitivity and strategies to 22 decrease inequities in maternity outcomes; and 23 (7) include implicit bias training. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 825 •HR 7585 IH (d) REPORT.—Not later than 6 months after the final 1 meeting of the Commission, the Secretary of Health and 2 Human Services shall— 3 (1) submit to Congress a report containing the 4 recommendations made by the Commission under 5 this section; and 6 (2) make such report publicly available. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 8 authorized to be appropriated to carry out this section 9 $1,000,000 for each of the fiscal years 2023 and 2024, 10 and such sums as are necessary for each of the fiscal years 11 2025 through 2027. 12 SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLAN- 13 NING GUIDELINES. 14 (a) IN GENERAL.—Not later than 180 days after the 15 date of enactment of this Act, the Secretary of Health and 16 Human Services and the Director of the Centers for Dis- 17 ease Control and Prevention shall— 18 (1) develop a plan for outreach to publicly fund- 19 ed health care providers, including federally qualified 20 health centers (as defined in section 1861(aa)(4) of 21 the Social Security Act (42 U.S.C. 1395x(aa)(4))) 22 and branches of the Indian Health Service, about 23 the quality family planning guidelines referred to in 24 section 5304; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 826 •HR 7585 IH (2) award grants to eligible entities to imple- 1 ment such guidelines for all patients seeking family 2 planning services. 3 (b) DEFINITION.—In this section, the term ‘‘eligible 4 entity’’ means a publicly funded health care provider that 5 serves persons of reproductive age. 6 Subtitle D—Federal Agency 7 Coordination on Maternal Health 8 SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON 9 THE PROMOTION OF OPTIMAL MATERNITY 10 OUTCOMES. 11 (a) IN GENERAL.—Part A of title II of the Public 12 Health Service Act (42 U.S.C. 202 et seq.) is amended 13 by adding at the end the following: 14 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 15 THE PROMOTION OF OPTIMAL MATERNITY 16 OUTCOMES. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Deputy Assistant Secretary for Women’s Health under 19 section 229 and in collaboration with the Federal officials 20 specified in subsection (b), shall establish the Interagency 21 Coordinating Committee on the Promotion of Optimal Ma- 22 ternity Outcomes (referred to in this section as the 23 ‘ICCPOM’). 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 827 •HR 7585 IH ‘‘(b) OTHER AGENCIES.—The officials specified in 1 this subsection are the Secretary of Labor, the Secretary 2 of Defense, the Secretary of Veterans Affairs, the Surgeon 3 General, the Director of the Centers for Disease Control 4 and Prevention, the Administrator of the Health Re- 5 sources and Services Administration, the Administrator of 6 the Centers for Medicare & Medicaid Services, the Direc- 7 tor of the Indian Health Service, the Administrator of the 8 Substance Abuse and Mental Health Services Administra- 9 tion, the Director of the National Institute of Child Health 10 and Human Development, the Director of the Agency for 11 Healthcare Research and Quality, the Assistant Secretary 12 for Children and Families, the Deputy Assistant Secretary 13 for Minority Health, the Director of the Office of Per- 14 sonnel Management, and such other Federal officials as 15 the Secretary of Health and Human Services determines 16 to be appropriate. 17 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 18 Women’s Health shall serve as the chair of the ICCPOM. 19 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 20 program development across the Federal Government with 21 respect to promotion of optimal maternity care, provided, 22 however, that nothing in this section shall be construed 23 as transferring regulatory or program authority from an 24 agency to the ICCPOM. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 828 •HR 7585 IH ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 1 seek the input of, and shall consult with, all appropriate 2 and interested stakeholders, including State health depart- 3 ments, public health research and interest groups, founda- 4 tions, childbearing individuals and their advocates, and 5 maternity care professional associations and organiza- 6 tions, reflecting racially, ethnically, demographically, and 7 geographically diverse communities. 8 ‘‘(f) ANNUAL REPORT.— 9 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 10 the ICCPOM, shall annually submit to Congress a 11 report that summarizes— 12 ‘‘(A) all programs and policies of Federal 13 agencies (including the Medicare Program 14 under title XVIII of the Social Security Act and 15 the Medicaid program under title XIX of such 16 Act) designed to promote optimal maternity 17 care, focusing particularly on programs and 18 policies that support the adoption of evidence- 19 based maternity care, as defined by timely, sci- 20 entifically sound systematic reviews; 21 ‘‘(B) all programs and policies of Federal 22 agencies (including the Medicare Program 23 under title XVIII of the Social Security Act and 24 the Medicaid program under title XIX of such 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 829 •HR 7585 IH Act) designed to address the problems of mater- 1 nal mortality and morbidity, infant mortality, 2 prematurity, and low birth weight, including 3 such programs and policies designed to address 4 racial and ethnic inequities with respect to each 5 of such problems; 6 ‘‘(C) the extent of progress in reducing 7 maternal mortality and infant mortality, low 8 birth weight, and prematurity at State and na- 9 tional levels; and 10 ‘‘(D) such other information regarding op- 11 timal maternity care (such as quality and per- 12 formance measures) as the Secretary deter- 13 mines to be appropriate. 14 ‘‘(2) REDUCING INEQUITIES WITH RESPECT TO 15 INDIGENOUS STATUS.—The information specified in 16 paragraph (1)(C) shall be included in each such re- 17 port in a manner that disaggregates such informa- 18 tion by race, ethnicity, and indigenous status in 19 order to determine the extent of progress in reduc- 20 ing racial and ethnic inequities and inequities related 21 to indigenous status. 22 ‘‘(3) CERTAIN INFORMATION.—Each report 23 under paragraph (1) shall include information 24 (disaggregated by race, ethnicity, and indigenous 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 830 •HR 7585 IH status, as applicable) on the following rates, trends, 1 and costs by State: 2 ‘‘(A) The rate and trend of primary cesar- 3 ean deliveries and repeat cesarean deliveries. 4 ‘‘(B) The rate and trend of vaginal births 5 after cesarean. 6 ‘‘(C) The rate and trend of vaginal breech 7 births. 8 ‘‘(D) The rate and trend of induction of 9 labor. 10 ‘‘(E) The rate and trend of freestanding 11 birth center births. 12 ‘‘(F) The rate and trend of planned and 13 unplanned home birth. 14 ‘‘(G) The rate and trends of attended 15 births by different types of maternity care pro- 16 viders, including by an obstetrician-gyne- 17 cologist, family practice physician, obstetrician- 18 gynecologist physician assistant, certified nurse- 19 midwife, certified midwife, and certified profes- 20 sional midwife. 21 ‘‘(H) The rate and trend of severe mater- 22 nal morbidity. 23 ‘‘(I) The rates and trends of prenatal and 24 postpartum anxiety and depression. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 831 •HR 7585 IH ‘‘(J) The rate and trend of pre-term birth. 1 ‘‘(K) The rate and trend of low birth 2 weight. 3 ‘‘(L) The cost of maternity care 4 disaggregated by place of birth and provider of 5 care, including— 6 ‘‘(i) uncomplicated vaginal birth; 7 ‘‘(ii) complicated vaginal birth; 8 ‘‘(iii) uncomplicated cesarean birth; 9 and 10 ‘‘(iv) complicated cesarean birth. 11 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated, in addition to amounts 13 authorized to be appropriated under section 229(e), to 14 carry out this section $1,000,000 for each of the fiscal 15 years 2023 through 2027.’’. 16 (b) CONFORMING AMENDMENTS.— 17 (1) INCLUSION AS DUTY OF HHS OFFICE ON 18 WOMEN’S HEALTH.—Section 229(b) of such Act (42 19 U.S.C. 237a(b)), as amended by section 5216, is 20 further amended by adding at the end the following 21 new paragraph: 22 ‘‘(9) establish the Interagency Coordinating 23 Committee on the Promotion of Optimal Maternity 24 Outcomes in accordance with section 229A; and’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 832 •HR 7585 IH (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 1 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 2 amended by inserting ‘‘(other than under subsection 3 (b)(9))’’ after ‘‘under this section’’. 4 SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH 5 CENTERS PROGRAM TO INCLUDE CENTERS 6 ON OPTIMAL MATERNITY OUTCOMES. 7 (a) IN GENERAL.—Not later than one year after the 8 date of the enactment of this Act, the Secretary of Health 9 and Human Services shall support the establishment of 10 additional Prevention Research Centers under the Preven- 11 tion Research Center Program administered by the Cen- 12 ters for Disease Control and Prevention. Such additional 13 centers shall each be known as a Center for Excellence 14 on Optimal Maternity Outcomes. 15 (b) RESEARCH.—Each Center for Excellence on Opti- 16 mal Maternity Outcomes shall— 17 (1) conduct at least one focused program of re- 18 search to improve maternity outcomes, including the 19 reduction of cesarean birth rates, early elective in- 20 ductions, prematurity rates, and low birth weight 21 rates within an underserved population that has a 22 disproportionately large burden of suboptimal mater- 23 nity outcomes, including maternal mortality and 24 morbidity, infant mortality, prematurity, or low 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 833 •HR 7585 IH birth weight, which such program shall include de- 1 veloping performance and quality measures for ac- 2 countability; 3 (2) work with partners on special interest 4 projects, as specified by the Centers for Disease 5 Control and Prevention and other relevant agencies 6 within the Department of Health and Human Serv- 7 ices, and on projects funded by other sources; and 8 (3) involve a minimum of two distinct birth set- 9 ting models, such as— 10 (A) a hospital labor and delivery model 11 and freestanding birth center model; or 12 (B) a hospital labor and delivery model 13 and planned home birth model. 14 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 15 for Excellence on Optimal Maternity Outcomes shall in- 16 clude the following interdisciplinary providers of maternity 17 care: 18 (1) Obstetrician-gynecologists. 19 (2) At least two of the following providers: 20 (A) Family practice physicians. 21 (B) Nurse practitioners. 22 (C) Physician assistants. 23 (D) Certified professional midwives, cer- 24 tified nurse-midwives, or certified midwives. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 834 •HR 7585 IH (d) SERVICES.—Research conducted by each Center 1 for Excellence on Optimal Maternity Outcomes shall in- 2 clude at least 2 (and preferably more) of the following sup- 3 portive provider services: 4 (1) Mental health. 5 (2) Doula labor support. 6 (3) Nutrition education. 7 (4) Childbirth education. 8 (5) Social work. 9 (6) Physical therapy or occupation therapy. 10 (7) Substance use disorder services. 11 (8) Home visiting. 12 (e) COORDINATION.—The programs of research at 13 each of the Centers of Excellence on Optimal Maternity 14 Outcomes shall complement and not replicate the work of 15 the other. 16 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 17 authorized to be appropriated to carry out this section 18 $2,000,000 for each of the fiscal years 2023 through 19 2027. 20 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 835 •HR 7585 IH SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER 1 FOR MEDICARE AND MEDICAID INNOVATION 2 TO EXPLICITLY INCLUDE MATERNITY CARE 3 AND CHILDREN’S HEALTH MODELS. 4 Section 1115A(b)(2) of the Social Security Act (42 5 U.S.C. 1315a(b)(2)) is amended— 6 (1) in subparagraph (B), by adding at the end 7 the following: 8 ‘‘(xxviii) Promoting evidence-based 9 models of care that have been associated 10 with reductions in pregnancy-related and 11 infant health inequities, including incor- 12 porating the use of and payment for 13 doulas, particularly community-based 14 doulas, and promoting support for people 15 during pregnancy and for the one-year pe- 16 riod after the last day of such person’s 17 pregnancy, through evidence-based models 18 of antepartum, birth, postpartum care, and 19 two-generation birthing person and new- 20 born care models, and supporting the risk- 21 appropriate use of out-of-hospital birth 22 models, including births at home and in 23 freestanding birth centers. Such models 24 shall be selected and evaluated based on 25 their impact on quality, equity, and devel- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 836 •HR 7585 IH opmental outcomes, notwithstanding any 1 other provision of this section.’’; 2 (2) in subparagraph (C), by adding at the end 3 the following: 4 ‘‘(ix) Whether the model includes a 5 regular process for ensuring the provision 6 of culturally and linguistically appropriate 7 services. 8 ‘‘(x) Whether health care services and 9 supportive services included in the model 10 are tailored to community health and 11 health-related social needs and provided by 12 community-based and community-led pro- 13 viders. 14 ‘‘(xi) Whether the model is designed 15 to mitigate harmful effects of discrimina- 16 tion on the basis of race, sex, disability, 17 ethnicity, language, and age.’’; and 18 (3) by adding at the end the following: 19 ‘‘(D) MANDATORY HEALTH EQUITY MOD- 20 ELS TO BE TESTED.—The Secretary shall se- 21 lect— 22 ‘‘(i) Medicaid global and episode-based 23 payment models for culturally and linguis- 24 tically appropriate antepartum, labor and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 837 •HR 7585 IH delivery, and postpartum doula services, in- 1 cluding community-based doula services, 2 that are— 3 ‘‘(I) structured to provide pay- 4 ment to doulas as individuals, health 5 care entity staff, or members of a 6 doula group or collective, or through a 7 third-party administrator; 8 ‘‘(II) designed to reduce racial 9 and intersecting health inequities; 10 ‘‘(III) designed to provide doulas 11 providing support with an equitable 12 and sustainable reimbursement rate; 13 ‘‘(IV) designed to reduce barriers 14 to workforce entry for culturally and 15 linguistically competent and racially 16 congruent doulas to provide services 17 to Medicaid enrollees; and 18 ‘‘(V) designed with input from 19 community-based doulas, maternal 20 health advocates, reproductive justice 21 advocates, and Medicaid beneficiaries; 22 ‘‘(ii) a Medicaid episode-based pay- 23 ment model for pregnancy-related services, 24 including health care services and sup- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 838 •HR 7585 IH portive services to address health-related 1 socials needs, during the prenatal, 2 intrapartum, and postpartum periods, to 3 improve health outcomes and reduce racial 4 health inequities, and to be designed with 5 input from maternity care providers, ma- 6 ternal health advocates, reproductive jus- 7 tice advocates, and Medicaid beneficiaries; 8 ‘‘(iii) a Medicaid alternative payment 9 model for a pregnancy-related health home 10 to improve health outcomes during and for 11 one year after pregnancy and during the 12 newborn period, and to reduce racial 13 health inequities, designed with input from 14 maternity care providers, maternal health 15 advocates, reproductive justice advocates, 16 and Medicaid beneficiaries; 17 ‘‘(iv) a Medicaid perinatal health 18 worker service delivery model for culturally 19 and linguistically appropriate and respect- 20 ful health care and supportive services that 21 are tailored to community health and 22 health-related social needs, designed to im- 23 prove health outcomes and mitigate harm- 24 ful effects of racism and other forms of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 839 •HR 7585 IH discrimination, and provided by commu- 1 nity-based and community-led providers; 2 and 3 ‘‘(v) one or more models exclusively 4 focused on early intervention and preven- 5 tion for children enrolled in a State plan 6 (or waiver of such plan) under title XIX or 7 a State child health plan under title XXI 8 using evidence-based interventions includ- 9 ing parenting support programs, home-vis- 10 iting services, and dyadic therapy treat- 11 ment for children and adolescents at-risk. 12 Such models shall be selected and evaluated 13 based on their impact on quality, equity, and 14 developmental outcomes, notwithstanding any 15 other provision of this section.’’. 16 SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY 17 PLANNING GUIDELINES. 18 (a) IN GENERAL.—Not later than six months after 19 the date of enactment of this Act, the Director of the Cen- 20 ters for Disease Control and Prevention and the Office 21 of Population Affairs shall review and expand the 2014 22 Quality Family Planning Guidelines to address— 23 (1) health inequities; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 840 •HR 7585 IH (2) the importance of patient-directed contra- 1 ceptive decision making. 2 (b) CONSULTATION.—In carrying out subsection (a), 3 the Director of the Centers for Disease Control and Pre- 4 vention and the Office of Population Affairs shall convene 5 a meeting, and solicit the views of, stakeholders including 6 experts on health inequities, experts on reproductive coer- 7 cion, representatives of provider organizations, patient ad- 8 vocates, reproductive justice organizations, organizations 9 that represent racial and ethnic minority communities, or- 10 ganizations that represent people with disabilities, organi- 11 zations that represent LGBTQ persons, and organizations 12 that represent people with limited English proficiency. 13 Subtitle E—Reproductive and 14 Sexual Health 15 SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT 16 BARRIERS TO ABORTION ACCESS AND VITAL 17 SOLUTIONS. 18 (a) FINDINGS.—Congress finds the following: 19 (1) Affordable, comprehensive health insurance 20 that includes coverage for a full range of pregnancy- 21 related care, including abortion, is critical to the 22 health of every person regardless of actual or per- 23 ceived race, color, national origin, immigration sta- 24 tus, sex (including sexual orientation, gender iden- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 841 •HR 7585 IH tity, pregnancy, childbirth, a medical condition relat- 1 ing to pregnancy or childbirth, or sex stereotyping), 2 age, or disability status. 3 (2) Abortion services are essential to health 4 care and access to those services is central to peo- 5 ple’s ability to participate equally in the economic 6 and social life of the United States. Abortion access 7 allows people who are pregnant to make their own 8 decisions about their pregnancies, their families, and 9 their lives. 10 (3) Reproductive justice seeks to address re- 11 strictions on reproductive health, including abortion, 12 that perpetuate systems of oppression, lack of bodily 13 autonomy, White supremacy, and anti-Black racism. 14 The violent legacy of these systems of oppression has 15 manifested in policies including enslavement, rape, 16 and experimentation on Black people, forced steri- 17 lizations, medical experimentation on low-income 18 people’s reproductive systems, and the forcible re- 19 moval of Indigenous children. Access to equitable re- 20 productive health care, including abortion services, 21 has always been deficient in the United States for 22 Black, Indigenous, and other People of Color 23 (BIPOC) and their families. Transgender, non- 24 binary, and gender-expansive individuals, and spe- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00841 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 842 •HR 7585 IH cifically those who are Black, disabled, and at the 1 intersections of multiple forms of oppression, also 2 experience inequitable access to abortion services due 3 to systemic violence. Centering abortion rights and 4 access as a ‘‘women’s health’’ issue restricts access 5 to those with reproductive needs who do not identify 6 as cisgender women. In order to work towards repro- 7 ductive justice for all communities, transgender, 8 nonbinary, and gender expansive must be centered 9 in conversations of abortion access. Improving abor- 10 tion access for this community requires a gender- 11 neutral approach to abortion care, rights, and justice 12 policy. 13 (4) The legacy of restrictions on reproductive 14 health, rights, and justice is not a dated vestige of 15 a dark history. Access to abortion services is ob- 16 structed across the United States in various ways, 17 including blockades of health care facilities and asso- 18 ciated violence, prohibitions of, and restrictions on, 19 insurance coverage, parental involvement laws (noti- 20 fication and consent), restrictions that shame and 21 stigmatize people seeking abortion services, and 22 medically unnecessary regulations that neither con- 23 fer any health benefit nor further the safety of abor- 24 tion services, but which harm people by delaying, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 843 •HR 7585 IH complicating access to, and reducing the availability 1 of, abortion services. As of December 2, 2021, 19 2 States have enacted 106 restrictions, including 12 3 new abortion bans, making 2021 the year with the 4 highest number of restrictions passed since Roe v. 5 Wade was decided in 1973. Additionally, 21 States 6 are poised to immediately ban or significantly re- 7 strict access to abortion services if the Supreme 8 Court chooses to overturn or weaken Roe v. Wade. 9 These unprecedented attacks on abortion rights and 10 access fall especially heavily on people with low in- 11 comes, BIPOC, immigrants, young people, people 12 with disabilities, those living in rural and other 13 medically underserved areas, and transgender, non- 14 binary, and gender expansive individuals. 15 (5) Since 1976, the Federal Government has 16 withheld funds for abortion coverage in most cir- 17 cumstances through the Hyde amendment and simi- 18 lar coverage restrictions, affecting individuals of re- 19 productive age in the United States who are insured 20 through the Medicaid program, as well as individuals 21 who receive insurance or care through other Federal 22 health plans and programs. Of women aged 15 to 44 23 enrolled in Medicaid in 2017, 55 percent lived in the 24 35 States and the District of Columbia that do not 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 844 •HR 7585 IH cover abortion, except in limited circumstances. This 1 amounts to roughly 7,300,000 women of reproduc- 2 tive age, including 3,100,000 women living below the 3 Federal poverty level. Women of color are dispropor- 4 tionately likely to be insured by the Medicaid pro- 5 gram, and nationwide, 32 percent of Black women 6 and 27 percent of Hispanic women aged 15 to 44 7 were enrolled in Medicaid in 2017, compared with 8 16 percent of White women. 9 (6) Abortion-specific restrictions are even more 10 compounded by the ongoing criminalization of people 11 who are pregnant, including those who are incarcer- 12 ated, living with HIV, or with substance-use dis- 13 orders. These communities already experience health 14 inequities due to social, political, and environmental 15 inequities, and restrictions on abortion services exac- 16 erbate these harms. Removing medically unjustified 17 restrictions on abortion services would constitute one 18 important step on the path toward realizing repro- 19 ductive justice by ensuring that the full range of re- 20 productive health care is accessible to all who need 21 it. 22 (7) Abortion-specific restrictions are a tool of 23 gender oppression, as they target health care serv- 24 ices that are used primarily by individuals with re- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00844 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 845 •HR 7585 IH productive needs. These paternalistic restrictions 1 rely on and reinforce harmful stereotypes about gen- 2 der roles, people’s decision making, and people’s 3 need for protection instead of support, undermining 4 their ability to control their own lives and well-being. 5 These restrictions harm the basic autonomy, dignity, 6 and equality of individuals with reproductive health 7 needs, and their ability to participate in the social 8 and economic life of the Nation. 9 (8) Many abortion-specific restrictions do not 10 confer any health or safety benefits on the patient. 11 Instead, these restrictions have the purpose and ef- 12 fect of unduly burdening people’s personal and pri- 13 vate medical decisions to end their pregnancies by 14 making access to abortion services more difficult, 15 invasive, and costly, often forcing people to travel 16 significant distances and make multiple unnecessary 17 visits to the provider, and in some cases, foreclosing 18 the option altogether. 19 (9) Congress has used its authority in the past 20 to protect access to abortion services and health care 21 providers’ ability to provide abortion services. In the 22 early 1990s, protests and blockades at health care 23 facilities where abortion services were provided, and 24 associated violence, increased dramatically and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00845 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 846 •HR 7585 IH reached crisis level, requiring congressional action. 1 Congress passed the Freedom of Access to Clinic 2 Entrances Act (Public Law 103–259; 108 Stat. 694) 3 to address that situation and protect physical access 4 to abortion services. 5 (10) Congressional action is necessary to put an 6 end to harmful restrictions, to federally protect ac- 7 cess to abortion services for everyone regardless of 8 where they live, and to protect the ability of health 9 care providers to provide these services in a safe and 10 accessible manner. 11 (11) The Equal Access to Abortion Coverage in 12 Health Insurance Act of 2021 or the EACH Act of 13 2021 (H.R. 2234, S. 1021) introduced in the 117th 14 Congress, would reverse the Hyde amendment and 15 related abortion coverage restrictions. It would cre- 16 ate an enforceable statutory right for people who re- 17 ceive health coverage or care through enumerated 18 Federal programs (including Medicaid, the Chil- 19 dren’s Health Insurance Program, Medicare, the In- 20 dian Health Service, among others) and plans (in- 21 cluding government-sponsored health insurance due 22 to a current or former employment relationship) to 23 receive abortion coverage. It would require the Fed- 24 eral government to facilitate abortion access for indi- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00846 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 847 •HR 7585 IH viduals eligible to receive health care in Federal fa- 1 cilities or in facilitates with which it contracts to 2 provide health care, such as immigration detention 3 centers. It also prohibits the Federal Government 4 from prohibiting, restricting, or otherwise inhibiting 5 State or local governments or private health insur- 6 ance issuers from providing abortion coverage. 7 (12) The Women’s Health Protection Act of 8 2021 (H.R. 3755, S. 1975) introduced in the 117th 9 Congress, would establish an enforceable statutory 10 right for health care providers to provide, and abor- 11 tion patients to receive, abortions free from medi- 12 cally unnecessary restrictions, limitations, and bans 13 that delay, and at times, completely obstruct, access 14 to abortion. 15 (b) SENSE OF CONGRESS.—It is the sense of Con- 16 gress that eliminating the Hyde amendment, enacting the 17 Equal Access to Abortion Coverage in Health Insurance 18 Act of 2021, and enacting the Women’s Health Protection 19 Act of 2021, are critical to— 20 (1) promoting equitable abortion access, includ- 21 ing coverage, for all who seek care; 22 (2) creating enforceable rights to receive, and 23 receive coverage for, such care; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00847 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 848 •HR 7585 IH (3) advancing equitable access to comprehensive 1 health coverage, which cannot be achieved without 2 abortion coverage; and 3 (4) alleviating urgent racial, gender, and other 4 inequities in health and health care and cor- 5 responding reproductive injustices. 6 SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND 7 INFORMATION PROGRAMS. 8 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 9 CATION PROGRAM.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Director of the Centers for Disease 12 Control and Prevention, shall develop and dissemi- 13 nate to the public medically accurate and complete 14 information on emergency contraceptives. 15 (2) DISSEMINATION.—The Secretary may dis- 16 seminate medically accurate and complete informa- 17 tion under paragraph (1) directly or through ar- 18 rangements with nonprofit organizations, community 19 health workers, including promotores, consumer 20 groups, institutions of higher education, clinics, the 21 media, and Federal, State, and local agencies. 22 (3) INFORMATION.—The information dissemi- 23 nated under paragraph (1) shall— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00848 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 849 •HR 7585 IH (A) include, at a minimum, a description 1 of emergency contraceptives and an explanation 2 of the use, safety, efficacy, affordability, and 3 availability, including over-the-counter access, 4 of such contraceptives and options for access to 5 such contraceptives without cost-sharing 6 through insurance and other programs; and 7 (B) 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00849 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 850 •HR 7585 IH (A) information describing the use, safety, 1 efficacy, and availability of emergency contra- 2 ceptives, and options for access without cost- 3 sharing through insurance and other programs; 4 (B) a recommendation regarding the use of 5 such contraceptives; and 6 (C) information explaining how to obtain 7 copies of the information developed under sub- 8 section (a) for distribution to the patients of 9 the providers. 10 (c) DEFINITIONS.—In this section: 11 (1) HEALTH CARE PROVIDER.—The term 12 ‘‘health care provider’’ means an individual who is li- 13 censed or certified under State law to provide health 14 care services and who is operating within the scope 15 of such license. Such term shall include a phar- 16 macist. 17 (2) INSTITUTION OF HIGHER EDUCATION.—The 18 term ‘‘institution of higher education’’ has the same 19 meaning given such term in section 101(a) of the 20 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 21 (3) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services. 23 (d) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00850 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 851 •HR 7585 IH such sums as may be necessary for each of the fiscal years 1 2023 through 2027. 2 SEC. 5403. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 3 MACIES TO ENSURE PROVISION OF FDA-AP- 4 PROVED CONTRACEPTION. 5 Part B of title II of the Public Health Service Act 6 (42 U.S.C. 238 et seq.) is amended by adding at the end 7 the following: 8 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 9 OF FDA-APPROVED CONTRACEPTION. 10 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 11 pharmacy that receives Food and Drug Administration- 12 approved drugs or devices in interstate commerce shall 13 maintain compliance with the following: 14 ‘‘(1) If a customer requests a contraceptive or 15 a medication related to a contraceptive, including 16 emergency contraception, that is in stock, the phar- 17 macy shall ensure that the contraceptive is provided 18 to the customer without delay. 19 ‘‘(2) If a customer requests a contraceptive or 20 a medication related to a contraceptive that is not 21 in stock and the pharmacy in the normal course of 22 business stocks contraception, the pharmacy shall 23 immediately inform the customer that the contracep- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00851 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 852 •HR 7585 IH tive is not in stock and without delay offer the cus- 1 tomer the following options: 2 ‘‘(A) If the customer prefers to obtain the 3 contraceptive or a medication related to a con- 4 traceptive through a referral or transfer, the 5 pharmacy shall— 6 ‘‘(i) locate a pharmacy of the cus- 7 tomer’s choice or the closest pharmacy 8 confirmed to have the contraceptive or a 9 medication related to a contraceptive in 10 stock; and 11 ‘‘(ii) refer the customer or transfer 12 the prescription to that pharmacy. 13 ‘‘(B) If the customer prefers for the phar- 14 macy to order the contraceptive or a medication 15 related to a contraceptive, the pharmacy shall 16 obtain the contraceptive or medication under 17 the pharmacy’s standard procedure for expe- 18 dited ordering of medication and notify the cus- 19 tomer when the contraceptive or medication ar- 20 rives. 21 ‘‘(3) The pharmacy shall ensure that— 22 ‘‘(A) the pharmacy does not operate an en- 23 vironment in which customers are intimidated, 24 threatened, or harassed in the delivery of serv- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00852 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 853 •HR 7585 IH ices relating to a request for contraception or a 1 medication related to a contraceptive; 2 ‘‘(B) the pharmacy’s employees do not 3 interfere with or obstruct the delivery of serv- 4 ices relating to a request for contraception or a 5 medication related to a contraceptive; 6 ‘‘(C) the pharmacy’s employees do not in- 7 tentionally misrepresent or deceive customers 8 about the availability of a contraceptive or a 9 medication related to a contraceptive, or the 10 mechanism of action of such contraceptive or 11 medication; 12 ‘‘(D) the pharmacy’s employees do not 13 breach medical confidentiality with respect to a 14 request for a contraceptive or a medication re- 15 lated to a contraceptive or threaten to breach 16 such confidentiality; or 17 ‘‘(E) the pharmacy’s employees do not 18 refuse to return a valid, lawful prescription for 19 a contraceptive or a medication related to a 20 contraceptive upon customer request. 21 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 22 STOCKED.—Nothing in subsection (a)(2) shall be con- 23 strued to require any pharmacy to comply with such sub- 24 section if the pharmacy does not ordinarily stock contra- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00853 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 854 •HR 7585 IH ceptives or a medication related to a contraceptive in the 1 normal course of business. 2 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 3 MACY PRACTICE.—This section does not prohibit a phar- 4 macy from refusing to provide a contraceptive or a medi- 5 cation related to a contraceptive to a customer in accord- 6 ance with any of the following: 7 ‘‘(1) If it is unlawful to dispense the contracep- 8 tive or a medication related to a contraceptive to the 9 customer without a valid, lawful prescription and no 10 such prescription is presented. 11 ‘‘(2) If the customer is unable to pay for the 12 contraceptive or the medication related to a contra- 13 ceptive. 14 ‘‘(3) If the employee of the pharmacy refuses to 15 provide the contraceptive or a medication related to 16 a contraceptive on the basis of a professional clinical 17 judgment. 18 ‘‘(d) RELATION TO OTHER LAW.— 19 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 20 this section shall be construed to invalidate or limit 21 rights, remedies, procedures, or legal standards 22 under title VII of the Civil Rights Act of 1964. 23 ‘‘(2) CERTAIN CLAIMS.—The Religious Free- 24 dom Restoration Act of 1993 shall not provide a 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00854 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 855 •HR 7585 IH basis for a claim concerning, or a defense to a claim 1 under, this section, or provide a basis for challenging 2 the application or enforcement of this section. 3 ‘‘(e) PREEMPTION.—This section does not preempt 4 any provision of State law or any professional obligation 5 made applicable by a State board or other entity respon- 6 sible for licensing or discipline of pharmacies or phar- 7 macists, to the extent that such State law or professional 8 obligation provides protections for customers that are 9 greater than the protections provided by this section. 10 ‘‘(f) ENFORCEMENT.— 11 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 12 lates a requirement of subsection (a) is liable to the 13 United States for a civil penalty in an amount not 14 exceeding $1,000 per day of violation, not to exceed 15 $100,000 for all violations adjudicated in a single 16 proceeding. 17 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 18 aggrieved as a result of a violation of a requirement 19 of subsection (a) may, in any court of competent ju- 20 risdiction, commence a civil action against the phar- 21 macy involved to obtain appropriate relief, including 22 actual and punitive damages, injunctive relief, and a 23 reasonable attorney’s fee and cost. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00855 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 856 •HR 7585 IH ‘‘(3) LIMITATIONS.—A civil action under para- 1 graph (1) or (2) may not be commenced against a 2 pharmacy after the expiration of the 5-year period 3 beginning on the date on which the pharmacy alleg- 4 edly engaged in the violation involved. 5 ‘‘(g) DEFINITIONS.—In this section: 6 ‘‘(1) CONTRACEPTION.—The term ‘contracep- 7 tion’ or ‘contraceptive’ means any drug or device ap- 8 proved by the Food and Drug Administration to pre- 9 vent pregnancy. 10 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 11 a person hired, by contract or any other form of an 12 agreement, by a pharmacy. 13 ‘‘(3) MEDICATION RELATED TO A CONTRACEP- 14 TIVE.—The term ‘medication related to a contracep- 15 tive’ means any drug or device approved by the Food 16 and Drug Administration that a medical professional 17 determines necessary to use before or in conjunction 18 with a contraceptive. 19 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 20 an entity that— 21 ‘‘(A) is authorized by a State to engage in 22 the business of selling prescription drugs at re- 23 tail; and 24 ‘‘(B) employs one or more employees. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00856 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 857 •HR 7585 IH ‘‘(5) PRODUCT.—The term ‘product’ means a 1 Food and Drug Administration-approved drug or de- 2 vice. 3 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 4 The term ‘professional clinical judgment’ means the 5 use of professional knowledge and skills to form a 6 clinical judgment, in accordance with prevailing 7 medical standards. 8 ‘‘(7) WITHOUT DELAY.—The term ‘without 9 delay’, with respect to a pharmacy providing, pro- 10 viding a referral for, or ordering contraception, or 11 transferring the prescription for contraception, 12 means within the usual and customary timeframe at 13 the pharmacy for providing, providing a referral for, 14 or ordering other products, or transferring the pre- 15 scription for other products, respectively. 16 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 17 fect on the 31st day after the date of the enactment of 18 this section, without regard to whether the Secretary has 19 issued any guidance or final rule regarding this section.’’. 20 SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY 21 YOUTH. 22 (a) PURPOSE.—The purpose of this section is to pro- 23 vide young people with sex education and sexual health 24 services that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00857 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 858 •HR 7585 IH (1) promote and uphold the rights of young 1 people to information and services that empower 2 them to make decisions about their bodies, health, 3 sexuality, families, and communities in all areas of 4 life; 5 (2) are evidence-informed, comprehensive in 6 scope, confidential, equitable, accessible, medically 7 accurate and complete, age and developmentally ap- 8 propriate, culturally responsive, and trauma-in- 9 formed and resilience-oriented; 10 (3) provide information about the prevention, 11 treatment, and care of pregnancy, sexually trans- 12 mitted infections, and interpersonal violence; 13 (4) provide information about the importance of 14 consent as a basis for healthy relationships and for 15 autonomy in health care; 16 (5) provide information on gender roles and 17 gender discrimination; 18 (6) provide information on the historical and 19 current condition in which education and health sys- 20 tems, policies, programs, services, and practices have 21 uniquely and adversely impacted Black, Indigenous, 22 Latinx, Asian, Asian American and Pacific Islander, 23 and other People of Color; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00858 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 859 •HR 7585 IH (7) redress inequities in the delivery of sex edu- 1 cation and sexual health services to marginalized 2 young people. 3 (b) DEFINITIONS.—In this section: 4 (1) AGE AND DEVELOPMENTALLY APPRO- 5 PRIATE.—The term ‘‘age and developmentally appro- 6 priate’’ means topics, messages, and teaching meth- 7 ods suitable to particular ages, age groups, or devel- 8 opmental levels, based on cognitive, emotional, so- 9 cial, and behavioral capacity of most young people at 10 that age level. 11 (2) CHARACTERISTICS OF EFFECTIVE PRO- 12 GRAMS.—The term ‘‘characteristics of effective pro- 13 grams’’ means the aspects of evidence-informed pro- 14 grams, including development, content, and imple- 15 mentation of such programs, that— 16 (A) have been shown to be effective in 17 terms of increasing knowledge, clarifying values 18 and attitudes, increasing skills, and impacting 19 behavior; and 20 (B) are widely recognized by leading med- 21 ical and public health agencies to be effective in 22 changing sexual behaviors that lead to sexually 23 transmitted infections, unintended pregnancy, 24 and interpersonal violence among young people. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00859 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 860 •HR 7585 IH (3) CONSENT.—The term ‘‘consent’’ means af- 1 firmative, conscious, and voluntary agreement to en- 2 gage in interpersonal, physical, or sexual activity. 3 (4) CULTURALLY RESPONSIVE.—The term ‘‘cul- 4 turally responsive’’ means education and services 5 that— 6 (A) embrace and actively engage and ad- 7 just to young people and their various cultural 8 identities; 9 (B) recognize the ways in which many 10 marginalized young people face unique barriers 11 in our society that result in increased adverse 12 health outcomes and associated stereotypes; and 13 (C) may address the ways in which racism 14 has shaped national health care policy, the last- 15 ing historical trauma associated with reproduc- 16 tive health experiments and forced sterilizations 17 of Black, Latinx, and Indigenous communities, 18 or sexual stereotypes assigned to young People 19 of Color or LGBTQ+ people. 20 (5) EVIDENCE-INFORMED.—The term ‘‘evi- 21 dence-informed’’ means incorporates characteristics, 22 content, or skills that have been proven to be effec- 23 tive through evaluation in changing sexual behavior. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00860 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 861 •HR 7585 IH (6) GENDER EXPRESSION.—The term ‘‘gender 1 expression’’ means the expression of one’s gender, 2 such as through behavior, clothing, haircut, or voice, 3 and which may or may not conform to socially de- 4 fined behaviors and characteristics typically associ- 5 ated with being either masculine or feminine. 6 (7) GENDER IDENTITY.—The term ‘‘gender 7 identity’’ means the gender-related identity, appear- 8 ance, mannerisms, or other gender-related character- 9 istics of an individual, regardless of the individual’s 10 designated sex at birth. 11 (8) INCLUSIVE.—The term ‘‘inclusive’’ means 12 content and skills that ensure marginalized young 13 people are valued, respected, centered, and sup- 14 ported in sex education instruction and materials. 15 (9) INSTITUTION OF HIGHER EDUCATION.—The 16 term ‘‘institution of higher education’’ has the 17 meaning given the term in section 101 of the Higher 18 Education Act of 1965 (20 U.S.C. 1001). 19 (10) INTERPERSONAL VIOLENCE.—The term 20 ‘‘interpersonal violence’’ means abuse, assault, bul- 21 lying, dating violence, domestic violence, harassment, 22 intimate partner violence, or stalking. 23 (11) MARGINALIZED YOUNG PEOPLE.—The 24 term ‘‘marginalized young people’’ means young peo- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00861 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 862 •HR 7585 IH ple who are disadvantaged by underlying structural 1 barriers and social inequities, including young people 2 who are— 3 (A) Black, Indigenous, and other People of 4 Color; 5 (B) immigrants; 6 (C) in contact with the foster care system; 7 (D) in contact with the juvenile justice sys- 8 tem; 9 (E) experiencing homelessness; 10 (F) pregnant or parenting; 11 (G) lesbian, gay, bisexual, transgender, or 12 queer; 13 (H) living with HIV; 14 (I) living with disabilities; 15 (J) from families with low-incomes; or 16 (K) living in rural areas. 17 (12) MEDICALLY ACCURATE AND COMPLETE.— 18 The term ‘‘medically accurate and complete’’ means 19 that— 20 (A) the information provided through the 21 education is verified or supported by the weight 22 of research conducted in compliance with ac- 23 cepted scientific methods and is published in 24 peer-reviewed journals, where applicable; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00862 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 863 •HR 7585 IH (B) the education contains information 1 that leading professional organizations and 2 agencies with relevant expertise in the field rec- 3 ognize as accurate, objective, and complete. 4 (13) RESILIENCE.—The term ‘‘resilience’’ 5 means the ability to adapt to trauma and tragedy. 6 (14) SECRETARY.—The term ‘‘Secretary’’ 7 means the Secretary of Health and Human Services. 8 (15) SEX EDUCATION.—The term ‘‘sex edu- 9 cation’’ means high quality teaching and learning 10 that— 11 (A) is delivered, to the maximum extent 12 practicable, following the National Sexuality 13 Education Standards of the Future of Sex Ed 14 Initiative; 15 (B) is about a broad variety of topics re- 16 lated to sex and sexuality, including— 17 (i) puberty and adolescent develop- 18 ment; 19 (ii) sexual and reproductive anatomy 20 and physiology; 21 (iii) sexual orientation, gender iden- 22 tity, and gender expression; 23 (iv) contraception, pregnancy, and re- 24 production; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00863 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 864 •HR 7585 IH (v) HIV and other STIs; 1 (vi) consent and healthy relationships; 2 and 3 (vii) interpersonal violence; 4 (C) explores values and beliefs about such 5 topics; and 6 (D) helps young people in gaining the 7 skills that are needed to navigate relationships 8 and manage one’s own sexual health. 9 (16) SEXUAL DEVELOPMENT.—The term ‘‘sex- 10 ual development’’ means the lifelong process of phys- 11 ical, behavioral, cognitive, and emotional growth and 12 change as it relates to an individual’s sexuality and 13 sexual maturation, including puberty, identity devel- 14 opment, socio-cultural influences, and sexual behav- 15 iors. 16 (17) SEXUAL HEALTH SERVICES.—The term 17 ‘‘sexual health services’’ includes— 18 (A) sexual health information, education, 19 and counseling; 20 (B) all methods of contraception approved 21 by the Food and Drug Administration; 22 (C) routine gynecological care, including 23 human papillomavirus (HPV) vaccines and can- 24 cer screenings; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00864 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 865 •HR 7585 IH (D) pre-exposure prophylaxis or post-expo- 1 sure prophylaxis; 2 (E) substance use and mental health serv- 3 ices; 4 (F) interpersonal violence survivor services; 5 and 6 (G) other prevention, care, or treatment 7 services. 8 (18) SEXUAL ORIENTATION.—The term ‘‘sexual 9 orientation’’ means an individual’s romantic, emo- 10 tional, or sexual attraction to other people. 11 (19) TRAUMA.—The term ‘‘trauma’’ means a 12 response to an event, series of events, or set of cir- 13 cumstances that is experienced or witnessed by an 14 individual or group of people as physically or emo- 15 tionally harmful or life-threatening with lasting ad- 16 verse effects on their functioning and mental, phys- 17 ical, social, emotional, or spiritual well-being. 18 (20) TRAUMA-INFORMED AND RESILIENCE-ORI- 19 ENTED.—The term ‘‘trauma-informed and resil- 20 ience-oriented’’ means an approach that realizes the 21 prevalence of trauma, recognizes the various ways 22 individuals, organizations, and communities may re- 23 spond to trauma differently, recognizes that resil- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00865 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 866 •HR 7585 IH ience can be built, and responds by putting this 1 knowledge into practice. 2 (21) YOUNG PEOPLE.—The term ‘‘young peo- 3 ple’’ means individuals who are ages 10 through 29 4 at the time of commencement of participation in a 5 project supported under this section. 6 (22) YOUTH-FRIENDLY SEXUAL HEALTH SERV- 7 ICES.—The term ‘‘youth-friendly sexual health serv- 8 ices’’ means sexual health services that are provided 9 in a confidential, equitable, and accessible manner 10 that makes it easy and comfortable for young people 11 to seek out and receive services. 12 (c) GRANTS FOR SEX EDUCATION AT ELEMENTARY 13 AND SECONDARY SCHOOLS AND YOUTH-SERVING ORGA- 14 NIZATIONS.— 15 (1) PROGRAM AUTHORIZED.—The Secretary, in 16 coordination with the Secretary of Education, shall 17 award grants, on a competitive basis, to eligible enti- 18 ties to enable such eligible entities to carry out 19 projects that provide young people with sex edu- 20 cation. 21 (2) DURATION.—Grants awarded under this 22 subsection shall be for a period of 5 years. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00866 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 867 •HR 7585 IH (3) ELIGIBLE ENTITY.—In this subsection, the 1 term ‘‘eligible entity’’ means a public or private enti- 2 ty that delivers health education to young people. 3 (4) APPLICATIONS.—An eligible entity 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. 8 (5) PRIORITY.—In awarding grants under this 9 subsection, the Secretary shall give priority to eligi- 10 ble entities that are— 11 (A) State educational agencies or local 12 educational agencies; or 13 (B) Indian Tribes or Tribal organizations, 14 as defined in section 4 of the Indian Self-Deter- 15 mination and Education Assistance Act (25 16 U.S.C. 5304). 17 (6) USE OF FUNDS.—Each eligible entity that 18 receives a grant under this subsection shall use the 19 grant funds to carry out a project that provides 20 young people with sex education. 21 (d) GRANTS FOR SEX EDUCATION AT INSTITUTIONS 22 OF HIGHER EDUCATION.— 23 (1) PROGRAM AUTHORIZED.—The Secretary, in 24 coordination with the Secretary of Education, shall 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00867 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 868 •HR 7585 IH award grants, on a competitive basis, to institutions 1 of higher education or consortia of such institutions 2 to enable such institutions to provide students with 3 age and developmentally appropriate sex education. 4 (2) DURATION.—Grants awarded under this 5 subsection shall be for a period of 5 years. 6 (3) APPLICATIONS.—An institution of higher 7 education or consortium of such institutions desiring 8 a grant under this subsection shall submit an appli- 9 cation to the Secretary at such time, in such man- 10 ner, and containing such information as the Sec- 11 retary may require. 12 (4) PRIORITY.—In awarding grants under this 13 subsection, the Secretary shall give priority to an in- 14 stitution of higher education that— 15 (A) has an enrollment of needy students, 16 as defined in section 318(b) of the Higher Edu- 17 cation Act of 1965 (20 U.S.C. 1059e(b)); 18 (B) is a Hispanic-serving institution, as 19 defined in section 502(a) of such Act (20 20 U.S.C. 1101a(a)); 21 (C) is a Tribal College or University, as 22 defined in section 316(b) of such Act (20 23 U.S.C. 1059c(b)); 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00868 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 869 •HR 7585 IH (D) is an Alaska Native-serving institution, 1 as defined in section 317(b) of such Act (20 2 U.S.C. 1059d(b)); 3 (E) is a Native Hawaiian-serving institu- 4 tion, as defined in section 317(b) of such Act 5 (20 U.S.C. 1059d(b)); 6 (F) is a Predominantly Black Institution, 7 as defined in section 318(b) of such Act (20 8 U.S.C. 1059e(b)); 9 (G) is a Native American-serving, non- 10 tribal institution, as defined in section 319(b) 11 of such Act (20 U.S.C. 1059f(b)); 12 (H) is an Asian American and Native 13 American Pacific Islander-serving institution, as 14 defined in section 320(b) of such Act (20 15 U.S.C. 1059g(b)); or 16 (I) is a minority institution, as defined in 17 section 365 of such Act (20 U.S.C. 1067k), 18 with an enrollment of needy students, as de- 19 fined in section 312 of such Act (20 U.S.C. 20 1058). 21 (5) USES OF FUNDS.—An institution of higher 22 education or consortium of such institutions receiv- 23 ing a grant under this subsection shall use grant 24 funds to develop and implement a project to inte- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00869 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 870 •HR 7585 IH grate sex education into the institution of higher 1 education in order to reach a large number of stu- 2 dents, by carrying out 1 or more of the following ac- 3 tivities: 4 (A) Adopting and incorporating age and 5 developmentally appropriate sex education into 6 student orientation, general education, or 7 courses. 8 (B) Developing or adopting and imple- 9 menting educational programming outside of 10 class that delivers age and developmentally ap- 11 propriate sex education to students. 12 (C) Developing or adopting and imple- 13 menting innovative technology-based approaches 14 to deliver age and developmentally appropriate 15 sex education to students. 16 (D) Developing or adopting and imple- 17 menting peer-led activities to generate discus- 18 sion, educate, and raise awareness among stu- 19 dents about age and developmentally appro- 20 priate sex education. 21 (E) Developing or adopting and imple- 22 menting policies and practices to link students 23 to sexual health services. 24 (e) GRANTS FOR EDUCATOR TRAINING.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00870 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 871 •HR 7585 IH (1) PROGRAM AUTHORIZED.—The Secretary, in 1 coordination with the Secretary of Education, shall 2 award grants, on a competitive basis, to eligible enti- 3 ties to enable such eligible entities to carry out the 4 activities described in paragraph (5). 5 (2) DURATION.—Grants awarded under this 6 subsection shall be for a period of 5 years. 7 (3) ELIGIBLE ENTITY.—In this subsection, the 8 term ‘‘eligible entity’’ means— 9 (A) a State educational agency or local 10 educational agency; 11 (B) an Indian Tribe or Tribal organiza- 12 tion, as defined in section 4 of the Indian Self- 13 Determination and Education Assistance Act 14 (25 U.S.C. 5304); 15 (C) a State or local department of health; 16 (D) an educational service agency; 17 (E) a nonprofit institution of higher edu- 18 cation or a consortium of such institutions; or 19 (F) a national or statewide nonprofit orga- 20 nization or consortium of nonprofit organiza- 21 tions that has as its primary purpose the im- 22 provement of provision of sex education through 23 training and effective teaching of sex education. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00871 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 872 •HR 7585 IH (4) APPLICATION.—An eligible entity desiring a 1 grant under this subsection shall submit an applica- 2 tion to the Secretary at such time, in such manner, 3 and containing such information as the Secretary 4 may require. 5 (5) AUTHORIZED ACTIVITIES.— 6 (A) REQUIRED ACTIVITY.—Each eligible 7 entity receiving a grant under this subsection 8 shall use grant funds for professional develop- 9 ment and training of relevant teachers, health 10 educators, faculty, administrators, and staff, in 11 order to increase effective teaching of sex edu- 12 cation to young people. 13 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 14 ble entity receiving a grant under this sub- 15 section may use grant funds to— 16 (i) provide training and support for 17 educators about the content, skills, and 18 professional disposition needed to imple- 19 ment sex education effectively; 20 (ii) develop and provide training and 21 support to educators on incorporating anti- 22 racist and gender inclusive policies and 23 practices in sex education; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00872 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 873 •HR 7585 IH (iii) support the dissemination of in- 1 formation on effective practices and re- 2 search findings concerning the teaching of 3 sex education; 4 (iv) support research on— 5 (I) effective sex education teach- 6 ing practices; and 7 (II) the development of assess- 8 ment instruments and strategies to 9 document— 10 (aa) young people’s under- 11 standing of sex education; and 12 (bb) the effects of sex edu- 13 cation; 14 (v) convene conferences on sex edu- 15 cation, in order to effectively train edu- 16 cators in the provision of sex education; 17 and 18 (vi) develop and disseminate appro- 19 priate research-based materials to foster 20 sex education. 21 (C) SUBGRANTS.—Each eligible entity re- 22 ceiving a grant under this subsection may 23 award subgrants to nonprofit organizations that 24 possess a demonstrated record of providing 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00873 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 874 •HR 7585 IH training to teachers, health educators, faculty, 1 administrators, and staff on sex education to— 2 (i) train educators in sex education; 3 (ii) support internet or distance learn- 4 ing related to sex education; 5 (iii) promote rigorous academic stand- 6 ards and assessment techniques to guide 7 and measure student performance in sex 8 education; 9 (iv) encourage replication of best 10 practices and model programs to promote 11 sex education; 12 (v) develop and disseminate effective, 13 research-based sex education learning ma- 14 terials; or 15 (vi) develop academic courses on the 16 pedagogy of sex education at institutions 17 of higher education. 18 (f) AUTHORIZATION OF GRANTS TO SUPPORT THE 19 DELIVERY OF SEXUAL HEALTH SERVICES TO 20 MARGINALIZED YOUNG PEOPLE.— 21 (1) PROGRAM AUTHORIZED.—The Secretary 22 shall award grants, on a competitive basis, to eligible 23 entities to enable such entities to provide youth- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00874 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 875 •HR 7585 IH friendly sexual health services to marginalized young 1 people. 2 (2) DURATION.—Grants awarded under this 3 subsection shall be for a period of 5 years. 4 (3) ELIGIBLE ENTITY.—In this subsection, the 5 term ‘‘eligible entity’’ means— 6 (A) a public or private youth-serving orga- 7 nization; or 8 (B) a covered entity, as defined in section 9 340B of the Public Health Service Act (42 10 U.S.C. 256b). 11 (4) APPLICATIONS.—An eligible entity desiring 12 a grant under this subsection shall submit an appli- 13 cation to the Secretary at such time, in such man- 14 ner, and containing such information as the Sec- 15 retary may require. 16 (5) USES OF FUNDS.—Each eligible entity that 17 receives a grant under this subsection may use the 18 grant funds to— 19 (A) develop and implement an evidence-in- 20 formed project to deliver sexual health services 21 to marginalized young people; 22 (B) establish, alter, or modify staff posi- 23 tions, service delivery policies and practices, 24 service delivery locations, service delivery envi- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00875 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 876 •HR 7585 IH ronments, service delivery schedules, or other 1 services components in order to increase youth- 2 friendly sexual health services to marginalized 3 young people; 4 (C) conduct outreach to marginalized 5 young people to invite them to participate in 6 the eligible entity’s sexual health services and to 7 provide feedback to inform improvements in the 8 delivery of such services; 9 (D) establish and refine systems of referral 10 to connect marginalized young people to other 11 sexual health services and supportive services; 12 (E) establish partnerships and collabora- 13 tions with entities providing services to 14 marginalized young people to link such young 15 people to sexual health services, such as by de- 16 livering health services at locations where they 17 congregate, providing transportation to loca- 18 tions where sexual health services are provided, 19 or other linkages to services approaches; 20 (F) provide evidence-informed, comprehen- 21 sive in scope, confidential, equitable, accessible, 22 medically accurate and complete, age and devel- 23 opmentally appropriate, culturally responsive, 24 and trauma-informed and resilience-oriented 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00876 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 877 •HR 7585 IH sexual health information to marginalized 1 young people in the languages and cultural con- 2 texts that are most appropriate for the 3 marginalized young people to be served by the 4 eligible entity; 5 (G) promote effective communication re- 6 garding sexual health among marginalized 7 young people; and 8 (H) provide training and support for eligi- 9 ble entity personnel and community members 10 who work with marginalized young people about 11 the content, skills, and professional disposition 12 needed to provide youth-friendly sex education 13 and youth-friendly sexual health services. 14 (g) REPORTING AND IMPACT EVALUATION.— 15 (1) GRANTEE REPORT TO SECRETARY.—For 16 each year an eligible entity receives grant funds 17 under subsection (d), (e), (f), or (g), the eligible en- 18 tity shall submit to the Secretary a report that in- 19 cludes— 20 (A) the use of grant funds by the eligible 21 entity; 22 (B) how the use of grant funds has in- 23 creased the access of young people to sex edu- 24 cation or sexual health services; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00877 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 878 •HR 7585 IH (C) such other information as the Sec- 1 retary may require. 2 (2) SECRETARY’S REPORT TO CONGRESS.—Not 3 later than 1 year after the date of the enactment of 4 this Act, and annually thereafter for a period of 5 5 years, the Secretary shall prepare and submit to 6 Congress a report on the activities funded under this 7 section. The Secretary’s report to Congress shall in- 8 clude— 9 (A) a statement of how grants awarded by 10 the Secretary meet the purposes described in 11 subsection (b)(1); and 12 (B) information about— 13 (i) the number of eligible entities that 14 are receiving grant funds under sub- 15 sections (d), (e), (f), and (g); 16 (ii) the specific activities supported by 17 grant funds awarded under subsections 18 (d), (e), (f), and (g); 19 (iii) the number of young people 20 served by projects funded under sub- 21 sections (d), (e), (f), and (g), in the aggre- 22 gate and disaggregated and cross-tabulated 23 by grant program, race and ethnicity, sex, 24 sexual orientation, gender identity, and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00878 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 879 •HR 7585 IH other characteristics determined by the 1 Secretary (except that such disaggregation 2 or cross-tabulation shall not be required in 3 a case in which the results would reveal 4 personally identifiable information about 5 an individual young person); 6 (iv) the number of teachers, health 7 educators, faculty, school administrators, 8 and staff trained under subsection (f); and 9 (v) the status of the evaluation re- 10 quired under paragraph (3). 11 (3) MULTI-YEAR EVALUATION.— 12 (A) IN GENERAL.—Not later than 6 13 months after the date of the enactment of this 14 Act, the Secretary shall enter into a contract 15 with a nonprofit organization with experience in 16 conducting impact evaluations to conduct a 17 multi-year evaluation on the impact of the 18 projects funded under subsections (d), (e), (f), 19 and (g) and to report to Congress and the Sec- 20 retary on the findings of such evaluation. 21 (B) EVALUATION.—The evaluation con- 22 ducted under this paragraph shall— 23 (i) be conducted in a manner con- 24 sistent with relevant, nationally recognized 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00879 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 880 •HR 7585 IH professional and technical evaluation 1 standards; 2 (ii) use sound statistical methods and 3 techniques relating to the behavioral 4 sciences, including quasi-experimental de- 5 signs, inferential statistics, and other 6 methodologies and techniques that allow 7 for conclusions to be reached; 8 (iii) be carried out by an independent 9 organization that has not received a grant 10 under subsection (d), (e), (f), or (g); and 11 (iv) be designed to provide informa- 12 tion on output measures and outcome 13 measures to be determined by the Sec- 14 retary. 15 (C) REPORT.—Not later than 6 years after 16 the date of enactment of this Act, the organiza- 17 tion conducting the evaluation under this para- 18 graph shall prepare and submit to the appro- 19 priate committees of Congress and the Sec- 20 retary a report on such evaluation. Such report 21 shall be made publicly available, including on 22 the website of the Department of Health and 23 Human Services. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00880 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 881 •HR 7585 IH (h) NONDISCRIMINATION.—Activities funded under 1 this section shall not discriminate on the basis of actual 2 or perceived sex (including sexual orientation and gender 3 identity), age, parental status, race, color, ethnicity, na- 4 tional origin, disability, or religion. Nothing in this section 5 shall be construed to invalidate or limit rights, remedies, 6 procedures, or legal standards available under any other 7 Federal law or any law of a State or a political subdivision 8 of a State, including the Civil Rights Act of 1964 (42 9 U.S.C. 2000a et seq.), title IX of the Education Amend- 10 ments of 1972 (20 U.S.C. 1681 et seq.), section 504 of 11 the Rehabilitation Act of 1973 (29 U.S.C. 794), the Amer- 12 icans with Disabilities Act of 1990 (42 U.S.C. 12101 et 13 seq.), and section 1557 of the Patient Protection and Af- 14 fordable Care Act (42 U.S.C. 18116). 15 (i) LIMITATION.—No Federal funds provided under 16 this section may be used for sex education or sexual health 17 services that— 18 (1) withhold health-promoting or life-saving in- 19 formation about sexuality-related topics, including 20 HIV; 21 (2) are medically inaccurate or incomplete; 22 (3) promote gender or racial stereotypes or are 23 unresponsive to gender or racial inequities; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00881 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 882 •HR 7585 IH (4) fail to address the needs of sexually active 1 young people; 2 (5) fail to address the needs of pregnant or par- 3 enting young people; 4 (6) fail to address the needs of survivors of 5 interpersonal violence; 6 (7) fail to address the needs of young people of 7 all physical, developmental, or mental abilities; 8 (8) fail to be inclusive of individuals with vary- 9 ing gender identities, gender expressions, and sexual 10 orientations; or 11 (9) are inconsistent with the ethical imperatives 12 of medicine and public health. 13 (j) AMENDMENTS TO OTHER LAWS.— 14 (1) AMENDMENT TO THE PUBLIC HEALTH 15 SERVICE ACT.—Section 2500 of the Public Health 16 Service Act (42 U.S.C. 300ee) is amended by strik- 17 ing subsections (b) through (d) and inserting the fol- 18 lowing: 19 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 20 education and information receiving funds under this sub- 21 chapter shall include information about the potential ef- 22 fects of intravenous substance use.’’. 23 (2) AMENDMENTS TO THE ELEMENTARY AND 24 SECONDARY EDUCATION ACT OF 1965.—Section 8526 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00882 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 883 •HR 7585 IH of the Elementary and Secondary Education Act of 1 1965 (20 U.S.C. 7906) is amended— 2 (A) by striking paragraphs (3), (5), and 3 (6); 4 (B) in paragraph (2), by inserting ‘‘or’’ 5 after the semicolon; 6 (C) by redesignating paragraph (4) as 7 paragraph (3); and 8 (D) in paragraph (3), as redesignated by 9 subparagraph (C), by striking the semicolon 10 and inserting a period. 11 (k) FUNDING.— 12 (1) AUTHORIZATION.—For the purpose of car- 13 rying out this section, there is authorized to be ap- 14 propriated $100,000,000 for each of fiscal years 15 2022 through 2027. Amounts appropriated under 16 this paragraph shall remain available until expended. 17 (2) RESERVATIONS OF FUNDS.— 18 (A) IN GENERAL.—Of the amount author- 19 ized under paragraph (1), the Secretary shall 20 reserve— 21 (i) not more than 30 percent for the 22 purposes of awarding grants for sex edu- 23 cation at elementary and secondary schools 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00883 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 884 •HR 7585 IH and youth-serving organizations under sub- 1 section (d); 2 (ii) not more than 10 percent for the 3 purpose of awarding grants for sex edu- 4 cation at institutions of higher education 5 under subsection (e); 6 (iii) not more than 15 percent for the 7 purpose of awarding grants for educator 8 training under subsection (f); 9 (iv) not more than 30 percent for the 10 purpose of awarding grants for sexual 11 health services for marginalized youth 12 under subsection (g); and 13 (v) not less than 5 percent for the 14 purpose of carrying out the reporting and 15 impact evaluation required under sub- 16 section (h). 17 (B) RESEARCH, TRAINING AND TECHNICAL 18 ASSISTANCE.—The Secretary shall reserve not 19 less than 10 percent of the amount authorized 20 under paragraph (1) for expenditures by the 21 Secretary to provide, directly or through a com- 22 petitive grant process, research, training, and 23 technical assistance, including dissemination of 24 research and information regarding effective 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00884 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 885 •HR 7585 IH and promising practices, providing consultation 1 and resources, and developing resources and 2 materials to support the activities of recipients 3 of grants. In carrying out such functions, the 4 Secretary shall collaborate with a variety of en- 5 tities that have expertise in sex education and 6 sexual health services standards setting, design, 7 development, delivery, research, monitoring, and 8 evaluation. 9 (3) REPROGRAMMING OF ABSTINENCE ONLY 10 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli- 11 gated balance of funds made available to carry out 12 section 510 of the Social Security Act (42 U.S.C. 13 710) (as in effect on the day before the date of en- 14 actment of this Act) are hereby transferred and shall 15 be used by the Secretary to carry out this section. 16 The amounts transferred and made available to 17 carry out this section shall remain available until ex- 18 pended. 19 (4) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 20 RIAGE PROGRAM.—Section 510 of the Social Secu- 21 rity Act (42 U.S.C. 710 et seq.) is repealed. 22 SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 23 GENCIES. 24 (a) MEDICARE.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00885 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 886 •HR 7585 IH (1) LIMITATION ON PAYMENT.—Section 1 1866(a)(1) of the Social Security Act (42 U.S.C. 2 1395cc(a)(1)) is amended— 3 (A) by moving the indentation of subpara- 4 graph (W) 2 ems to the left; 5 (B) in subparagraph (X)— 6 (i) by moving the indentation 2 ems 7 to the left; and 8 (ii) by striking ‘‘and’’ at the end; 9 (C) in subparagraph (Y)— 10 (i) by striking ‘‘and’’ at the end of 11 item (bb); and 12 (ii) by striking the period at the end 13 and inserting ‘‘; and’’; and 14 (D) by inserting after subparagraph (Y) 15 the following new subparagraph: 16 ‘‘(Z) in the case of a hospital or critical access 17 hospital, to adopt and enforce a policy to ensure 18 compliance with the requirements of subsection (l) 19 and to meet the requirements of such subsection.’’. 20 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 21 the Social Security Act (42 U.S.C. 1395cc) is 22 amended by adding at the end the following new 23 subsection: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00886 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 887 •HR 7585 IH ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 1 GENCIES.— 2 ‘‘(1) IN GENERAL.—For purposes of subsection 3 (a)(1)(Z), a hospital meets the requirements of this 4 subsection if the hospital provides each of the serv- 5 ices described in paragraph (2) to each individual, 6 whether or not eligible for benefits under this title 7 or under any other form of health insurance, who 8 comes to the hospital on or after January 1, 2021, 9 and— 10 ‘‘(A) who states to hospital personnel that 11 they are victims of sexual assault; 12 ‘‘(B) who is accompanied by an individual 13 who states to hospital personnel that the indi- 14 vidual is a victim of sexual assault; or 15 ‘‘(C) whom hospital personnel, during the 16 course of treatment and care for the individual, 17 have reason to believe is a victim of sexual as- 18 sault. 19 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 20 purposes of paragraph (1), the services described in 21 this subparagraph are the following: 22 ‘‘(A) Provision of medically and factually 23 accurate and unbiased written and oral infor- 24 mation about emergency contraception that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00887 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 888 •HR 7585 IH ‘‘(i) is written in clear and concise 1 language; 2 ‘‘(ii) is readily comprehensible; 3 ‘‘(iii) includes an explanation that 4 emergency contraceptives— 5 ‘‘(I) have been approved by the 6 Food and Drug Administration for in- 7 dividuals and are a safe and effective 8 way to prevent pregnancy after unpro- 9 tected intercourse or contraceptive 10 failure if taken in a timely manner; 11 ‘‘(II) are more effective the soon- 12 er it is taken; and 13 ‘‘(III) do not cause an abortion 14 and cannot interrupt an established 15 pregnancy; 16 ‘‘(iv) meet such conditions regarding 17 the provision of such information in lan- 18 guages other than English as the Secretary 19 may establish; and 20 ‘‘(v) are provided without regard to 21 the ability of the individual or their family 22 to pay costs associated with the provision 23 of such information to the individual. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00888 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 889 •HR 7585 IH ‘‘(B) Immediate offer to provide emergency 1 contraception to the individual at the hospital 2 and, in the case that such individual accepts 3 such offer, immediate provision to such indi- 4 vidual of such contraception on the same day it 5 is requested without regard to the inability of 6 the individual or their family to pay costs asso- 7 ciated with the offer and provision of such con- 8 traception. 9 ‘‘(C) Development and implementation of a 10 written policy to ensure that an individual is 11 present at the hospital, or on-call, who— 12 ‘‘(i) has authority to dispense or pre- 13 scribe emergency contraception, independ- 14 ently, or under a protocol prepared by a 15 physician for the administration of emer- 16 gency contraception at the hospital to a 17 victim of sexual assault; and 18 ‘‘(ii) is trained to comply with the re- 19 quirements of this section. 20 ‘‘(D) Provision of medically and factually 21 accurate and unbiased written and oral infor- 22 mation and counseling about post-exposure pro- 23 phylaxis (PEP) protocol for the prevention of 24 HIV. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00889 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 890 •HR 7585 IH ‘‘(E) Immediate offer to begin PEP to the 1 individual at the hospital except in cases where 2 the medical professional’s best judgement is 3 that further evaluation is required or that such 4 a regimen will be substantially detrimental to 5 the health of such individual. Such provision 6 shall be offered regardless of the individual’s 7 ability to pay. Hospitals shall be responsible for 8 ensuring adequate supply of PEP medications 9 to provide to patients. 10 ‘‘(3) HOSPITAL DEFINED.—For purposes of 11 this paragraph, the term ‘hospital’ includes a critical 12 access hospital, as defined in section 13 1861(mm)(1).’’. 14 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 15 Section 1903(i) of the Social Security Act (42 U.S.C. 16 1396b(i)) is amended by inserting after paragraph (8) the 17 following new paragraph: 18 ‘‘(9) with respect to any amount expended for 19 care or services furnished under the plan by a hos- 20 pital on or after January 1, 2021, unless such hos- 21 pital meets the requirements specified in section 22 1866(l) for purposes of title XVIII;’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00890 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 891 •HR 7585 IH SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2021. 1 (a) SHORT TITLE.—This section may be cited as the 2 ‘‘Menstrual Equity For All Act of 2021’’. 3 (b) MENSTRUAL PRODUCTS FOR STUDENTS AT ELE- 4 MENTARY AND SECONDARY SCHOOLS.— 5 (1) IN GENERAL.—Section 4108(5)(C) of the 6 Elementary and Secondary Education Act of 1965 7 (20 U.S.C. 7118(5)(C)) is amended— 8 (A) in clause (vi), by striking ‘‘or’’ after 9 the semicolon; 10 (B) in clause (vii), by inserting ‘‘or’’ after 11 the semicolon; and 12 (C) by adding at the end the following: 13 ‘‘(viii) provide free menstrual products 14 to students who use menstrual products;’’. 15 (2) DEFINITIONS.—Section 4102 of the Ele- 16 mentary and Secondary Education Act of 1965 (20 17 U.S.C. 7112) is amended— 18 (A) by redesignating paragraphs (6) 19 through (8) as paragraphs (7) through (9), re- 20 spectively; and 21 (B) by inserting after paragraph (5) the 22 following: 23 ‘‘(6) MENSTRUAL PRODUCTS.—The term ‘men- 24 strual products’ means sanitary napkins and tam- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00891 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 892 •HR 7585 IH pons that conform to applicable industry stand- 1 ards.’’. 2 (3) RULEMAKING.—Not later than 1 year after 3 the date of enactment of this section, the Secretary 4 of Education, in consultation with the Secretary of 5 Health and Human Services, shall promulgate rules 6 with respect to the definition of ‘‘menstrual prod- 7 ucts’’ in paragraph (6) of section 4102 of the Ele- 8 mentary and Secondary Education Act of 1965 (20 9 U.S.C. 7112), as amended by section 3(b). 10 (c) MENSTRUAL PRODUCTS FOR STUDENTS AT IN- 11 STITUTIONS OF HIGHER EDUCATION.— 12 (1) PURPOSE.—The purpose of this section is 13 to alleviate— 14 (A) the barriers to academic success faced 15 by many college and graduate students due to 16 the inability of such students to afford to pur- 17 chase menstrual products; and 18 (B) the unique set of burdens that college 19 and graduate students experiencing period pov- 20 erty face that can be compounded by lack of ac- 21 cess to basic needs such as housing, food, trans- 22 portation, and access to physical and mental 23 health services. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00892 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 893 •HR 7585 IH (2) IN GENERAL.—The Secretary of Education 1 shall establish a program to award grants, on a com- 2 petitive basis, to at least 4 institutions of higher 3 education, to— 4 (A) support programs that provide free 5 menstrual products to students; and 6 (B) report on best practices of such pro- 7 grams. 8 (3) APPLICATION.—To apply for a grant under 9 this subsection, an institution of higher education 10 shall submit to the Secretary an application in such 11 form, at such time, and containing such information 12 as the Secretary determines appropriate, including 13 an assurance that such grant will be used to carry 14 out the activities described in paragraph (5). 15 (4) COMMUNITY COLLEGES.—At least 50 per- 16 cent of the grants awarded under this subsection 17 shall be awarded to community colleges. 18 (5) GRANT USES.—A grant awarded under this 19 subsection may only be used to— 20 (A) carry out or expand activities that 21 fund programs that support direct provision of 22 free menstrual products to students in appro- 23 priate campus locations, including— 24 (i) campus restroom facilities; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00893 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 894 •HR 7585 IH (ii) wellness centers; and 1 (iii) on-campus residential buildings; 2 (B) report on best practices of such pro- 3 grams; 4 (C) conduct outreach to students to en- 5 courage participation in menstrual equity pro- 6 grams and services; 7 (D) help eligible students apply for and en- 8 roll in local, State, and Federal public assist- 9 ance programs; and 10 (E) coordinate and collaborate with gov- 11 ernment or community-based organizations to 12 carry out the activities described in subpara- 13 graphs (A) through (D). 14 (6) PRIORITY.—In awarding grants under this 15 subsection, the Secretary shall prioritize— 16 (A) institutions with Federal Pell Grant 17 enrollment that is at least 25 percent of the 18 total enrollment of such institution; and 19 (B) historically Black colleges and univer- 20 sities, Hispanic-serving institutions, Asian 21 American and Native American Pacific Is- 22 lander-serving institutions, and other minority 23 serving institutions. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00894 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 895 •HR 7585 IH (7) MENSTRUAL PRODUCT DEFINED.—In this 1 subsection, the term ‘‘menstrual product’’ means a 2 sanitary napkin or tampon that conforms to industry 3 standards. 4 (8) AUTHORIZATION OF APPROPRIATIONS.— 5 There are authorized to be appropriated, out of 6 funds appropriated for a fiscal year to the Fund for 7 the Improvement of Postsecondary Education under 8 section 741 of the Higher Education Act of 1965 9 (20 U.S.C. 1138), $5,000,000 to carry out the grant 10 program under this subsection. 11 (d) MENSTRUAL PRODUCTS FOR INCARCERATED IN- 12 DIVIDUALS AND DETAINEES.— 13 (1) REQUIREMENT FOR STATES.—Beginning on 14 the date that is 180 days after the date of the enact- 15 ment of this section, and annually thereafter, the 16 chief executive officer of each State that receives a 17 grant under subpart 1 of part E of title I of the 18 Omnibus Crime Control and Safe Streets Act of 19 1968 (42 U.S.C. 3750 et seq.) (commonly referred 20 to as the ‘‘Edward Byrne Memorial Justice Assist- 21 ance Grant Program’’) shall submit to the Attorney 22 General a certification, in such form and containing 23 such information as the Attorney General may re- 24 quire, that— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00895 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 896 •HR 7585 IH (A) all incarcerated individuals and detain- 1 ees in that State have access to menstrual prod- 2 ucts— 3 (i) on demand; and 4 (ii) at no cost to such individuals and 5 detainees; and 6 (B) no visitor is prohibited from visiting an 7 incarcerated individual due to the visitor’s use 8 of menstrual products. 9 (2) REDUCTION IN GRANT FUNDING.—In the 10 case of a State whose chief executive officer fails to 11 submit a certification required under paragraph (1) 12 in a fiscal year, the Attorney General shall reduce 13 the amount that the State would have otherwise re- 14 ceived under section 505 of title I of the Omnibus 15 Crime Control and Safe Streets Act of 1968 (42 16 U.S.C. 3755) by 20 percent for the following fiscal 17 year. 18 (3) REALLOCATION.—Amounts not allocated to 19 a State under section 505 of title I of the Omnibus 20 Crime Control and Safe Streets Act of 1968 (42 21 U.S.C. 3755) for a fiscal year pursuant to para- 22 graph (2) shall be reallocated under such section to 23 States that submit such certifications. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00896 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 897 •HR 7585 IH (4) MENSTRUAL PRODUCTS.—For the purposes 1 of paragraph (1), the term ‘‘menstrual products’’ 2 means sanitary napkins and tampons that conform 3 to applicable industry standards. 4 (5) AVAILABILITY FOR FEDERAL PRISONERS.— 5 The Attorney General shall make rules requiring, 6 and the Director of the Bureau of Prisons shall take 7 such actions as may be necessary to ensure, the dis- 8 tribution and accessibility (without charge) of men- 9 strual products to prisoners in the custody of the 10 Bureau of Prisons, including any prisoner in a Fed- 11 eral penal or correctional institution, any Federal 12 prisoner in a State penal or correctional institution, 13 and any Federal prisoner in a facility administered 14 by a private detention entity, and that each prisoner 15 who requires these products may receive them in 16 sufficient quantity. 17 (6) AVAILABILITY FOR DETAINEES.—The Sec- 18 retary of Homeland Security shall take such actions 19 as may be necessary to ensure that menstrual prod- 20 ucts are distributed and made accessible to each 21 alien detained by the Secretary of Homeland Secu- 22 rity, including any alien in a facility administered by 23 a private detention entity, at no expense to the alien. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00897 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 898 •HR 7585 IH (e) MENSTRUAL PRODUCTS AVAILABILITY FOR 1 HOMELESS INDIVIDUALS UNDER EMERGENCY FOOD AND 2 SHELTER GRANT PROGRAM.—Subsection (a) of section 3 316 of the McKinney-Vento Homeless Assistance Act (42 4 U.S.C. 11346(a)) is amended— 5 (1) in paragraph (5), by striking ‘‘and’’ at the 6 end; 7 (2) in paragraph (6), by striking the period at 8 the end and inserting ‘‘; and’’; and 9 (3) by adding at the end the following new 10 paragraph: 11 ‘‘(7) guidelines that ensure that amounts pro- 12 vided under the program to private nonprofit organi- 13 zations and local governments may be used to pro- 14 vide sanitary napkins and tampons that conform to 15 applicable industry standards.’’. 16 (f) MENSTRUAL PRODUCTS COVERED BY MED- 17 ICAID.— 18 (1) IN GENERAL.—Section 1905 of the Social 19 Security Act (42 U.S.C. 1396d) is amended— 20 (A) in subsection (a)— 21 (i) by redesignating paragraphs (30) 22 and (31) as paragraphs (31) and (32), re- 23 spectively; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00898 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 899 •HR 7585 IH (ii) by inserting after paragraph (29) 1 the following new paragraph: 2 ‘‘(30) menstrual products (as defined in sub- 3 section (hh));’’; and 4 (B) by adding at the end the following: 5 ‘‘(jj) MENSTRUAL PRODUCTS.—For purposes of sub- 6 section (a)(30), the term ‘menstrual products’ means sani- 7 tary napkins, tampons, liners, cups, and similar items 8 used by individuals with respect to menstruation and that 9 conform to industry standards.’’. 10 (2) EFFECTIVE DATE.— 11 (A) IN GENERAL.—Subject to subpara- 12 graph (B), the amendments made by this sub- 13 section shall apply with respect to medical as- 14 sistance furnished during or after the first cal- 15 endar quarter beginning on or after the date 16 that is 1 year after the date of the enactment 17 of this section. 18 (B) EXCEPTION FOR STATE LEGISLA- 19 TION.—In the case of a State plan under title 20 XIX of the Social Security Act (42 U.S.C. 1396 21 et seq.) that the Secretary of Health and 22 Human Services determines requires State leg- 23 islation in order for the respective plan to meet 24 any requirement imposed by amendments made 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00899 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 900 •HR 7585 IH by this section, the respective plan shall not be 1 regarded as failing to comply with the require- 2 ments of such title solely on the basis of its fail- 3 ure to meet such an additional requirement be- 4 fore the first day of the first calendar quarter 5 beginning after the close of the first regular 6 session of the State legislature that begins after 7 the date of the enactment of this section. For 8 purposes of the previous sentence, in the case 9 of a State that has a 2-year legislative session, 10 each year of the session shall be considered to 11 be a separate regular session of the State legis- 12 lature. 13 (g) MENSTRUAL PRODUCTS FOR EMPLOYEES.—Sec- 14 tion 6 of the Occupational Safety and Health Act of 1970 15 (29 U.S.C. 655) is amended by adding at the end the fol- 16 lowing: 17 ‘‘(h) The Secretary shall by rule promulgate a re- 18 quirement that each employer with not less than 100 em- 19 ployees provide menstrual products free of charge for em- 20 ployees of the employer. For purposes of the preceding 21 sentence, ‘menstrual products’ means sanitary napkins 22 and tampons that conform to applicable industry stand- 23 ards.’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00900 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 901 •HR 7585 IH (h) MENSTRUAL PRODUCTS IN FEDERAL BUILD- 1 INGS.— 2 (1) REQUIREMENT.—Each appropriate author- 3 ity shall ensure that menstrual products are stocked 4 in, and available free of charge in, each covered rest- 5 room in each covered public building under the juris- 6 diction of such authority. 7 (2) DEFINITIONS.—In this section: 8 (A) APPROPRIATE AUTHORITY.—The term 9 ‘‘appropriate authority’’ means the head of a 10 Federal agency, the Architect of the Capitol, or 11 other official authority responsible for the oper- 12 ation of a covered public building. 13 (B) COVERED PUBLIC BUILDING.—The 14 term ‘‘covered public building’’ means a public 15 building, as defined in section 3301 of title 40, 16 United States Code, that is open to the public 17 and contains a public restroom, and includes a 18 building listed in section 6301 or 5101 of such 19 title. 20 (C) COVERED RESTROOM.—The term ‘‘cov- 21 ered restroom’’ means a restroom in a covered 22 public building. 23 (D) MENSTRUAL PRODUCTS.—The term 24 ‘‘menstrual products’’ means sanitary napkins 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00901 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 902 •HR 7585 IH and tampons that conform to applicable indus- 1 try standards. 2 SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 3 WOMEN’S HEALTH. 4 Section 229(b) of the Public Health Service Act (42 5 U.S.C. 237a(b)), as amended by sections 5217 and 5301, 6 is further amended by adding at the end the following: 7 ‘‘(10) facilitate policymakers, health system 8 leaders and providers, consumers, and other stake- 9 holders in understanding optimal maternity care and 10 support for the provision of such care, including the 11 priorities of— 12 ‘‘(A) protecting, promoting, and supporting 13 the innate capacities of childbearing individuals 14 and their newborns for childbirth, 15 breastfeeding, and attachment; 16 ‘‘(B) using obstetric interventions only 17 when such interventions are supported by 18 strong, high-quality evidence, and minimizing 19 overuse of maternity practices that have been 20 shown to have benefit in limited situations and 21 that can expose people, infants, or both to risk 22 of harm if used routinely and indiscriminately, 23 including continuous electronic fetal monitoring, 24 labor induction, epidural analgesia, primary ce- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00902 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 903 •HR 7585 IH sarean section, and routine repeat cesarean 1 birth; 2 ‘‘(C) reliably incorporating noninvasive, 3 evidence-based practices that have a docu- 4 mented correlation with considerable improve- 5 ment in outcomes with no detrimental side ef- 6 fects, such as smoking cessation programs in 7 pregnancy, maternal immunizations, and proven 8 models (including group prenatal care, mid- 9 wifery care, and doula support) that integrate 10 health assessment, education, and support into 11 a unified program and supporting evidence- 12 based breastfeeding promotion efforts with re- 13 spect for a breastfeeding individual’s personal 14 decision making; 15 ‘‘(D) a shared understanding of the quali- 16 fications of licensed providers of maternity care 17 and the best evidence about the safety, satisfac- 18 tion, outcomes, and costs of maternity care, and 19 appropriate deployment of such caregivers with- 20 in the maternity care workforce to address the 21 needs of childbearing individuals and newborns 22 and the growing shortage of maternity care- 23 givers; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00903 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 904 •HR 7585 IH ‘‘(E) a shared understanding of the results 1 of the best available research comparing hos- 2 pital, birth center, and planned home births, in- 3 cluding information about each setting’s safety, 4 satisfaction, outcomes, and costs; 5 ‘‘(F) a shared understanding of the impor- 6 tance for the safety and choices of birthing 7 families of an integrated maternity care system 8 with seamless processes for consultation, shared 9 care, transfer and transport across maternity 10 care settings, and providers when birthing peo- 11 ple and their newborns require a higher level of 12 care; 13 ‘‘(G) high-quality, evidence-based child- 14 birth education that— 15 ‘‘(i) promotes a healthy and safe ap- 16 proach to pregnancy, childbirth, and early 17 parenting; 18 ‘‘(ii) is taught by certified educators, 19 peer counselors, and health professionals; 20 and 21 ‘‘(iii) promotes informed decision 22 making by childbearing individuals; and 23 ‘‘(H) developing measures that enable a 24 more robust, balanced set of standardized ma- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00904 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 905 •HR 7585 IH ternity care measures, including performance 1 and quality measures.’’. 2 SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN 3 STUDENTS, INTERNS, AND RESIDENTS SU- 4 PERVISED BY CERTIFIED NURSE MIDWIVES 5 OR CERTIFIED MIDWIVES WITHIN INPATIENT 6 HOSPITAL SERVICES UNDER MEDICARE. 7 (a) IN GENERAL.—Section 1861(b) of the Social Se- 8 curity Act (42 U.S.C. 1395x(b)) is amended— 9 (1) in paragraph (6), by striking ‘‘; or’’ at the 10 end and inserting ‘‘, or in the case of services in a 11 hospital or osteopathic hospital by a student midwife 12 or an intern or resident-in-training under a teaching 13 program previously described in this paragraph who 14 is in the field of obstetrics and gynecology, if such 15 student midwife, intern, or resident-in-training is su- 16 pervised by a certified nurse-midwife or certified 17 midwife to the extent permitted under applicable 18 State law and as may be authorized by the hos- 19 pital;’’; 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00905 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 906 •HR 7585 IH ‘‘(8) a certified nurse-midwife or certified mid- 1 wife where the hospital has a teaching program ap- 2 proved as specified in paragraph (6), if— 3 ‘‘(A) the hospital elects to receive any pay- 4 ment due under this title for reasonable costs of 5 such services; and 6 ‘‘(B) all certified nurse-midwives or cer- 7 tified midwives in such hospital agree not to bill 8 charges for professional services rendered in 9 such hospital to individuals covered under the 10 insurance program established by this title.’’. 11 (b) EFFECTIVE DATE.—The amendments made by 12 subsection (a) shall apply to services furnished on or after 13 the date of the enactment of this Act. 14 SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS 15 AND MINORITY-SERVING INSTITUTIONS TO 16 INCREASE DIVERSITY IN MATERNAL, REPRO- 17 DUCTIVE, AND SEXUAL HEALTH PROFES- 18 SIONALS. 19 (a) GRANTS TO HEALTH PROFESSIONAL ORGANIZA- 20 TIONS.— 21 (1) IN GENERAL.—The Secretary of Health and 22 Human Services, acting through the Administrator 23 of the Health Resources and Services Administra- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00906 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 907 •HR 7585 IH tion, shall carry out a grant program under which 1 the Secretary may make to eligible organizations— 2 (A) for fiscal year 2023, planning grants 3 described in paragraph (2); and 4 (B) for the subsequent 4-year period, im- 5 plementation grants described in paragraph (3). 6 (2) PLANNING GRANTS.— 7 (A) IN GENERAL.—Planning grants de- 8 scribed in this paragraph are grants for the fol- 9 lowing purposes: 10 (i) To collect data and identify any 11 workforce inequalities, with respect to a 12 health profession, at each of the following 13 areas along the health professional con- 14 tinuum: 15 (I) Pipeline availability, with re- 16 spect to students at the high school 17 and college or university levels consid- 18 ering, and working toward, entrance 19 in the profession, including barriers 20 triggered by criminal records. 21 (II) Entrance into the training 22 program for the profession. 23 (III) Graduation from such train- 24 ing program. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00907 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 908 •HR 7585 IH (IV) Entrance into practice, in- 1 cluding barriers triggered by criminal 2 records. 3 (V) Retention in practice for 4 more than a 5-year period. 5 (ii) To develop one or more strategies 6 to address the workforce inequalities with- 7 in the health profession, as identified 8 under (and in response to the findings pur- 9 suant to) clause (i). 10 (B) APPLICATION.—To be eligible to re- 11 ceive a grant under this paragraph, an eligible 12 health professional organization shall submit to 13 the Secretary an application in such form and 14 manner and containing such information as 15 specified by the Secretary. 16 (C) AMOUNT.—Each grant awarded under 17 this paragraph shall be for an amount not to 18 exceed $300,000. 19 (D) REPORT.—Each recipient of a grant 20 under this paragraph shall submit to the Sec- 21 retary a report containing— 22 (i) information on the extent and dis- 23 tribution of workforce inequities identified 24 through the grant; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00908 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 909 •HR 7585 IH (ii) reasonable objectives and strate- 1 gies developed to address such inequalities 2 within a 5-, 10-, and 25-year period. 3 (3) IMPLEMENTATION GRANTS.— 4 (A) IN GENERAL.—Implementation grants 5 described in this paragraph are grants to imple- 6 ment one or more of the strategies developed 7 pursuant to a planning grant awarded under 8 paragraph (2). 9 (B) APPLICATION.—To be eligible to re- 10 ceive a grant under this paragraph, an eligible 11 health professional organization shall submit to 12 the Secretary an application in such form and 13 manner as specified by the Secretary. Each 14 such application shall contain information on— 15 (i) the capability of the organization 16 to carry out a strategy described in sub- 17 paragraph (A); 18 (ii) the involvement of partners or 19 coalitions; 20 (iii) the organization’s plans for devel- 21 oping sustainability of the efforts after the 22 culmination of the grant cycle, and any 23 other information specified by the Sec- 24 retary. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00909 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 910 •HR 7585 IH (C) AMOUNT; DURATION.—Each grant 1 awarded under this paragraph shall be for an 2 amount not to exceed $500,000 each year of 3 the grant. The term of a grant under this sub- 4 section shall not exceed 4 years. 5 (D) REPORTS.—For each of the first 3 6 years for which an eligible health professional 7 organization is awarded a grant under this 8 paragraph, the organization shall submit to the 9 Secretary of Health and Human Services a re- 10 port on the activities carried out by such orga- 11 nization through the grant during such year 12 and objectives for the subsequent year. For the 13 fourth year for which an eligible health profes- 14 sional organization is awarded a grant under 15 this paragraph, the organization shall submit to 16 the Secretary a report that includes an analysis 17 of all the activities carried out by the organiza- 18 tion through the grant and a detailed plan for 19 the continuation of the organization’s outreach 20 efforts. 21 (4) ELIGIBLE HEALTH PROFESSIONAL ORGANI- 22 ZATION DEFINED.—For purposes of this subsection, 23 the term ‘‘eligible health professional organization’’ 24 means a professional organization representing ob- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00910 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 911 •HR 7585 IH stetrician-gynecologists, certified nurse midwives, 1 certified midwives, family practice physicians, nurse 2 practitioners whose scope of practice includes mater- 3 nity or sexual and reproductive health care, physi- 4 cian assistants whose scope of practice includes ob- 5 stetrical or sexual and reproductive health care, or 6 certified professional midwives, adolescent medicine 7 specialists, and pediatricians who provide sexual and 8 reproductive health care. 9 (b) GRANTS TO MINORITY-SERVING INSTITU- 10 TIONS.— 11 (1) IN GENERAL.—The Secretary of Health and 12 Human Services, acting through the Administrator 13 of the Health Resources and Services Administration 14 (referred to in this section as the ‘‘Secretary’’), shall 15 carry out a grant program under which the Sec- 16 retary may make to eligible organizations— 17 (A) for fiscal years 2023 and 2024, plan- 18 ning grants described in paragraph (2); and 19 (B) for the subsequent ten-year period, im- 20 plementation grants described in paragraph (3). 21 (2) PLANNING GRANTS.— 22 (A) IN GENERAL.—Planning grants de- 23 scribed in this paragraph are grants for plans 24 the following purposes: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00911 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 912 •HR 7585 IH (i) To develop or expand academic 1 programs to educate maternity care clini- 2 cians and maternity care support per- 3 sonnel, including— 4 (I) nurses with the intention of 5 providing maternity, newborn, or sex- 6 ual and reproductive health care; 7 (II) nurse-practitioners whose 8 scope of practice includes maternity, 9 newborn, or sexual and reproductive 10 health care; and 11 (III) maternity care support per- 12 sonnel, such as doulas and lactation 13 counselors. 14 (ii) To develop or expand academic 15 programs to educate obstetrician-gyne- 16 cologists. 17 (B) APPLICATION.—To be eligible to re- 18 ceive a grant under this paragraph, an eligible 19 minority serving institution shall submit to the 20 Secretary an application in such form and man- 21 ner and containing such information as speci- 22 fied by the Secretary. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00912 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 913 •HR 7585 IH (C) AMOUNT.—Each grant awarded under 1 this paragraph shall be for an amount not to 2 exceed $400,000 for each of two years. 3 (D) REPORT.—Each recipient of a grant 4 under this paragraph shall submit to the Sec- 5 retary an annual report describing the planned 6 development or expansion of educational pro- 7 grams, including— 8 (i) the types of clinical or support per- 9 sonnel and the degrees or certificates to be 10 conferred; 11 (ii) the associated curricula; 12 (iii) the faculty and their capabilities 13 and commitments, including any plans for 14 recruitment; 15 (iv) the anticipated number of stu- 16 dents to be enrolled and plans for their re- 17 cruitment and social, emotional, and finan- 18 cial support; and 19 (v) the objectives and strategies for 20 addressing inequities and preparing stu- 21 dents to provide high-quality culturally 22 congruent care. 23 (3) IMPLEMENTATION GRANTS.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00913 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 914 •HR 7585 IH (A) IN GENERAL.—Implementation grants 1 described in this paragraph are grants to imple- 2 ment the strategies developed under paragraph 3 (2). 4 (B) APPLICATION.—To be eligible to re- 5 ceive a grant under this paragraph, an eligible 6 minority serving institution shall submit to the 7 Secretary of Health and Human Services an 8 application in such form and manner as speci- 9 fied by the Secretary. Each such application 10 shall contain information on the capability of 11 the institution to carry out a strategy described 12 in paragraph (2), plans for sustainability of the 13 program after the culmination of the grant 14 cycle, and any other information specified by 15 the Secretary. 16 (C) AMOUNT.—Each grant under this 17 paragraph shall be for an amount not to exceed 18 $1,000,000 each year during the 10-year period 19 of the grant. 20 (D) REPORTS.— 21 (i) INITIAL PERIOD.—For each of the 22 first 9 years for which an eligible minority- 23 serving institution is awarded a grant 24 under this paragraph, the institution shall 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00914 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 915 •HR 7585 IH submit a report to the Secretary on the ac- 1 tivities carried out by such institution 2 through the grant during such year and 3 objectives for the subsequent year. 4 (ii) FINAL YEAR.—For the tenth year 5 for which an eligible minority-serving insti- 6 tution is awarded a grant under this para- 7 graph, the organization shall submit to the 8 Secretary a report that includes an anal- 9 ysis of all the activities carried out by the 10 institution through the grant and a de- 11 tailed plan for continuation of the edu- 12 cational program. 13 (4) ELIGIBLE MINORITY-SERVING INSTITUTIONS 14 DEFINED.—For the purposes of this subsection, the 15 term ‘‘minority-serving institution’’ means a histori- 16 cally Black college or university, Tribal college or 17 university, Latino-serving institution, Asian Amer- 18 ican and Pacific Islander serving institution, or 19 other minority serving institution of higher edu- 20 cation. 21 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 22 authorized to be appropriated to carry out— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00915 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 916 •HR 7585 IH (1) subsection (a), $2,000,000 for fiscal year 1 2023 and $3,000,000 for each of the fiscal years 2 2024 through 2027; and 3 (2) subsection (b), $4,000,000 for each of fiscal 4 years 2023 and 2024 and $10,000,000 for each of 5 fiscal years 2025 through 2034. 6 Subtitle F—Children’s Health 7 SEC. 5501. CARING FOR KIDS ACT. 8 (a) PERMANENT EXTENSION OF CHILDREN’S 9 HEALTH INSURANCE PROGRAM.— 10 (1) IN GENERAL.—Section 2104(a)(28) of the 11 Social Security Act (42 U.S.C. 1397dd(a)(28)) is 12 amended to read as follows: 13 ‘‘(28) for fiscal year 2027 and each subsequent 14 year, such sums as are necessary to fund allotments 15 to States under subsections (c) and (m).’’. 16 (2) ALLOTMENTS.— 17 (A) IN GENERAL.—Section 2104(m) of the 18 Social Security Act (42 U.S.C. 1397dd(m)) is 19 amended— 20 (i) in paragraph (2)(B)(i), by striking 21 ‘‘,, 2023, and 2027’’ and inserting ‘‘and 22 2023’’; 23 (ii) in paragraph (7)— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00916 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 917 •HR 7585 IH (I) in subparagraph (A), by strik- 1 ing ‘‘and ending with fiscal year 2 2027,’’; and 3 (II) in the flush left matter at 4 the end, by striking ‘‘or fiscal year 5 2026’’ and inserting ‘‘fiscal year 6 2026, or a subsequent even-numbered 7 fiscal year’’; 8 (iii) in paragraph (9)— 9 (I) by striking ‘‘(10), or (11)’’ 10 and inserting ‘‘or (10)’’; and 11 (II) by striking ‘‘2023, or 2027,’’ 12 and inserting ‘‘or 2023’’; and 13 (iv) by striking paragraph (11). 14 (B) CONFORMING AMENDMENT.—Section 15 50101(b)(2) of the Bipartisan Budget Act of 16 2018 (Public Law 115–123) is repealed. 17 (b) PERMANENT EXTENSIONS OF OTHER PROGRAMS 18 AND DEMONSTRATION PROJECTS.— 19 (1) PEDIATRIC QUALITY MEASURES PRO- 20 GRAM.—Section 1139A(i)(1) of the Social Security 21 Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 22 (A) in subparagraph (C), by striking at the 23 end ‘‘and’’; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00917 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 918 •HR 7585 IH (B) in subparagraph (D), by striking the 1 period at the end and insert a semicolon; and 2 (C) by adding at the end the following new 3 subparagraphs: 4 ‘‘(E) for fiscal year 2028, $15,000,000 for 5 the purpose of carrying out this section (other 6 than subsections (e), (f), and (g)); and 7 ‘‘(F) for a subsequent fiscal year, the 8 amount appropriated under this paragraph for 9 the previous fiscal year, increased by the per- 10 centage increase in the consumer price index for 11 all urban consumers (all items; United States 12 city average) over such previous fiscal year, for 13 the purpose of carrying out this section (other 14 than subsections (e), (f), and (g)).’’. 15 (2) EXPRESS LANE ELIGIBILITY OPTION.—Sec- 16 tion 1902(e)(13) of the Social Security Act (42 17 U.S.C. 1396a(e)(13)) is amended by striking sub- 18 paragraph (I). 19 (3) ASSURANCE OF AFFORDABILITY STANDARD 20 FOR CHILDREN AND FAMILIES.— 21 (A) IN GENERAL.—Section 2105(d)(3) of 22 the Social Security Act (42 U.S.C. 23 1397ee(d)(3)) is amended— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00918 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 919 •HR 7585 IH (i) in the paragraph heading, by strik- 1 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 2 (ii) in subparagraph (A), in the mat- 3 ter preceding clause (i)— 4 (I) by striking ‘‘During the pe- 5 riod that begins on the date of enact- 6 ment of the Patient Protection and 7 Affordable Care Act and ends on Sep- 8 tember 30, 2027’’ and inserting ‘‘Be- 9 ginning on the date of the enactment 10 of the Patient Protection and Afford- 11 able Care Act’’; 12 (II) by striking ‘‘During the pe- 13 riod that begins on October 1, 2019, 14 and ends on September 30, 2027’’ 15 and inserting ‘‘Beginning on October 16 1, 2019’’; and 17 (III) by striking ‘‘The preceding 18 sentences shall not be construed as 19 preventing a State during any such 20 periods from’’ and inserting ‘‘The pre- 21 ceding sentences shall not be con- 22 strued as preventing a State from’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00919 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 920 •HR 7585 IH (B) CONFORMING AMENDMENTS.—Section 1 1902(gg)(2) of the Social Security Act (42 2 U.S.C. 1396a(gg)(2)) is amended— 3 (i) in the paragraph heading, by strik- 4 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 5 (ii) by striking ‘‘through September 6 30’’ and all that follows through ‘‘ends on 7 September 30, 2027’’ and inserting ‘‘(but 8 beginning on October 1, 2019,’’. 9 (4) QUALIFYING STATES OPTION.—Section 10 2105(g)(4) of the Social Security Act (42 U.S.C. 11 1397ee(g)(4)) is amended— 12 (A) in the paragraph heading, by striking 13 ‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 14 inserting ‘‘AFTER FISCAL YEAR 2008’’; and 15 (B) in subparagraph (A), by striking ‘‘for 16 any of fiscal years 2009 through 2027’’ and in- 17 serting ‘‘for any fiscal year after fiscal year 18 2008’’. 19 (5) OUTREACH AND ENROLLMENT PROGRAM.— 20 Section 2113 of the Social Security Act (42 U.S.C. 21 1397mm) is amended— 22 (A) in subsection (a)— 23 (i) in paragraph (1), by striking ‘‘dur- 24 ing the period of fiscal years 2009 through 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00920 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 921 •HR 7585 IH 2027’’ and inserting ‘‘, beginning with fis- 1 cal year 2009,’’; 2 (ii) in paragraph (2)— 3 (I) by striking ‘‘10 percent of 4 such amounts’’ and inserting ‘‘10 per- 5 cent of such amounts for the period or 6 the fiscal year for which such amounts 7 are appropriated’’; and 8 (II) by striking ‘‘during such pe- 9 riod’’ and inserting ‘‘, during such pe- 10 riod or such fiscal year,’’; and 11 (iii) in paragraph (3), by striking 12 ‘‘For the period of fiscal years 2024 13 through 2027, an amount equal to 10 per- 14 cent of such amounts’’ and inserting ‘‘Be- 15 ginning with fiscal year 2024, an amount 16 equal to 10 percent of such amounts for 17 the period or the fiscal year for which such 18 amounts are appropriated’’; and 19 (B) in subsection (g)— 20 (i) by striking ‘‘2017,,’’ and inserting 21 ‘‘2017,’’; 22 (ii) by striking ‘‘and $48,000,000’’ 23 and inserting ‘‘$48,000,000’’; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00921 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 922 •HR 7585 IH (iii) by inserting after ‘‘through 1 2027’’ the following: ‘‘, $12,000,000 for 2 fiscal year 2028, and, for each fiscal year 3 after fiscal year 2028, the amount appro- 4 priated under this subsection for the pre- 5 vious fiscal year, increased by the percent- 6 age increase in the consumer price index 7 for all urban consumers (all items; United 8 States city average) over such previous fis- 9 cal year’’. 10 (6) CHILD ENROLLMENT CONTINGENCY 11 FUND.—Section 2104(n) of the Social Security Act 12 (42 U.S.C. 1397dd(n)) is amended— 13 (A) in paragraph (2)— 14 (i) in subparagraph (A)(ii)— 15 (I) by striking ‘‘and 2024 16 through 2026’’ and inserting ‘‘begin- 17 ning with fiscal year 2024’’; and 18 (II) by striking ‘‘2023, and 19 2027’’ and inserting ‘‘, and 2023’’; 20 and 21 (ii) in subparagraph (B)— 22 (I) by striking ‘‘2024 through 23 2026’’ and inserting ‘‘beginning with 24 fiscal year 2024’’; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00922 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 923 •HR 7585 IH (II) by striking ‘‘2023, and 1 2027’’ and inserting ‘‘, and 2023’’; 2 and 3 (B) in paragraph (3)(A)— 4 (i) by striking ‘‘fiscal years 2024 5 through 2026’’ and inserting ‘‘beginning 6 with fiscal year 2024’’; and 7 (ii) by striking ‘‘2023, or 2027’’ and 8 inserting ‘‘, or 2023’’. 9 SEC. 5502. END DIAPER NEED ACT OF 2021. 10 (a) TARGETED FUNDING FOR DIAPER ASSISTANCE 11 (INCLUDING DIAPERING SUPPLIES AND ADULT INCONTI- 12 NENCE MATERIALS AND SUPPLIES) THROUGH THE SO- 13 CIAL SERVICES BLOCK GRANT PROGRAM.— 14 (1) INCREASE IN FUNDING FOR SOCIAL SERV- 15 ICES BLOCK GRANT PROGRAM.— 16 (A) IN GENERAL.—The amount specified 17 in subsection (c) of section 2003 of the Social 18 Security Act (42 U.S.C. 1397b) for purposes of 19 subsections (a) and (b) of such section is 20 deemed to be $1,900,000,000 for each of fiscal 21 years 2023 through 2026, of which, the amount 22 equal to $200,000,000, reduced by the amounts 23 reserved under subparagraph (B)(ii) for each 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00923 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 924 •HR 7585 IH such fiscal year, shall be obligated by States in 1 accordance with paragraph (2). 2 (B) APPROPRIATION.— 3 (i) IN GENERAL.—Out of any money 4 in the Treasury of the United States not 5 otherwise appropriated, there is appro- 6 priated $200,000,000 for each of fiscal 7 years 2023 through 2026, to carry out this 8 subsection. 9 (ii) RESERVATIONS.— 10 (I) PURPOSES.—The Secretary 11 shall reserve, from the amount appro- 12 priated under clause (i) to carry out 13 this subsection— 14 (aa) for each of fiscal years 15 2023 through 2026, not more 16 than 2 percent of the amount ap- 17 propriated for the fiscal year for 18 purposes of entering into an 19 agreement with a national entity 20 described in clause (iii) to assist 21 in providing technical assistance 22 and training, to support effective 23 policy, practice, research, and 24 cross-system collaboration among 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00924 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 925 •HR 7585 IH grantees and subgrantees, and to 1 assist in the administration of 2 the program described in this 3 subsection; and 4 (bb) for fiscal year 2023, an 5 amount, not to exceed 6 $2,000,000, for purposes of con- 7 ducting an evaluation under 8 paragraph (4). 9 (II) NO STATE ENTITLEMENT TO 10 RESERVED FUNDS.—The State enti- 11 tlement under section 2002(a) of the 12 Social Security Act (42 U.S.C. 13 1397a(a)) shall not apply to the 14 amounts reserved under subclause (I). 15 (iii) NATIONAL ENTITY DESCRIBED.— 16 A national entity described in this clause is 17 a nonprofit organization described in sec- 18 tion 501(c)(3) of the Internal Revenue 19 Code of 1986 and exempt from taxation 20 under section 501(a) of such Code, that— 21 (I) has experience in more than 1 22 State in the area of— 23 (aa) community distribu- 24 tions of basic need services, in- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00925 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 926 •HR 7585 IH cluding experience collecting, 1 warehousing, and distributing 2 basic necessities such as diapers, 3 food, or menstrual products; 4 (bb) child care; 5 (cc) child development ac- 6 tivities in low-income commu- 7 nities; or 8 (dd) motherhood, father- 9 hood, or parent education efforts 10 serving low-income parents of 11 young children; 12 (II) demonstrates competency to 13 implement a project, provide fiscal ac- 14 countability, collect data, and prepare 15 reports and other necessary docu- 16 mentation; and 17 (III) demonstrates a willingness 18 to share information with researchers, 19 practitioners, and other interested 20 parties. 21 (2) RULES GOVERNING USE OF ADDITIONAL 22 FUNDS.— 23 (A) IN GENERAL.—Funds are used in ac- 24 cordance with this paragraph if— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00926 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 927 •HR 7585 IH (i) the State, in consultation with rel- 1 evant stakeholders, including agencies, pro- 2 fessional associations, and nonprofit orga- 3 nizations, distributes the funds to eligible 4 entities to— 5 (I) decrease the need for diapers 6 and diapering supplies and adult in- 7 continence materials and supplies in 8 low-income families and meet such 9 unmet needs of infants and toddlers, 10 medically complex children, and low- 11 income adults and adults with disabil- 12 ities in such families through— 13 (aa) the distribution of free 14 diapers and diapering supplies, 15 medically necessary diapers, and 16 adult incontinence materials and 17 supplies; 18 (bb) community outreach to 19 assist in participation in existing 20 diaper distribution programs or 21 programs that distribute medi- 22 cally necessary diapers or adult 23 incontinence materials and sup- 24 plies; or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00927 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 928 •HR 7585 IH (cc) improving access to dia- 1 pers and diapering supplies, 2 medically necessary diapers, and 3 adult incontinence materials and 4 supplies; and 5 (II) increase the ability of com- 6 munities and low-income families in 7 such communities to provide for the 8 need for diapers and diapering sup- 9 plies, medically necessary diapers, and 10 adult continence materials and sup- 11 plies, of infants and toddlers, medi- 12 cally complex children, and low-income 13 adults and adults with disabilities; 14 (ii) the funds are used subject to the 15 limitations in section 2005 of the Social 16 Security Act (42 U.S.C. 1397d); 17 (iii) the funds are used to supplement, 18 not supplant, State general revenue funds 19 provided for the purposes described in 20 clause (i); and 21 (iv) the funds are not used for costs 22 that are reimbursable by the Federal 23 Emergency Management Agency, under a 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00928 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 929 •HR 7585 IH contract for insurance, or by self-insur- 1 ance. 2 (B) ALLOWABLE USES BY ELIGIBLE ENTI- 3 TIES.—An eligible entity receiving funds made 4 available under paragraph (1) shall use the 5 funds for any of the following: 6 (i) To pay for the purchase and dis- 7 tribution of diapers and diapering supplies, 8 medically necessary diapers, and funding 9 diaper (including medically necessary dia- 10 pers) distribution that serves low-income 11 families with— 12 (I) 1 or more children 3 years of 13 age or younger; or 14 (II) 1 or more medically complex 15 children. 16 (ii) To pay for the purchase and dis- 17 tribution of adult incontinence materials 18 and supplies and funding distribution of 19 such materials and supplies that serves 20 low-income families with 1 or more low-in- 21 come adults or adults with disabilities who 22 rely on adult incontinence materials and 23 supplies. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00929 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 930 •HR 7585 IH (iii) To integrate activities carried out 1 under clause (i) with other basic needs as- 2 sistance programs serving eligible children 3 and their families, including the following: 4 (I) Programs funded by the tem- 5 porary assistance for needy families 6 program under part A of title IV of 7 the Social Security Act (42 U.S.C. 8 601 et seq.), including the State 9 maintenance of effort provisions of 10 such program. 11 (II) Programs designed to sup- 12 port the health of eligible children, 13 such as the Children’s Health Insur- 14 ance Program under title XXI of the 15 Social Security Act, the Medicaid pro- 16 gram under title XIX of such Act, or 17 State funded health care programs. 18 (III) Programs funded through 19 the special supplemental nutrition 20 program for women, infants, and chil- 21 dren under section 17 of the Child 22 Nutrition Act of 1966. 23 (IV) Programs that offer early 24 home visiting services, including the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00930 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 931 •HR 7585 IH maternal, infant, and early childhood 1 home visiting program (including the 2 Tribal home visiting program) under 3 section 511 of the Social Security Act 4 (42 U.S.C. 711). 5 (V) Programs to provide im- 6 proved and affordable access to child 7 care, including programs funded 8 through the Child Care and Develop- 9 ment Fund, the temporary assistance 10 for needy families program under part 11 A of title IV of the Social Security 12 Act (42 U.S.C. 601 et seq.), or a 13 State-funded program. 14 (C) AVAILABILITY OF FUNDS.— 15 (i) FUNDS DISTRIBUTED TO ELIGIBLE 16 ENTITIES.—Funds made available under 17 paragraph (1) that are distributed to an el- 18 igible entity by a State for a fiscal year 19 may be expended by the eligible entity only 20 in such fiscal year or the succeeding fiscal 21 year. 22 (ii) EVALUATION.—Funds reserved 23 under paragraph (1)(B)(ii)(I)(aa) to carry 24 out the evaluation under paragraph (4) 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00931 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 932 •HR 7585 IH shall be available for expenditure during 1 the 3-year period that begins on the date 2 of enactment of this Act. 3 (D) NO EFFECT ON OTHER PROGRAMS.— 4 Any assistance or benefits received by a family 5 through funds made available under paragraph 6 (1) shall be disregarded for purposes of deter- 7 mining the family’s eligibility for, or amount of, 8 benefits under any other Federal needs-based 9 programs. 10 (3) ANNUAL REPORTS.—A State shall include 11 in the annual report required under section 2006 of 12 the Social Security Act (42 U.S.C. 1397e) covering 13 each of fiscal years 2022 through 2025, information 14 detailing how eligible entities, including subgrantees, 15 used funds made available under paragraph (1) to 16 distribute diapers and diapering supplies and adult 17 incontinence materials and supplies to families in 18 need. Each such report shall include the following: 19 (A) The number and age of infants, tod- 20 dlers, medically complex children, and low-in- 21 come adults and adults with disabilities who re- 22 ceived assistance or benefits through such 23 funds. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00932 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 933 •HR 7585 IH (B) The number of families that have re- 1 ceived assistance or benefits through such 2 funds. 3 (C) The number of diapers, medically nec- 4 essary diapers, or adult incontinence materials 5 and supplies (such as adult diapers, briefs, pro- 6 tective underwear, pull-ons, pull-ups, liners, 7 shields, guards, pads, undergarments), and the 8 number of each type of diapering or adult in- 9 continence supply, distributed through the use 10 of such funds. 11 (D) The ZIP Code or ZIP Codes where the 12 eligible entity (or subgrantee) distributed dia- 13 pers and diapering supplies and adult inconti- 14 nence materials and supplies. 15 (E) The method or methods the eligible en- 16 tity (or subgrantee) uses to distribute diapers 17 and diapering supplies and, adult incontinence 18 materials and supplies. 19 (F) Such other information as the Sec- 20 retary may specify. 21 (4) EVALUATION.—The Secretary, in consulta- 22 tion with States, the national entity described in 23 paragraph (1)(B)(iii), and eligible entities receiving 24 funds made available under this subsection, shall— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00933 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 934 •HR 7585 IH (A) not later than 2 years after the date 1 of enactment of this Act— 2 (i) complete an evaluation of the effec- 3 tiveness of the assistance program carried 4 out pursuant to this subsection, such as 5 the effect of activities carried out under 6 this section on mitigating the health and 7 developmental risks of unmet diaper need 8 among infants, toddlers, medically complex 9 children, and other family members in low- 10 income families, including the risks of dia- 11 per dermatitis, urinary tract infections, 12 and parental and child depression and anx- 13 iety; 14 (ii) submit to the relevant congres- 15 sional committees a report on the results 16 of such evaluation; and 17 (iii) publish the results of the evalua- 18 tion on the internet website of the Depart- 19 ment of Health and Human Services; 20 (B) not later than 3 years after the date 21 of enactment of this Act, update the evaluation 22 required by subparagraph (A)(i); and 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00934 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 935 •HR 7585 IH (C) not later than 90 days after completion 1 of the updated evaluation under subparagraph 2 (B)— 3 (i) submit to the relevant congres- 4 sional committees a report describing the 5 results of such updated evaluation; and 6 (ii) publish the results of such evalua- 7 tion on the internet website of the Depart- 8 ment of Health and Human Services. 9 (5) GUIDANCE.—Not later than 180 days after 10 enactment of this Act, the Secretary shall issue 11 guidance regarding how the provisions of this sub- 12 section should be carried out, including information 13 regarding eligible entities, allowable use of funds, 14 and reporting requirements. 15 (6) DEFINITIONS.—In this subsection: 16 (A) ADULT INCONTINENCE MATERIALS 17 AND SUPPLIES.—The term ‘‘adult incontinence 18 materials and supplies’’ means those supplies 19 that are used to assist low-income adults or 20 adults with disabilities and includes adult dia- 21 pers, briefs, protective underwear, pull-ons, 22 pull-ups, liners, shields, guards, pads, undergar- 23 ments, disposable wipes, over-the-counter adult 24 diaper rash cream products, intermittent cath- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00935 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 936 •HR 7585 IH eterization, indwelling catheters, condom cath- 1 eters, urinary drainage bags, external collection 2 devices, wearable urinals, and penile clamps. 3 (B) ADULTS WITH DISABILITIES.—The 4 term ‘‘adults with disabilities’’ means individ- 5 uals who— 6 (i) have attained age 18; and 7 (ii) have a disability (as such term is 8 defined, with respect to an individual, in 9 section 3 of the Americans with Disabil- 10 ities Act of 1990 (42 U.S.C. 12102)). 11 (C) DIAPER.—The term ‘‘diaper’’ means 12 an absorbent garment that— 13 (i) is washable or disposable that may 14 be worn by an infant or toddler who is not 15 toilet-trained; and 16 (ii) if disposable— 17 (I) does not use any latex or 18 common allergens; and 19 (II) meets or exceeds the quality 20 standards for diapers commercially 21 available through retail sale in the fol- 22 lowing categories: 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00936 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 937 •HR 7585 IH (aa) Absorbency (with ac- 1 ceptable rates for first and sec- 2 ond wetting). 3 (bb) Waterproof outer cover. 4 (cc) Flexible leg openings. 5 (dd) Refastening closures. 6 (D) DIAPERING SUPPLIES.—The term 7 ‘‘diapering supplies’’ means items, including di- 8 aper wipes and diaper cream, necessary to en- 9 sure that— 10 (i) an eligible child using a diaper is 11 properly cleaned and protected from diaper 12 rash; or 13 (ii) a medically complex child who 14 uses a medically necessary diaper is prop- 15 erly cleaned and protected from diaper 16 rash. 17 (E) ELIGIBLE CHILD.—The term ‘‘eligible 18 child’’ means a child who— 19 (i) has not attained 4 years of age; 20 and 21 (ii) is a member of a low-income fam- 22 ily. 23 (F) ELIGIBLE ENTITIES.—The term ‘‘eligi- 24 ble entity’’ means a State or local governmental 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00937 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 938 •HR 7585 IH entity, an Indian tribe or tribal organization (as 1 defined in section 4 of the Indian Self-Deter- 2 mination and Education Assistance Act), or a 3 nonprofit organization described in section 4 501(c)(3) of the Internal Revenue Code of 1986 5 and exempt from taxation under section 501(a) 6 of such Code that— 7 (i) has experience in the area of— 8 (I) community distributions of 9 basic need services, including experi- 10 ence collecting, warehousing, and dis- 11 tributing basic necessities such as dia- 12 pers, food, or menstrual products; 13 (II) child care; 14 (III) child development activities 15 in low-income communities; or 16 (IV) motherhood, fatherhood, or 17 parent education efforts serving low- 18 income parents of young children; 19 (ii) demonstrates competency to im- 20 plement a project, provide fiscal account- 21 ability, collect data, and prepare reports 22 and other necessary documentation; and 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00938 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 939 •HR 7585 IH (iii) demonstrates a willingness to 1 share information with researchers, practi- 2 tioners, and other interested parties. 3 (G) FEDERAL POVERTY LINE.—The term 4 ‘‘Federal poverty line’’ means the Federal pov- 5 erty line as defined by the Office of Manage- 6 ment and Budget and revised annually in ac- 7 cordance with section 673(2) of the Omnibus 8 Budget Reconciliation Act of 1981 applicable to 9 a family of the size involved. 10 (H) LOW-INCOME.—The term ‘‘low-in- 11 come’’, with respect to a family, means a family 12 whose self-certified income is not more than 13 200 percent of the Federal poverty line. 14 (I) MEDICALLY COMPLEX CHILD.—The 15 term ‘‘medically complex child’’ means an indi- 16 vidual who has attained age 3 and for whom a 17 licensed health care provider has provided a di- 18 agnosis of bowel or bladder incontinence, a 19 bowel or bladder condition that causes excess 20 urine or stool (such as short gut syndrome or 21 diabetes insipidus), or a severe skin condition 22 that causes skin erosions (such as epidermolysis 23 bullosa). 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00939 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 940 •HR 7585 IH (J) MEDICALLY NECESSARY DIAPER.—The 1 term ‘‘medically necessary diaper’’ means an 2 absorbent garment that is— 3 (i) washable or disposable; 4 (ii) worn by a medically complex child 5 who has been diagnosed with bowel or 6 bladder incontinence, a bowel or bladder 7 condition that causes excess urine or stool 8 (such as short gut syndrome or diabetes 9 insipidus), or a severe skin condition that 10 causes skin erosions (such as epidermolysis 11 bullosa) and needs such garment to correct 12 or ameliorate such condition; and 13 (iii) if disposable— 14 (I) does not use any latex or 15 common allergens; and 16 (II) meets or exceeds the quality 17 standards for diapers commercially 18 available through retail sale in the fol- 19 lowing categories: 20 (aa) Absorbency (with ac- 21 ceptable rates for first and sec- 22 ond wetting). 23 (bb) Waterproof outer cover. 24 (cc) Flexible leg openings. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00940 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 941 •HR 7585 IH (dd) Refastening closures. 1 (7) EXEMPTION OF PROGRAM FROM SEQUES- 2 TRATION.— 3 (A) IN GENERAL.—Section 255(h) of the 4 Balanced Budget and Emergency Deficit Con- 5 trol Act of 1985 (2 U.S.C. 905(h)) is amended 6 by inserting after ‘‘Supplemental Security In- 7 come Program (28–0406–0–1–609).’’ the fol- 8 lowing: 9 ‘‘Targeted funding for States for diaper assist- 10 ance (including diapering supplies and adult inconti- 11 nence materials and supplies) through the Social 12 Services Block Grant Program.’’. 13 (B) APPLICABILITY.—The amendment 14 made by this paragraph shall apply to any se- 15 questration order issued under the Balanced 16 Budget and Emergency Deficit Control Act of 17 1985 (2 U.S.C. 900 et seq.) on or after the 18 date of enactment of this Act. 19 (b) IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 20 COMPLEX CHILDREN.—Section 1915(c) of the Social Se- 21 curity Act (42 U.S.C. 1396n(c)) is amended by adding at 22 the end the following new paragraph: 23 ‘‘(11)(A) In the case of any waiver under this sub- 24 section that provides medical assistance to a medically 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00941 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 942 •HR 7585 IH complex child who has been diagnosed with bowel or blad- 1 der incontinence, a bowel or bladder condition that causes 2 excess urine or stool (such as short gut syndrome or diabe- 3 tes insipidus), or a severe skin condition that causes skin 4 erosions (such as epidermolysis bullosa), such medical as- 5 sistance shall include, for the duration of the waiver, the 6 provision of 200 medically necessary diapers per month 7 and diapering supplies. Such medical assistance may in- 8 clude the provision of medically necessary diapers in 9 amounts greater than 200 if a licensed health care pro- 10 vider (such as a physician, nurse practitioner, or physician 11 assistant) specifies that such greater amounts are nec- 12 essary for such medically complex child. 13 ‘‘(B) For purposes of this paragraph: 14 ‘‘(i) The term ‘medically complex child’ means 15 an individual who has attained age 3 and for whom 16 a licensed health care provider has provided a diag- 17 nosis of 1 or more significant chronic conditions. 18 ‘‘(ii) The term ‘medically necessary diaper’ 19 means an absorbent garment that is— 20 ‘‘(I) washable or disposable; 21 ‘‘(II) worn by a medically complex child 22 who has been diagnosed with a condition de- 23 scribed in subparagraph (A) and needs such 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00942 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 943 •HR 7585 IH garment to correct or ameliorate such condition; 1 and 2 ‘‘(III) if disposable— 3 ‘‘(aa) does not use any latex or com- 4 mon allergens; and 5 ‘‘(bb) meets or exceeds the quality 6 standards for diapers commercially avail- 7 able through retail sale in the following 8 categories: 9 ‘‘(AA) Absorbency (with accept- 10 able rates for first and second wet- 11 ting). 12 ‘‘(BB) Waterproof outer cover. 13 ‘‘(CC) Flexible leg openings. 14 ‘‘(DD) Refastening closures. 15 ‘‘(iii) The term ‘diapering supplies’ means 16 items, including diaper wipes and diaper creams, 17 necessary to ensure that a medically complex child 18 who has been diagnosed with a condition described 19 in subparagraph (A) and uses a medically necessary 20 diaper is properly cleaned and protected from diaper 21 rash.’’. 22 (c) INCLUSION OF DIAPERS AND DIAPERING SUP- 23 PLIES AS QUALIFIED MEDICAL EXPENSES.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00943 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 944 •HR 7585 IH (1) HEALTH SAVINGS ACCOUNTS.—Section 1 223(d)(2) of the Internal Revenue Code of 1986 is 2 amended— 3 (A) by inserting ‘‘, medically necessary dia- 4 pers, and diapering supplies’’ after ‘‘menstrual 5 care products’’ in the last sentence of subpara- 6 graph (A); and 7 (B) by adding at the end the following new 8 subparagraph: 9 ‘‘(E) MEDICALLY NECESSARY DIAPERS 10 AND DIAPERING SUPPLIES.—For purposes of 11 this paragraph— 12 ‘‘(i) MEDICALLY NECESSARY DIA- 13 PERS.—The term ‘medically necessary dia- 14 per’ means an absorbent garment which is 15 washable or disposable and which is worn 16 by an individual who has attained 3 years 17 of age because of medical necessity, such 18 as someone who has been diagnosed with 19 bowel or bladder incontinence, a bowel or 20 bladder condition that causes excess urine 21 or stool (such as short gut syndrome or di- 22 abetes insipidus), or a severe skin condi- 23 tion that causes skin erosions (such as 24 epidermolysis bullosa) and needs such gar- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00944 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 945 •HR 7585 IH ment to correct or ameliorate such condi- 1 tion, to serve a preventative medical pur- 2 pose, or to correct or ameliorate defects or 3 physical or mental illnesses or conditions 4 diagnosed by a licensed health care pro- 5 vider, and, if disposable— 6 ‘‘(I) does not use any latex or 7 common allergens; and 8 ‘‘(II) meets or exceeds the quality 9 standards for diapers commercially 10 available through retail sale in the fol- 11 lowing categories: 12 ‘‘(aa) Absorbency (with ac- 13 ceptable rates for first and sec- 14 ond wetting). 15 ‘‘(bb) Waterproof outer 16 cover. 17 ‘‘(cc) Flexible leg openings. 18 ‘‘(dd) Refastening closures. 19 ‘‘(ii) DIAPERING SUPPLIES.—The 20 term ‘diapering supplies’ means items, in- 21 cluding diaper wipes and diaper creams, 22 necessary to ensure that an individual 23 wearing medically necessary diapers is 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00945 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 946 •HR 7585 IH properly cleaned and protected from diaper 1 rash.’’. 2 (2) ARCHER MSAS.—The last sentence of sec- 3 tion 220(d)(2)(A) of such Code is amended by in- 4 serting ‘‘, medically necessary diapers (as defined in 5 section 223(d)(2)(E)), and diapering supplies (as de- 6 fined in section 223(d)(2)(E))’’ after ‘‘menstrual 7 care products (as defined in section 223(d)(2)(D))’’. 8 (3) HEALTH FLEXIBLE SPENDING ARRANGE- 9 MENTS AND HEALTH REIMBURSEMENT ARRANGE- 10 MENTS.—Section 106(f) of such Code is amended— 11 (A) by inserting ‘‘, medically necessary dia- 12 pers (as defined in section 223(d)(2)(E)), and 13 diapering supplies (as defined in section 14 223(d)(2)(E))’’ after ‘‘menstrual care products 15 (as defined in section 223(d)(2)(D))’’; and 16 (B) in the heading, by inserting ‘‘, MEDI- 17 CALLY NECESSARY DIAPERS, AND DIAPERING 18 SUPPLIES’’ after ‘‘MENSTRUAL CARE PROD- 19 UCTS’’. 20 (4) EFFECTIVE DATES.— 21 (A) DISTRIBUTIONS FROM CERTAIN AC- 22 COUNTS.—The amendments made by para- 23 graphs (1) and (2) shall apply to amounts paid 24 after December 31, 2023. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 947 •HR 7585 IH (B) REIMBURSEMENTS.—The amendment 1 made by paragraph (3) shall apply to expenses 2 incurred after December 31, 2023. 3 SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN 4 UNEXPECTED INFANT DEATH AND SUDDEN 5 UNEXPLAINED DEATH IN CHILDHOOD. 6 (a) ESTABLISHMENT.—The Secretary of Health and 7 Human Services, acting through the Administrator of the 8 Health Resources and Services Administration and in con- 9 sultation with the Director of the Centers for Disease Con- 10 trol and Prevention and the Director of the National Insti- 11 tutes of Health (in this section referred to as the ‘‘Sec- 12 retary’’), shall establish and implement a culturally and 13 linguistically competent public health awareness and edu- 14 cation campaign to provide information that is focused on 15 decreasing the risk factors for sudden unexpected infant 16 death and sudden unexplained death in childhood, includ- 17 ing educating individuals about safe sleep environments, 18 sleep positions, and reducing exposure to smoking during 19 pregnancy and after birth. 20 (b) TARGETED POPULATIONS.—The campaign under 21 subsection (a) shall be designed to reduce health inequities 22 through the targeting of populations with high rates of 23 sudden unexpected infant death and sudden unexplained 24 death in childhood. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00947 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 948 •HR 7585 IH (c) CONSULTATION.—In establishing and imple- 1 menting the campaign under subsection (a), the Secretary 2 shall consult with national organizations representing 3 health care providers, including nurses and physicians, 4 parents, child care providers, children’s advocacy and safe- 5 ty organizations, maternal and child health programs, nu- 6 trition professionals focusing on people, infants, and chil- 7 dren, and other individuals and groups determined nec- 8 essary by the Secretary for such establishment and imple- 9 mentation. 10 (d) GRANTS.— 11 (1) IN GENERAL.—In carrying out the cam- 12 paign under subsection (a), the Secretary shall 13 award grants to national organizations, State and 14 local health departments, and community-based or- 15 ganizations for the conduct of education and out- 16 reach programs for nurses, parents, child care pro- 17 viders, public health agencies, and community orga- 18 nizations. 19 (2) APPLICATION.—To be eligible to receive a 20 grant under paragraph (1), an entity shall submit to 21 the Secretary an application at such time, in such 22 manner, and containing such information as the Sec- 23 retary may require. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00948 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 949 •HR 7585 IH (e) AUTHORIZATION OF APPROPRIATIONS.—There is 1 authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2023 through 2027. 4 Subtitle G—Nutrition for Women, 5 Children, Families 6 SEC. 5601. REMOVING BARRIERS TO HEALTH CARE AND NU- 7 TRITION ASSISTANCE FOR CHILDREN, PREG- 8 NANT PERSONS, AND LAWFULLY PRESENT IN- 9 DIVIDUALS. 10 (a) MEDICAID.—Paragraph (4) of section 1903(v) of 11 the Social Security Act (42 U.S.C. 1396b(v)) is amended 12 to read as follows: 13 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 14 403, and 421 of the Personal Responsibility and Work Op- 15 portunity Reconciliation Act of 1996 and paragraph (1), 16 payment shall be made to a State under this section for 17 medical assistance furnished to an alien under this title 18 (including an alien described in such paragraph) who 19 meets any of the following conditions: 20 ‘‘(i) The alien is otherwise eligible for such as- 21 sistance under the State plan approved under this 22 title (other than the requirement of the receipt of 23 aid or assistance under title IV, supplemental secu- 24 rity income benefits under title XVI, or a State sup- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00949 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 950 •HR 7585 IH plementary payment) within either or both of the 1 following eligibility categories: 2 ‘‘(I) Children under 21 years of age, in- 3 cluding any optional targeted low-income child 4 (as such term is defined in section 5 1905(u)(2)(B)). 6 ‘‘(II) Pregnant persons during pregnancy 7 and during the 12-month period beginning on 8 the last day of the pregnancy. 9 ‘‘(ii) The alien is lawfully present in the United 10 States. 11 ‘‘(B) No debt shall accrue under an affidavit of sup- 12 port against any sponsor of an alien who meets the condi- 13 tions specified in subparagraph (A) on the basis of the 14 provision of medical assistance to such alien under this 15 paragraph and the cost of such assistance shall not be con- 16 sidered as an unreimbursed cost.’’. 17 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 18 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 19 amended to read as follows: 20 ‘‘(N) Paragraph (4) of section 1903(v) (re- 21 lating to coverage of categories of children, 22 pregnant persons, and other lawfully present in- 23 dividuals).’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00950 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 951 •HR 7585 IH (c) SUPPLEMENTAL NUTRITION ASSISTANCE FOR 1 LAWFULLY PRESENT INDIVIDUALS.— 2 (1) IN GENERAL.—Section 402(a)(2)(J) of the 3 Personal Responsibility and Work Opportunity Rec- 4 onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(J)) is 5 amended— 6 (A) in the subparagraph heading, by strik- 7 ing ‘‘CERTAIN CHILDREN’’ inserting ‘‘CHILDREN 8 AND LAWFULLY PRESENT INDIVIDUALS’’; and 9 (B) by striking ‘‘who is under 18 years of 10 age.’’ and inserting ‘‘who is— 11 ‘‘(i) under 21 years of age; or 12 ‘‘(ii) lawfully present in the United 13 States.’’. 14 (2) CONFORMING AMENDMENTS.— 15 (A) Section 402(a)(3) of such Act (8 16 U.S.C. 1612(a)(3)) is amended by striking sub- 17 paragraph (B) and inserting the following: 18 ‘‘(B) SNAP (FOOD STAMP PROGRAM).— 19 The supplemental nutrition assistance program 20 established under the Food and Nutrition Act 21 of 2008 (7 U.S.C. 2011 et seq.) (referred to in 22 this title as ‘SNAP’ or the ‘food stamp pro- 23 gram’).’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00951 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 952 •HR 7585 IH (B) Section 403(c)(2)(L) of such Act (42 1 U.S.C. 1613(c)(2)(L)) is amended by striking 2 ‘‘18’’ and all that follows through the period 3 and inserting ‘‘21, or to individuals who are 4 lawfully present in the United States, under the 5 supplemental nutrition assistance program es- 6 tablished under the Food and Nutrition Act of 7 2008 (7 U.S.C. 2011 et seq.).’’. 8 (C) Section 5(i)(2)(E) of the Food and 9 Nutrition Act of 2008 (7 U.S.C. 2014(i)(2)(E)) 10 is amended by striking ‘‘18 years of age.’’ and 11 inserting ‘‘21 years of age, or who is lawfully 12 present in the United States.’’. 13 (d) NONAPPLICATION OF SPONSOR DEEMING; AS- 14 SURING ELIGIBILITY FOR FAMILIES.—Section 421(d) of 15 the Personal Responsibility and Work Opportunity Rec- 16 onciliation Act of 1996 (8 U.S.C. 1631(d)) is amended 17 by striking paragraph (3) and inserting the following: 18 ‘‘(3) This section shall not apply to assistance 19 or benefits under the supplemental nutrition assist- 20 ance program established under the Food and Nutri- 21 tion Act of 2008 (7 U.S.C. 2011 et seq.) for a quali- 22 fied alien who is eligible under section 402(a)(2)(J) 23 and for any member of the household of such quali- 24 fied alien.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00952 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 953 •HR 7585 IH (e) ENSURING PROPER SCREENING.—Section 1 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 2 U.S.C. 2020(e)(2)(B)) is amended— 3 (1) by redesignating clauses (vi) and (vii) as 4 clauses (vii) and (viii), respectively; and 5 (2) by inserting after clause (v) the following: 6 ‘‘(vi) shall provide a method for imple- 7 menting section 421 of the Personal Re- 8 sponsibility and Work Opportunity Rec- 9 onciliation Act of 1996 (8 U.S.C. 1631) 10 that does not require any unnecessary in- 11 formation from applicants who may be ex- 12 empt from that provision;’’. 13 SEC. 5602. CLOSING THE MEAL GAP. 14 (a) ELIMINATION OF TIME LIMIT.— 15 (1) IN GENERAL.—Section 6 of the Food and 16 Nutrition Act of 2008 (7 U.S.C. 2015) is amend- 17 ed— 18 (A) by striking subsection (o); and 19 (B) by redesignating subsections (p) 20 through (s) as subsections (o) through (r), re- 21 spectively. 22 (2) ADDITIONAL ALLOCATIONS FOR STATES 23 THAT ENSURE AVAILABILITY OF WORK OPPORTUNI- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00953 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 954 •HR 7585 IH TIES.—Section 16(h) of the Food and Nutrition Act 1 of 2008 (7 U.S.C. 2025(h)) is amended— 2 (A) in paragraph (1)— 3 (i) in subparagraph (C)(iv)(I)— 4 (I) by striking ‘‘(F)(viii)’’ each 5 place it appears and inserting 6 ‘‘(E)(viii)’’; 7 (II) by striking ‘‘(F)(vii)(I)’’ each 8 place it appears and inserting 9 ‘‘(E)(vii)(I)’’; 10 (III) in item (bb)(BB), by strik- 11 ing ‘‘(F)(vii)(II)’’ and inserting 12 ‘‘(E)(vii)(II)’’; and 13 (IV) in item (cc), by striking 14 ‘‘(F)(vii)’’ and inserting ‘‘(E)(vii)’’; 15 (ii) by striking subparagraph (E); and 16 (iii) by redesignating subparagraph 17 (F) as subparagraph (E); 18 (B) in paragraphs (3) and (4), by striking 19 ‘‘(1)(F)’’ each place it appears and inserting 20 ‘‘(1)(E)’’; and 21 (C) in paragraph (5)(C)— 22 (i) in clause (ii), by adding ‘‘and’’ at 23 the end; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00954 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 955 •HR 7585 IH (ii) in clause (iii), by striking ‘‘; and’’ 1 and inserting a period; and 2 (iii) by striking clause (iv). 3 (3) CONFORMING AMENDMENTS.— 4 (A) Section 5(a) of the Food and Nutrition 5 Act of 2008 (7 U.S.C. 2014(a)) is amended in 6 the second sentence, by striking ‘‘(r)’’ and in- 7 serting ‘‘(q)’’. 8 (B) Section 6(d)(4) of the Food and Nutri- 9 tion Act of 2008 (7 U.S.C. 2015(d)(4)) is 10 amended— 11 (i) in subparagraph 12 (B)(ii)(I)(bb)(DD), by striking ‘‘or sub- 13 section (o)’’; and 14 (ii) in subparagraph (N), by striking 15 ‘‘or subsection (o)’’ each place it appears. 16 (C) Section 7(i)(1) of the Food and Nutri- 17 tion Act of 2008 (7 U.S.C. 2016(i)(1)) is 18 amended by striking ‘‘section 6(o)(2) of this 19 Act or’’. 20 (D) Section 16(h)(1) of the Food and Nu- 21 trition Act of 2008 (7 U.S.C. 2025(h)) is 22 amended— 23 (i) in subparagraph (B), in the matter 24 preceding clause (i), by striking ‘‘that—’’ 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00955 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 956 •HR 7585 IH and all that follows through the period at 1 the end of clause (ii) and inserting ‘‘that 2 is determined and adjusted by the Sec- 3 retary.’’; and 4 (ii) in clause (ii)(III)(ee)(AA) of sub- 5 paragraph (E) (as redesignated by para- 6 graph (2)(A)(iii)), by striking ‘‘, individ- 7 uals subject to the requirements under sec- 8 tion 6(o),’’. 9 (E) Section 51(d)(8)(A)(ii) of the Internal 10 Revenue Code of 1986 is amended— 11 (i) in subclause (I), by striking ‘‘, or’’ 12 at the end and inserting a period; 13 (ii) in the matter preceding subclause 14 (I), by striking ‘‘family—’’ and all that fol- 15 lows through ‘‘receiving’’ in subclause (I) 16 and inserting ‘‘family receiving’’; and 17 (iii) by striking subclause (II). 18 (F) Section 103(a)(2) of the Workforce In- 19 novation and Opportunity Act (29 U.S.C. 3113) 20 is amended— 21 (i) by striking subparagraph (D); and 22 (ii) by redesignating subparagraphs 23 (E) through (K) as subparagraphs (D) 24 through (J), respectively. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00956 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 957 •HR 7585 IH (G) Section 121(b)(2)(B) of the Workforce 1 Innovation and Opportunity Act (29 U.S.C. 2 3151) is amended— 3 (i) by striking clause (iv); and 4 (ii) by redesignating clauses (v) 5 through (vii) as clauses (iv) through (vi), 6 respectively. 7 (b) PARTICIPATION OF PUERTO RICO, AMERICAN 8 SAMOA, AND THE NORTHERN MARIANA ISLANDS IN SUP- 9 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 10 (1) DEFINITION OF STATE.—Subsection (r) of 11 section 3 of the Food and Nutrition Act of 2008 (7 12 U.S.C. 2012) is amended by inserting ‘‘the Com- 13 monwealth of Puerto Rico, American Samoa, the 14 Commonwealth of the Northern Mariana Islands,’’ 15 after ‘‘Guam,’’. 16 (2) ELIGIBLE HOUSEHOLDS.—Section 5 of the 17 Food and Nutrition Act of 2008 (7 U.S.C. 2014) is 18 amended— 19 (A) in subsection (c), in the undesignated 20 matter at the end, by striking ‘‘States or 21 Guam’’ and inserting ‘‘States, Guam, the Com- 22 monwealth of Puerto Rico, American Samoa, or 23 the Commonwealth of the Northern Mariana Is- 24 lands’’; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00957 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 958 •HR 7585 IH (B) by adding at the end the following: 1 ‘‘(o) PUERTO RICO, AMERICAN SAMOA, AND THE 2 NORTHERN MARIANA ISLANDS.—Notwithstanding any 3 other provision of this Act, including the requirements 4 under this section, the Commonwealth of Puerto Rico, 5 American Samoa, and the Commonwealth of the Northern 6 Mariana Islands shall each establish their own standards 7 of eligibility for participation by households in the supple- 8 mental nutrition assistance program.’’. 9 (3) EFFECTIVE DATE.— 10 (A) IN GENERAL.—The amendments made 11 by paragraphs (1) and (2) shall be effective 12 with respect to the Commonwealth of Puerto 13 Rico, American Samoa, and the Commonwealth 14 of the Northern Mariana Islands, as applicable, 15 on the date described in subparagraph (B) if 16 the Secretary of Agriculture submits to Con- 17 gress a certification under subsection (f)(2)(B) 18 of section 19 of the Food and Nutrition Act of 19 2008 (7 U.S.C. 2028). 20 (B) DATE DESCRIBED.—The date referred 21 to in subparagraph (A) is, with respect to the 22 Commonwealth of Puerto Rico, American 23 Samoa, and the Commonwealth of the Northern 24 Mariana Islands, the date established by the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00958 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 959 •HR 7585 IH Commonwealth of Puerto Rico, American 1 Samoa, or the Commonwealth of the Northern 2 Mariana Islands, respectively, in the applicable 3 plan of operation submitted to the Secretary of 4 Agriculture under subsection (f)(1)(A) of sec- 5 tion 19 of the Food and Nutrition Act of 2008 6 (7 U.S.C. 2028). 7 (c) TRANSITION OF PUERTO RICO, AMERICAN 8 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP- 9 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.—Section 10 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) 11 is amended— 12 (1) in subsection (a)(1)— 13 (A) in subparagraph (A), by striking 14 ‘‘and’’ at the end; 15 (B) in subparagraph (B), by striking the 16 period at the end and inserting ‘‘; and’’; and 17 (C) by adding at the end the following: 18 ‘‘(C) the Commonwealth of the Northern 19 Mariana Islands.’’; and 20 (2) by adding at the end the following: 21 ‘‘(f) TRANSITION OF PUERTO RICO, AMERICAN 22 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP- 23 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00959 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 960 •HR 7585 IH ‘‘(1) REQUEST FOR PARTICIPATION.—A govern- 1 mental entity may submit to the Secretary a request 2 to participate in the supplemental nutrition assist- 3 ance program, which shall include a plan of oper- 4 ation described in section 11(d), which shall include 5 the date on which the governmental entity intends to 6 begin participation in the program. 7 ‘‘(2) CERTIFICATION BY SECRETARY.— 8 ‘‘(A) IN GENERAL.—The Secretary shall 9 certify a governmental entity that submits a re- 10 quest under paragraph (1) as qualified to par- 11 ticipate in the supplemental nutrition assistance 12 program if the Secretary— 13 ‘‘(i) approves the plan of operation 14 submitted with the request, in accordance 15 with this subsection; and 16 ‘‘(ii) approves the applications de- 17 scribed in paragraph (4) in accordance 18 with that paragraph. 19 ‘‘(B) SUBMISSION OF CERTIFICATION TO 20 CONGRESS.—The Secretary shall submit each 21 certification under subparagraph (A) to Con- 22 gress. 23 ‘‘(3) DETERMINATION OF PLAN OF OPER- 24 ATION.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00960 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 961 •HR 7585 IH ‘‘(A) APPROVAL.—The Secretary shall ap- 1 prove a plan of operation submitted with a re- 2 quest under paragraph (1) if the plan satisfies 3 the requirements under this Act for a plan of 4 operation. 5 ‘‘(B) DISAPPROVAL.—If the Secretary does 6 not approve a plan of operation submitted with 7 a request under paragraph (1), the Secretary 8 shall provide to the governmental entity a state- 9 ment that describes each requirement under 10 this Act that is not satisfied by the plan. 11 ‘‘(4) APPROVAL OF RETAIL FOOD STORES.— 12 ‘‘(A) SOLICITATION OF APPLICATIONS.—If 13 the Secretary approves a plan of operation 14 under paragraph (3)(A) for a governmental en- 15 tity, the Secretary shall accept applications 16 from retail food stores located in that govern- 17 mental entity to be authorized under section 9 18 to participate in the supplemental nutrition as- 19 sistance program. 20 ‘‘(B) DETERMINATION.—The Secretary 21 shall authorize a retail food store applying to 22 participate in the supplemental nutrition assist- 23 ance program under subparagraph (A) if the 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00961 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 962 •HR 7585 IH application satisfies the requirements under this 1 Act for authorization of a retail food store. 2 ‘‘(5) PUERTO RICO.—In the case of a request 3 under paragraph (1) by the Commonwealth of Puer- 4 to Rico, notwithstanding subsection (g), the Sec- 5 retary shall allow the Commonwealth of Puerto Rico 6 to continue to carry out under the supplemental nu- 7 trition assistance program the Family Market Pro- 8 gram established pursuant to this section. 9 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 10 There are authorized to be appropriated to the Sec- 11 retary to carry out this subsection such sums as are 12 necessary for fiscal year 2023, to remain available 13 until expended. 14 ‘‘(g) TERMINATION OF EFFECTIVENESS.— 15 ‘‘(1) IN GENERAL.—Subsections (a) through (e) 16 shall cease to be effective with respect to the Com- 17 monwealth of Puerto Rico, American Samoa, and 18 the Commonwealth of the Northern Mariana Is- 19 lands, as applicable, on the date described in para- 20 graph (2) if the Secretary submits to Congress a 21 certification under subsection (f)(2)(B) for that gov- 22 ernmental entity. 23 ‘‘(2) DATE DESCRIBED.—The date referred to 24 in paragraph (1) is, with respect to the Common- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00962 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 963 •HR 7585 IH wealth of Puerto Rico, American Samoa, and the 1 Commonwealth of the Northern Mariana Islands, 2 the date established by the Commonwealth of Puerto 3 Rico, American Samoa, or the Commonwealth of the 4 Northern Mariana Islands, respectively, in the appli- 5 cable plan of operation submitted to the Secretary 6 under subsection (f)(1)(A).’’. 7 SEC. 5603. REPEAL OF DENIAL OF SUPPLEMENTAL NUTRI- 8 TION ASSISTANCE PROGRAM BENEFITS. 9 Section 115 of the Personal Responsibility and Work 10 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 11 is amended— 12 (1) in subsection (a), by striking ‘‘for—’’ and 13 all that follows and inserting ‘‘for assistance under 14 any State program funded under part A of title IV 15 of the Social Security Act (42 U.S.C. 601 et seq.).’’; 16 (2) in subsection (b)— 17 (A) by striking ‘‘OTHERS.—’’ and all that 18 follows through ‘‘FAMILIES.—The’’ and insert 19 ‘‘OTHERS.—The’’ 20 (B) by striking paragraph (2); and 21 (3) in subsection (e), by striking ‘‘it—’’ and all 22 that follows and inserting ‘‘the term in section 23 419(5) of the Social Security Act (42 U.S.C. 24 619(5)) when referring to assistance provided under 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00963 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 964 •HR 7585 IH a State program funded under paragraph A of title 1 IV of the Social Security Act (42 U.S.C. 601 et 2 seq.).’’. 3 Subtitle H—Universal School Meals 4 Program 5 SEC. 5701. SHORT TITLE. 6 This subtitle may be cited as the ‘‘Universal School 7 Meals Program Act of 2022’’. 8 SEC. 5702. EFFECTIVE DATE. 9 Unless otherwise provided, this subtitle, and the 10 amendments made by this subtitle, shall take effect 1 year 11 after the date of enactment of this section. 12 SEC. 5703. FREE SCHOOL BREAKFAST PROGRAM. 13 (a) IN GENERAL.—Section 4(a) of the Child Nutri- 14 tion Act of 1966 (42 U.S.C. 1773(a)) is amended, in the 15 first sentence— 16 (1) by striking ‘‘is hereby’’ and inserting ‘‘are’’; 17 and 18 (2) by inserting ‘‘to provide free breakfast to all 19 children enrolled at those schools’’ before ‘‘in accord- 20 ance’’. 21 (b) APPORTIONMENT TO STATES.—Section 4(b) of 22 the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)) is 23 amended— 24 (1) in paragraph (1)— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00964 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 965 •HR 7585 IH (A) in subparagraph (A)(i), by striking 1 subclause (II) and inserting the following: 2 ‘‘(II) the national average pay- 3 ment for free breakfasts, as specified 4 in subparagraph (B).’’; 5 (B) by striking subparagraph (B) and in- 6 serting the following: 7 ‘‘(B) PAYMENT AMOUNTS.— 8 ‘‘(i) IN GENERAL.—The national aver- 9 age payment for each free breakfast shall 10 be $2.72, adjusted annually for inflation in 11 accordance with clause (ii) and rounded in 12 accordance with clause (iii). 13 ‘‘(ii) INFLATION ADJUSTMENT.— 14 ‘‘(I) IN GENERAL.—The annual 15 inflation adjustment under clause (i) 16 shall reflect changes in the cost of op- 17 erating the free breakfast program 18 under this section, as indicated by the 19 change in the Consumer Price Index 20 for food away from home for all urban 21 consumers. 22 ‘‘(II) BASIS.—Each inflation an- 23 nual adjustment under clause (i) shall 24 reflect the changes in the Consumer 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00965 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 966 •HR 7585 IH Price Index for food away from home 1 for the most recent 12-month period 2 for which that data is available. 3 ‘‘(iii) ROUNDING.—On July 1, 2021, 4 and annually thereafter, the national aver- 5 age payment rate for free breakfast shall 6 be— 7 ‘‘(I) adjusted to the nearest 8 lower-cent increment; and 9 ‘‘(II) based on the unrounded 10 amounts for the preceding 12-month 11 period.’’; 12 (C) by striking subparagraphs (C) and 13 (E); and 14 (D) by redesignating subparagraph (D) as 15 subparagraph (C); 16 (2) by striking paragraphs (2) and (3); 17 (3) by redesignating paragraphs (4) and (5) as 18 paragraphs (2) and (3), respectively; and 19 (4) in paragraph (3) (as so redesignated), by 20 striking ‘‘paragraph (3) or (4)’’ and inserting ‘‘para- 21 graph (2)’’. 22 (c) STATE DISBURSEMENT TO SCHOOLS.—Section 4 23 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00966 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 967 •HR 7585 IH amended by striking subsection (c) and inserting the fol- 1 lowing: 2 ‘‘(c) STATE DISBURSEMENT TO SCHOOLS.—Funds 3 apportioned and paid to any State for the purpose of this 4 section shall be disbursed by the State educational agency 5 to schools selected by the State educational agency to as- 6 sist those schools in operating a breakfast program.’’. 7 (d) NO COLLECTION OF DEBT.— 8 (1) IN GENERAL.—Notwithstanding any other 9 provision of the Child Nutrition Act of 1966 (42 10 U.S.C. 1771 et seq.) or any other provision of law, 11 effective beginning on the date of enactment of this 12 Act, as a condition of participation in the breakfast 13 program under section 4 of that Act (42 U.S.C. 14 1773), a school— 15 (A) shall not collect any debt owed to the 16 school for unpaid meal charges; and 17 (B) shall continue to accrue debt for un- 18 paid meal charges— 19 (i) for the purpose of receiving reim- 20 bursement under section 5715; and 21 (ii) until the effective date specified in 22 section 5702. 23 (2) CHILD NUTRITION ACT OF 1966.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00967 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 968 •HR 7585 IH (A) IN GENERAL.—Section 4 of the Child 1 Nutrition Act of 1966 (42 U.S.C. 1773) is 2 amended by striking subsection (d) and insert- 3 ing the following: 4 ‘‘(d) NO COLLECTION OF DEBT.—A school partici- 5 pating in the free breakfast program under this section 6 shall not collect any debt owed to the school for unpaid 7 meal charges.’’. 8 (B) CONFORMING AMENDMENT.—Section 9 23(a) of the Child Nutrition Act of 1966 (42 10 U.S.C. 1793(a)) is amended by striking ‘‘school 11 in severe need, as described in section 4(d)(1)’’ 12 and inserting the following: ‘‘school— 13 ‘‘(1) that has a free breakfast program under 14 section 4 or seeks to initiate a free breakfast pro- 15 gram under that section; and 16 ‘‘(2) of which not less than 40 percent of the 17 students are identified students (as defined in para- 18 graph (8) of section 1113(a) of the Elementary and 19 Secondary Education Act of 1965 (20 U.S.C. 20 6313(a)))’’. 21 (e) NUTRITIONAL AND OTHER PROGRAM REQUIRE- 22 MENTS.—Section 4(e) of the Child Nutrition Act of 1966 23 (42 U.S.C. 1773(e)) is amended— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00968 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 969 •HR 7585 IH (1) in paragraph (1)(A), in the second sentence, 1 by striking ‘‘free or’’ and all that follows through 2 the period at the end and inserting ‘‘free to all chil- 3 dren enrolled at a school participating in the school 4 breakfast program.’’; and 5 (2) in paragraph (2), in the second sentence, by 6 striking ‘‘the full charge to the student for a break- 7 fast meeting the requirements of this section or’’. 8 (f) PROHIBITION ON BREAKFAST SHAMING, MEAL 9 DENIAL.— 10 (1) IN GENERAL.—Effective beginning on the 11 date of enactment of this Act, a school or school 12 food authority— 13 (A) shall not— 14 (i) physically segregate or otherwise 15 discriminate against any child participating 16 in the breakfast program under section 4 17 of the Child Nutrition Act of 1966 (42 18 U.S.C. 1773); or 19 (ii) overtly identify a child described 20 in clause (i) by a special token or ticket, 21 an announced or published list of names, 22 or any other means; and 23 (B) shall provide the program meal to any 24 child eligible under the program. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00969 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 970 •HR 7585 IH (2) CHILD NUTRITION ACT OF 1966.—Section 4 1 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) 2 is amended by adding at the end the following: 3 ‘‘(f) PROHIBITION ON BREAKFAST SHAMING.—A 4 school or school food authority shall not— 5 ‘‘(1) physically segregate or otherwise discrimi- 6 nate against any child participating in the free 7 breakfast program under this section; or 8 ‘‘(2) overtly identify a child described in para- 9 graph (1) by a special token or ticket, an announced 10 or published list of names, or any other means.’’. 11 (g) DEPARTMENT OF DEFENSE OVERSEAS DEPEND- 12 ENTS’ SCHOOLS.—Section 20(b) of the Child Nutrition 13 Act of 1966 (42 U.S.C. 1789(b)) is amended— 14 (1) by striking ‘‘and reduced-price’’; and 15 (2) by striking ‘‘and shall’’ and all that follows 16 through ‘‘section’’. 17 (h) CONFORMING AMENDMENTS.—The Child Nutri- 18 tion Act of 1966 (42 U.S.C. 1771 et seq.) is amended— 19 (1) by striking ‘‘or reduced price’’ each place it 20 appears; 21 (2) by striking ‘‘and reduced price’’ each place 22 it appears; and 23 (3) by striking ‘‘a reduced price’’ each place it 24 appears. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00970 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 971 •HR 7585 IH SEC. 5704. APPORTIONMENT TO STATES. 1 Section 4(b) of the Richard B. Russell National 2 School Lunch Act (42 U.S.C. 1753(b)) is amended— 3 (1) by striking paragraph (2) and inserting the 4 following: 5 ‘‘(2) PAYMENT AMOUNTS.— 6 ‘‘(A) IN GENERAL.—The national average 7 payment for each free lunch shall be $3.81, ad- 8 justed annually for inflation in accordance with 9 subparagraph (C) and rounded in accordance 10 with subparagraph (D). 11 ‘‘(B) ADDITIONAL PAYMENT FOR LOCAL 12 FOOD.— 13 ‘‘(i) DEFINITION OF LOCALLY- 14 SOURCED FARM PRODUCT.—In this sub- 15 paragraph, the term ‘locally-sourced farm 16 product’ means a farm product that— 17 ‘‘(I) is marketed to consumers— 18 ‘‘(aa) directly; or 19 ‘‘(bb) through intermediated 20 channels (such as food hubs and 21 cooperatives); and 22 ‘‘(II) with respect to the school 23 food authority purchasing the farm 24 product, is produced and distrib- 25 uted— 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00971 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 972 •HR 7585 IH ‘‘(aa) in the State in which 1 the school food authority is lo- 2 cated; or 3 ‘‘(bb) not more than 250 4 miles from the location of the 5 school food authority. 6 ‘‘(ii) ADDITIONAL PAYMENT ELIGI- 7 BILITY.—During a school year, a school 8 food authority shall receive an additional 9 payment described in clause (iii) if the 10 State certifies that the school food author- 11 ity served meals (including breakfasts, 12 lunches, suppers, and supplements) during 13 the last school year of which not less than 14 25 percent were made with locally-sourced 15 farm products. 16 ‘‘(iii) PAYMENT AMOUNT.— 17 ‘‘(I) IN GENERAL.—The addi- 18 tional payment amount under this 19 subparagraph shall be— 20 ‘‘(aa) $0.30 for each free 21 lunch and supper; 22 ‘‘(bb) $0.21 for each free 23 breakfast; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00972 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 973 •HR 7585 IH ‘‘(cc) $0.08 for each free 1 supplement. 2 ‘‘(II) ADJUSTMENTS.—Each ad- 3 ditional payment amount under sub- 4 clause (I) shall be adjusted annually 5 in accordance with subparagraph (C) 6 and rounded in accordance with sub- 7 paragraph (D). 8 ‘‘(iv) DISBURSEMENT.—The State 9 agency shall disburse funds made available 10 under this clause to school food authorities 11 eligible to receive additional reimburse- 12 ment. 13 ‘‘(C) INFLATION ADJUSTMENT.— 14 ‘‘(i) IN GENERAL.—The annual infla- 15 tion adjustment under subparagraphs (A) 16 and (B)(iii) shall reflect changes in the 17 cost of operating the free lunch program 18 under this Act, as indicated by the change 19 in the Consumer Price Index for food away 20 from home for all urban consumers. 21 ‘‘(ii) BASIS.—Each annual inflation 22 adjustment under subparagraphs (A) and 23 (B)(iii) shall reflect the changes in the 24 Consumer Price Index for food away from 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00973 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 974 •HR 7585 IH home for the most recent 12-month period 1 for which that data is available. 2 ‘‘(D) ROUNDING.—On July 1, 2021, and 3 annually thereafter, the national average pay- 4 ment rate for free lunch and the additional pay- 5 ment amount for free breakfast, lunch, supper, 6 and supplement under subparagraph (B) shall 7 be— 8 ‘‘(i) adjusted to the nearest lower-cent 9 increment; and 10 ‘‘(ii) based on the unrounded amounts 11 for the preceding 12-month period.’’; and 12 (2) by striking paragraph (3). 13 SEC. 5705. NUTRITIONAL AND OTHER PROGRAM REQUIRE- 14 MENTS. 15 (a) ELIMINATION OF FREE LUNCH ELIGIBILITY RE- 16 QUIREMENTS.— 17 (1) IN GENERAL.—Section 9 of the Richard B. 18 Russell National School Lunch Act (42 U.S.C. 19 1758) is amended by striking subsection (b) and in- 20 serting the following: 21 ‘‘(b) ELIGIBILITY.—All children enrolled in a school 22 that participates in the school lunch program under this 23 Act shall be eligible to receive free lunch under this Act.’’. 24 (2) CONFORMING AMENDMENTS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00974 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 975 •HR 7585 IH (A) Section 9 of the Richard B. Russell 1 National School Lunch Act (42 U.S.C. 1758) is 2 amended— 3 (i) in subsection (c), in the third sen- 4 tence, by striking ‘‘or at a reduced cost’’; 5 and 6 (ii) in subsection (e), by striking ‘‘, re- 7 duced price,’’. 8 (B) Section 18 of the Richard B. Russell 9 National School Lunch Act (42 U.S.C. 1769) is 10 amended— 11 (i) by striking subsection (j); and 12 (ii) by redesignating subsection (k) as 13 subsection (j). 14 (C) Section 28(b)(4) of the Richard B. 15 Russell National School Lunch Act (42 U.S.C. 16 1769i(b)(4)) is amended— 17 (i) by striking subparagraph (B); and 18 (ii) in subparagraph (A), by striking 19 the subparagraph designation and heading 20 and all that follows through ‘‘the Sec- 21 retary’’ and inserting ‘‘The Secretary’’. 22 (D) Section 17 of the Child Nutrition Act 23 of 1966 (42 U.S.C. 1786) is amended— 24 (i) in subsection (d)(2)(A)— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00975 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 976 •HR 7585 IH (I) by striking clause (i); and 1 (II) by redesignating clauses (ii) 2 and (iii) as clauses (i) and (ii), respec- 3 tively; and 4 (ii) in subsection (f)(17), by striking 5 ‘‘Notwithstanding subsection (d)(2)(A)(i), 6 not later’’ and inserting ‘‘Not later’’. 7 (E) Section 1902(a) of the Social Security 8 Act (42 U.S.C. 1396a(a)) is amended by strik- 9 ing paragraph (7) and inserting the following: 10 ‘‘(7) provide safeguards which restrict the use 11 or disclosure of information concerning applicants 12 and recipients to purposes directly connected with 13 the administration of the plan;’’. 14 (F) Section 1154(a)(2)(A)(i) of title 10, 15 United States Code, is amended by striking ‘‘in 16 accordance with section 9(b)(1) of the Richard 17 B. Russell National School Lunch Act (42 18 U.S.C. 1758(b)(1)’’. 19 (G) Section 4301 of the Food, Conserva- 20 tion, and Energy Act of 2008 (42 U.S.C. 21 1758a) is repealed. 22 (b) NO COLLECTION OF DEBT.— 23 (1) IN GENERAL.—Notwithstanding any other 24 provision of the Richard B. Russell National School 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00976 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 977 •HR 7585 IH Lunch Act (42 U.S.C. 1751 et seq.) or any other 1 provision of law, effective beginning on the date of 2 enactment of this Act, as a condition of participation 3 in the school lunch program under that Act, a 4 school— 5 (A) shall not collect any debt owed to the 6 school for unpaid meal charges; and 7 (B) shall continue to accrue debt for un- 8 paid meal charges— 9 (i) for the purpose of receiving reim- 10 bursement under section 5716; and 11 (ii) until the effective date specified in 12 section 5702. 13 (2) NATIONAL SCHOOL LUNCH ACT.— 14 (A) IN GENERAL.—Section 9 of the Rich- 15 ard B. Russell National School Lunch Act (42 16 U.S.C. 1758) is amended by striking subsection 17 (d) and inserting the following: 18 ‘‘(d) NO COLLECTION OF DEBT.—A school partici- 19 pating in the school lunch program under this Act shall 20 not collect any debt owed to the school for unpaid meal 21 charges.’’. 22 (B) CONFORMING AMENDMENTS.—Section 23 9(b)(8)(A) of the Richard B. Russell National 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00977 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 978 •HR 7585 IH School Lunch Act (42 U.S.C. 1758(b)(8)(A)) is 1 amended by striking ‘‘or subsection (d)’’. 2 SEC. 5706. SPECIAL ASSISTANCE PROGRAM. 3 (a) IN GENERAL.—Section 11 of the Richard B. Rus- 4 sell National School Lunch Act (42 U.S.C. 1759a) is re- 5 pealed. 6 (b) CONFORMING AMENDMENTS.— 7 (1) Section 6 of the Richard B. Russell Na- 8 tional School Lunch Act (42 U.S.C. 1755) is amend- 9 ed— 10 (A) in subsection (a)(2), by striking ‘‘sec- 11 tions 11 and 13’’ and inserting ‘‘section 13’’; 12 and 13 (B) in subsection (e)(1), in the matter pre- 14 ceding subparagraph (A), by striking ‘‘section 15 4, this section, and section 11’’ and inserting 16 ‘‘this section and section 4’’. 17 (2) Section 7(d) of the Richard B. Russell Na- 18 tional School Lunch Act (42 U.S.C. 1756(d)) is 19 amended by striking ‘‘or 11’’. 20 (3) Section 8(g) of the Richard B. Russell Na- 21 tional School Lunch Act (42 U.S.C. 1757(g)) is 22 amended by striking ‘‘and under section 11 of this 23 Act’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00978 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 979 •HR 7585 IH (4) Section 12(f) of the Richard B. Russell Na- 1 tional School Lunch Act (42 U.S.C. 1760(f)) is 2 amended by striking ‘‘11,’’. 3 (5) Section 7(a) of the Child Nutrition Act of 4 1966 (42 U.S.C. 1766(a)) is amended— 5 (A) in paragraph (1)(A), by striking ‘‘4, 6 11, and 17’’ and inserting ‘‘4 and 17’’; and 7 (B) in paragraph (2)(A), by striking ‘‘sec- 8 tions 4 and 11’’ and inserting ‘‘section 4’’. 9 SEC. 5707. PRICE FOR A PAID LUNCH. 10 Section 12 of the Richard B. Russell National School 11 Lunch Act (42 U.S.C. 1760) is amended— 12 (1) by striking subsection (p); and 13 (2) by redesignating subsections (q) and (r) as 14 subsections (p) and (q), respectively. 15 SEC. 5708. SUMMER FOOD SERVICE PROGRAM FOR CHIL- 16 DREN. 17 Section 13 of the Richard B. Russell National School 18 Lunch Act (42 U.S.C. 1761) is amended— 19 (1) in subsection (a)— 20 (A) in paragraph (2), by adding at the end 21 the following: 22 ‘‘(C) WAIVER.—If the Secretary deter- 23 mines that a program requirement under this 24 section limits the access of children to meals 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00979 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 980 •HR 7585 IH served under this section, the Secretary may 1 waive that program requirement. 2 ‘‘(D) ELIGIBILITY.—All children shall be 3 eligible to participate in the program under this 4 section.’’; and 5 (B) in paragraph (5), by striking ‘‘only 6 for’’ and all that follows through the period at 7 the end and inserting ‘‘for meals served to all 8 children.’’; 9 (2) in subsection (b)(2), by striking ‘‘may only 10 serve’’ and all that follows through ‘‘migrant chil- 11 dren’’; 12 (3) by striking subsection (c) and inserting the 13 following: 14 ‘‘(c) PAYMENTS.— 15 ‘‘(1) IN GENERAL.—Payments shall be made to 16 service institutions for meals served— 17 ‘‘(A) during the months of May through 18 September; 19 ‘‘(B) during school vacation at any time 20 during an academic school year; 21 ‘‘(C) during a teacher in-service day; and 22 ‘‘(D) on days that school is closed during 23 the months of October through April due to a 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00980 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 981 •HR 7585 IH natural disaster, building repair, court order, or 1 similar cause, as determined by the Secretary. 2 ‘‘(2) LIMITATION ON PAYMENTS.—A service in- 3 stitution shall receive payments under this section 4 for not more than 3 meals and 1 supplement per 5 child per day.’’; and 6 (4) in subsection (f)(3), by striking ‘‘, except 7 that’’ and all that follows through ‘‘section’’. 8 SEC. 5709. SUMMER ELECTRONIC BENEFIT TRANSFER FOR 9 CHILDREN PROGRAM. 10 Section 13(a) of the Richard B. Russell National 11 School Lunch Act (42 U.S.C. 1761(a)) is amended by add- 12 ing at the end the following: 13 ‘‘(13) SUMMER ELECTRONIC BENEFIT TRANS- 14 FER FOR CHILDREN PROGRAM.— 15 ‘‘(A) DEFINITIONS.—In this paragraph: 16 ‘‘(i) EBT CARD.—The term ‘EBT 17 card’ means an electronic benefit transfer 18 card. 19 ‘‘(ii) ELIGIBLE HOUSEHOLD.—The 20 term ‘eligible household’ means a house- 21 hold with— 22 ‘‘(I) an income that does not ex- 23 ceed 200 percent of the poverty line 24 (as defined in section 673 of the Com- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00981 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 982 •HR 7585 IH munity Services Block Grant Act (42 1 U.S.C. 9902)); and 2 ‘‘(II) 1 or more children. 3 ‘‘(iii) PROGRAM.—The term ‘Program’ 4 means the Summer Electronic Benefit 5 Transfer for Children Program established 6 under subparagraph (B). 7 ‘‘(B) ESTABLISHMENT.—The Secretary 8 shall establish a national program, to be known 9 as the ‘Summer Electronic Benefit Transfer for 10 Children Program’, under which the Secretary 11 shall issue EBT cards to eligible households to 12 provide food assistance during the summer 13 months. 14 ‘‘(C) EBT AMOUNT.— 15 ‘‘(i) IN GENERAL.—The value of an 16 EBT card provided under the Program to 17 an eligible household shall be $60 per 18 month per child (adjusted for inflation). 19 ‘‘(ii) ANNUAL LIMITATION.—No eligi- 20 ble household shall receive benefits under 21 the Program for more than 3 months in a 22 calendar year. 23 ‘‘(D) ADMINISTRATION.— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00982 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 983 •HR 7585 IH ‘‘(i) IN GENERAL.—Except as pro- 1 vided under this paragraph, the Program 2 shall be based on the summer electronic 3 benefit transfer for children demonstration 4 program carried out pursuant to section 5 749(g) of the Agriculture, Rural Develop- 6 ment, Food and Drug Administration, and 7 Related Agencies Appropriations Act, 2010 8 (Public Law 111–80; 123 Stat. 2132). 9 ‘‘(ii) SNAP OR WIC.— 10 ‘‘(I) IN GENERAL.—Subject to 11 subclause (II), a State shall admin- 12 ister the Program through the supple- 13 mental nutrition assistance program 14 established under the Food and Nutri- 15 tion Act of 2008 (7 U.S.C. 2011 et 16 seq.). 17 ‘‘(II) WIC OPTION.—If a State 18 has participated in the demonstration 19 program described in clause (i) before 20 the effective date specified in section 21 5702 of the Universal School Meals 22 Program Act of 2022, the State may 23 elect to administer the Program 24 through the special supplemental nu- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00983 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 984 •HR 7585 IH trition program for women, infants, 1 and children established by section 17 2 of the Child Nutrition Act of 1966 3 (42 U.S.C. 1786). 4 ‘‘(E) AUTHORIZATION OF APPROPRIA- 5 TIONS.—There are authorized to be appro- 6 priated to the Secretary to carry out this para- 7 graph such sums as are necessary for fiscal 8 year 2021 and each fiscal year thereafter.’’. 9 SEC. 5710. CHILD AND ADULT CARE FOOD PROGRAM. 10 Section 17 of the Richard B. Russell National School 11 Lunch Act (42 U.S.C. 1766) is amended— 12 (1) in subsection (a)(2), by striking subpara- 13 graph (B) and inserting the following: 14 ‘‘(B) any other private organization pro- 15 viding nonresidential child care or day care out- 16 side school hours for school children;’’; 17 (2) by striking subsection (c) and inserting the 18 following: 19 ‘‘(c) FREE MEALS.—Notwithstanding any other pro- 20 vision of law— 21 ‘‘(1) all meals and supplements served under 22 the program authorized under this section shall be 23 provided for free to participants of the program; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00984 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 985 •HR 7585 IH ‘‘(2) an institution that serves those meals and 1 supplements shall be reimbursed— 2 ‘‘(A) in the case of breakfast, at the rate 3 established for free breakfast under section 4 4(b)(1)(B)(i) of the Child Nutrition Act of 5 1966 (42 U.S.C. 1773(b)(1)(B)(i)); 6 ‘‘(B) in the case of lunch, at the rate es- 7 tablished for free lunch under section 8 4(b)(2)(A); and 9 ‘‘(C) in the case of a supplemental meal, 10 $0.96, adjusted for inflation in accordance with 11 section 4(b)(2)(C).’’; 12 (3) in subsection (f)— 13 (A) in paragraph (2), by striking subpara- 14 graph (B) and inserting the following: 15 ‘‘(B) LIMITATION TO REIMBURSEMENTS.— 16 An institution may claim reimbursement under 17 this paragraph for not more than 3 meals and 18 1 supplement per day per child.’’; and 19 (B) by striking paragraph (3); and 20 (4) in subsection (r)— 21 (A) in the subsection heading, by striking 22 ‘‘PROGRAM FOR AT-RISK SCHOOL CHILDREN’’ 23 and inserting ‘‘AFTERSCHOOL MEAL AND 24 SNACK PROGRAM’’; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00985 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 986 •HR 7585 IH (B) by striking ‘‘at-risk school’’ each place 1 it appears and inserting ‘‘eligible’’; 2 (C) in paragraph (1)— 3 (i) in the paragraph heading, by strik- 4 ing ‘‘AT-RISK SCHOOL’’ and inserting ‘‘ELI- 5 GIBLE’’; and 6 (ii) in subparagraph (B), by striking 7 ‘‘operated’’ and all that follows through 8 the period at the end and inserting a pe- 9 riod; and 10 (D) in paragraph (4)(A), by striking ‘‘only 11 for’’ and all that follows through the period at 12 the end and inserting the following: ‘‘for— 13 ‘‘(i) not more than 1 meal and 1 sup- 14 plement per child per day served on a reg- 15 ular school day; and 16 ‘‘(ii) not more than 3 meals and 1 17 supplement per child per day served on 18 any day other than a regular school day.’’. 19 SEC. 5711. MEALS AND SUPPLEMENTS FOR CHILDREN IN 20 AFTERSCHOOL CARE. 21 Section 17A of the Richard B. Russell National 22 School Lunch Act (42 U.S.C. 1766a) is amended— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00986 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 987 •HR 7585 IH (1) in the section heading, by striking ‘‘MEAL 1 SUPPLEMENTS’’ and inserting ‘‘MEALS AND SUP- 2 PLEMENTS’’; 3 (2) in subsection (a)(1), by striking ‘‘meal sup- 4 plements’’ and inserting ‘‘free meals and supple- 5 ments’’; 6 (3) in subsection (b), by inserting ‘‘meals and’’ 7 before ‘‘supplements’’; and 8 (4) by striking subsection (c) and inserting the 9 following: 10 ‘‘(c) REIMBURSEMENT.— 11 ‘‘(1) IN GENERAL.— 12 ‘‘(A) MEALS.—A free meal provided under 13 this section to a child shall be reimbursed at a 14 rate of $3.81, adjusted annually for inflation in 15 accordance with paragraph (3)(A) and rounded 16 in accordance with paragraph (3)(B). 17 ‘‘(B) SUPPLEMENTS.—A free supplement 18 provided under this section to a child shall be 19 reimbursed at the rate at which free supple- 20 ments are reimbursed under section 21 17(c)(2)(C). 22 ‘‘(2) LIMITATION TO REIMBURSEMENTS.—An 23 institution may claim reimbursement under this sec- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00987 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 988 •HR 7585 IH tion for not more than 1 meal and 1 supplement per 1 day per child served on a regular school day. 2 ‘‘(3) INFLATION; ROUNDING.— 3 ‘‘(A) INFLATION ADJUSTMENT.— 4 ‘‘(i) IN GENERAL.—The annual infla- 5 tion adjustment under paragraph (1)(A) 6 shall reflect changes in the cost of oper- 7 ating the program under this section, as 8 indicated by the change in the Consumer 9 Price Index for food away from home for 10 all urban consumers. 11 ‘‘(ii) BASIS.—Each inflation annual 12 adjustment under paragraph (1)(A) shall 13 reflect the changes in the Consumer Price 14 Index for food away from home for the 15 most recent 12-month period for which 16 that data is available. 17 ‘‘(B) ROUNDING.—On July 1, 2021, and 18 annually thereafter, the reimbursement rate for 19 a free meal under this section shall be— 20 ‘‘(i) adjusted to the nearest lower-cent 21 increment; and 22 ‘‘(ii) based on the unrounded amounts 23 for the preceding 12-month period.’’. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00988 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 989 •HR 7585 IH SEC. 5712. ACCESS TO LOCAL FOODS: FARM TO SCHOOL 1 PROGRAM. 2 Section 18(g)(5) of the Richard B. Russell National 3 School Lunch Act (42 U.S.C. 1769(g)(5)) is amended by 4 striking subparagraph (B) and inserting the following: 5 ‘‘(B) serve a high proportion of identified 6 students (as defined in paragraph (8) of section 7 1113(a) of the Elementary and Secondary Edu- 8 cation Act of 1965 (20 U.S.C. 6313(a)));’’. 9 SEC. 5713. FRESH FRUIT AND VEGETABLE PROGRAM. 10 Section 19(d) of the Richard B. Russell National 11 School Lunch Act (42 U.S.C. 1769a(d)) is amended— 12 (1) in paragraph (1)— 13 (A) in the matter preceding subparagraph 14 (A), by striking ‘‘paragraph (2) of this sub- 15 section and’’; 16 (B) in subparagraph (A), in the matter 17 preceding clause (i), by striking ‘‘school—’’ and 18 all that follows through ‘‘submits’’ in clause (ii) 19 and inserting ‘‘school that submits’’; 20 (C) in subparagraph (B), by striking 21 ‘‘schools’’ and all that follows through ‘‘Act’’ 22 and inserting ‘‘high-need schools (as defined in 23 section 2211(b) of the Elementary and Sec- 24 ondary Education Act of 1965 (20 U.S.C. 25 6631(b)))’’; and 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00989 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 990 •HR 7585 IH (D) in subparagraph (D)— 1 (i) by striking clause (i); and 2 (ii) by redesignating clauses (ii) 3 through (iv) as clauses (i) through (iii), re- 4 spectively; and 5 (2) by striking paragraphs (2) and (3) and in- 6 serting the following: 7 ‘‘(2) OUTREACH TO HIGH-NEED SCHOOLS.— 8 Prior to making decisions regarding school participa- 9 tion in the program, a State agency shall inform 10 high-need schools (as defined in section 2211(b) of 11 the Elementary and Secondary Education Act of 12 1965 (20 U.S.C. 6631(b))), including Tribal schools, 13 of the eligibility of the schools for the program.’’. 14 SEC. 5714. TRAINING, TECHNICAL ASSISTANCE, AND FOOD 15 SERVICE MANAGEMENT INSTITUTE. 16 Section 21(a)(1)(B) of the Richard B. Russell Na- 17 tional School Lunch Act (42 U.S.C. 1769b–1(a)(1)(B)) is 18 amended in the matter preceding clause (i) by striking 19 ‘‘certified to receive free or reduced price meals’’ and in- 20 serting ‘‘who are identified students (as defined in para- 21 graph (8) of section 1113(a) of the Elementary and Sec- 22 ondary Education Act of 1965 (20 U.S.C. 6313(a))’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00990 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 991 •HR 7585 IH SEC. 5715. REIMBURSEMENT OF SCHOOL MEAL DELIN- 1 QUENT DEBT PROGRAM. 2 (a) DEFINITIONS.—In this section: 3 (1) DELINQUENT DEBT.—The term ‘‘delinquent 4 debt’’ means the debt owed by a parent or guardian 5 of a child to a school— 6 (A) as of the effective date specified in sec- 7 tion 5702; and 8 (B) for meals served by the school under— 9 (i) the school breakfast program 10 under section 4 of the Child Nutrition Act 11 of 1966 (42 U.S.C. 1773); 12 (ii) the school lunch program estab- 13 lished under the Richard B. Russell Na- 14 tional School Lunch Act (42 U.S.C. 1751 15 et seq.); or 16 (iii) both of the programs described in 17 clauses (i) and (ii). 18 (2) PROGRAM.—The term ‘‘program’’ means 19 the program established under subsection (b)(1). 20 (3) SECRETARY.—The term ‘‘Secretary’’ means 21 the Secretary of Agriculture. 22 (b) REIMBURSEMENT PROGRAM.— 23 (1) ESTABLISHMENT.—Not later than 60 days 24 after the effective date specified in section 5702, the 25 Secretary shall establish a program under which the 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00991 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 992 •HR 7585 IH Secretary shall reimburse each school participating 1 in a program described in clause (i) or (ii) of sub- 2 section (a)(1)(B) for all delinquent debt. 3 (2) FORM FOR REIMBURSEMENT.—To carry out 4 the program, the Secretary shall design and dis- 5 tribute a form to State agencies to collect data on 6 all delinquent debt in applicable schools in the State, 7 grouped by school food authority. 8 (3) COMPLETION DATE.—The Secretary shall 9 provide all reimbursements under the program not 10 later than 180 days after the effective date specified 11 in section 5702. 12 (c) REPORT.—Not later than 2 years after the effec- 13 tive date specified in section 5702, the Comptroller Gen- 14 eral of the United States shall submit to Congress and 15 make publicly available a report that describes the suc- 16 cesses and challenges of the program. 17 SEC. 5716. CONFORMING AMENDMENTS. 18 The Richard B. Russell National School Lunch Act 19 (42 U.S.C. 1751 et seq.) is amended— 20 (1) by striking ‘‘or reduced price’’ each place it 21 appears; 22 (2) by striking ‘‘or a reduced price’’ each place 23 it appears; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00992 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 993 •HR 7585 IH (3) by striking ‘‘and reduced price’’ each place 1 it appears; and 2 (4) by striking ‘‘a reduced price’’ each place it 3 appears. 4 SEC. 5717. MEASURE OF POVERTY. 5 Section 1113(a) of the Elementary and Secondary 6 Education Act of 1965 (20 U.S.C. 6313(a)) is amended— 7 (1) in paragraph (5)(A), by striking ‘‘the num- 8 ber of children eligible for a free or reduced price 9 lunch under the Richard B. Russell National School 10 Lunch Act (42 U.S.C. 1751 et seq.)’’ and inserting 11 ‘‘the number of identified students’’; and 12 (2) by adding at the end the following: 13 ‘‘(8) IDENTIFIED STUDENTS DEFINED.— 14 ‘‘(A) IN GENERAL.—In this subsection, the 15 term ‘identified students’ means the number of 16 students— 17 ‘‘(i) who are— 18 ‘‘(I) homeless children and 19 youths, as defined under section 20 725(2) of the McKinney-Vento Home- 21 less Assistance Act (42 U.S.C. 22 11434a(2)); 23 ‘‘(II) runaway and homeless 24 youth served by programs established 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00993 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 994 •HR 7585 IH under the Runaway and Homeless 1 Youth Act (34 U.S.C. 11201 et seq.); 2 ‘‘(III) migratory children, as de- 3 fined under section 1309; or 4 ‘‘(IV) foster children; 5 ‘‘(ii) who are eligible for and receiving 6 medical assistance under the program of 7 medical assistance established under title 8 XIX of the Social Security Act (42 U.S.C. 9 1396 et seq.); or 10 ‘‘(iii) who participate (or who are part 11 of a household that participates) in at least 12 one of the following: 13 ‘‘(I) The supplemental nutrition 14 assistance program established under 15 the Food and Nutrition Act of 2008 16 (7 U.S.C. 2011 et seq.). 17 ‘‘(II) A State program funded 18 under the program of block grants to 19 States for temporary assistance for 20 needy families established under part 21 A of title IV of the Social Security 22 Act (42 U.S.C. 601 et seq.). 23 ‘‘(III) The food distribution pro- 24 gram on Indian reservations estab- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00994 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 995 •HR 7585 IH lished under section 4(b) of the Food 1 and Nutrition Act of 2008 (7 U.S.C. 2 2013(b)). 3 ‘‘(IV) A Head Start program au- 4 thorized under the Head Start Act 5 (42 U.S.C. 9831 et seq.) or a com- 6 parable State-funded Head Start or 7 pre-kindergarten program. 8 ‘‘(B) MULTIPLIER.—In determining the 9 number of identified students under subpara- 10 graph (A), the local educational agency shall 11 multiply the number determined under such 12 subparagraph by 1.6.’’. 13 SEC. 5718. SUPPLEMENTAL NUTRITION ASSISTANCE PRO- 14 GRAM. 15 (a) AGREEMENT FOR DIRECT CERTIFICATION.— 16 (1) IN GENERAL.—Section 11 of the Food and 17 Nutrition Act of 2008 (7 U.S.C. 2020) is amend- 18 ed— 19 (A) by striking subsection (u); and 20 (B) by redesignating subsections (v) 21 through (x) as subsections (u) through (w), re- 22 spectively. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00995 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 996 •HR 7585 IH (2) CONFORMING AMENDMENTS.—Section 11(e) 1 of the Food and Nutrition Act of 2008 (7 U.S.C. 2 2020(e)) is amended— 3 (A) in paragraph (8)(F), by striking ‘‘or 4 subsection (u)’’; and 5 (B) in paragraph (26)(B), by striking 6 ‘‘(x)’’ and inserting ‘‘(w)’’. 7 (b) NUTRITION EDUCATION AND OBESITY PREVEN- 8 TION GRANT PROGRAM.—Section 28(a) of the Food and 9 Nutrition Act of 2008 (7 U.S.C. 2036a(a)) is amended 10 by striking paragraph (1) and inserting the following: 11 ‘‘(1) an individual eligible for benefits under 12 this Act;’’. 13 SEC. 5719. HIGHER EDUCATION ACT OF 1965. 14 (a) TEACHER QUALITY ENHANCEMENT.—Subpara- 15 graph (A) of section 200(11) of the Higher Education Act 16 of 1965 (20 U.S.C. 1021(11)) is amended to read as fol- 17 lows: 18 ‘‘(A) IN GENERAL.—The term ‘high-need 19 school’ means a school that is in the highest 20 quartile of schools in a ranking of all schools 21 served by a local educational agency, ranked in 22 descending order by percentage of students 23 from low-income families enrolled in such 24 schools, as determined by the local educational 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00996 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 997 •HR 7585 IH agency based on one of the following measures 1 of poverty: 2 ‘‘(i) The percentage of students aged 3 5 through 17 in poverty counted in the 4 most recent census data approved by the 5 Secretary. 6 ‘‘(ii) The percentage of students in 7 families receiving assistance under the 8 State program funded under the program 9 of block grants to States for temporary as- 10 sistance for needy families established 11 under part A of title IV of the Social Secu- 12 rity Act (42 U.S.C. 601 et seq.). 13 ‘‘(iii) The percentage of students eligi- 14 ble to receive medical assistance under the 15 program of medical assistance established 16 under title XIX of the Social Security Act 17 (42 U.S.C. 1396 et seq.). 18 ‘‘(iv) A composite of two or more of 19 the measures described in clauses (i) 20 through (iii).’’. 21 (b) GEAR UP.—Subparagraph (A) of section 22 404B(d)(1) of the Higher Education Act of 1965 (20 23 U.S.C. 1070a–22(d)(1)) is amended to read as follows: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00997 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 998 •HR 7585 IH ‘‘(A) provide services under this chapter to 1 at least one grade level of students, beginning 2 not later than 7th grade, in a participating 3 school— 4 ‘‘(i) that has a 7th grade; and 5 ‘‘(ii) in which— 6 ‘‘(I) at least 50 percent of the 7 students enrolled are identified stu- 8 dents (as defined in section 9 1113(a)(8) of the Elementary and 10 Secondary Education Act of 1965); or 11 ‘‘(II) if an eligible entity deter- 12 mines that it would promote the effec- 13 tiveness of a program, an entire grade 14 level of students, beginning not later 15 than the 7th grade, reside in public 16 housing, as defined in section 3(b)(1) 17 of the United States Housing Act of 18 1937 (42 U.S.C. 1437a(b)(1)).’’. 19 (c) SIMPLIFIED NEEDS TEST.—Section 479(d)(2) of 20 the Higher Education Act of 1965 (20 U.S.C. 21 1087ss(d)(2)) is amended— 22 (1) by striking subparagraph (C); and 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00998 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 999 •HR 7585 IH (2) by redesignating subparagraphs (D) 1 through (F) as subparagraphs (C) through (E), re- 2 spectively. 3 (d) EARLY FEDERAL PELL GRANT COMMITMENT 4 DEMONSTRATION PROGRAM.—Section 894(b) of the 5 Higher Education Act of 1965 (20 U.S.C. 1161y(b)) is 6 amended— 7 (1) in paragraph (1)(B), by striking ‘‘qualify 8 for a free or reduced price school lunch under the 9 Richard B. Russell National School Lunch Act (42 10 U.S.C. 1751 et seq.) or the Child Nutrition Act of 11 1966 (42 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 12 identified students (as defined in section 1113(a)(8) 13 of the Elementary and Secondary Education Act of 14 1965)’’; and 15 (2) in paragraph (5), by striking ‘‘eligible for a 16 free or reduced price school lunch under the Richard 17 B. Russell National School Lunch Act (42 U.S.C. 18 1751 et seq.) or the Child Nutrition Act of 1966 (42 19 U.S.C. 1771 et seq.)’’ and inserting ‘‘identified stu- 20 dents (as defined in section 1113(a)(8) of the Ele- 21 mentary and Secondary Education Act of 1965)’’. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 00999 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1000 •HR 7585 IH SEC. 5720. ELEMENTARY AND SECONDARY EDUCATION ACT 1 OF 1965. 2 (a) LITERACY EDUCATION FOR ALL.—Section 3 2221(b)(3)(B) of the Elementary and Secondary Edu- 4 cation Act of 1965 (20 U.S.C. 6641(b)(3)(B)) is amend- 5 ed— 6 (1) by striking clause (i); and 7 (2) by redesignating clauses (ii) and (iii) as 8 clauses (i) and (ii), respectively. 9 (b) GRANTS FOR EDUCATION INNOVATION AND RE- 10 SEARCH.—Section 4611(d)(2) of the Elementary and Sec- 11 ondary Education Act of 1965 (20 U.S.C. 7261(d)(2)) is 12 amended— 13 (1) by striking subparagraph (B); and 14 (2) by redesignating subparagraphs (C) and 15 (D) as subparagraphs (B) and (C), respectively. 16 (c) ELIGIBILITY FOR HEAVILY IMPACTED LOCAL 17 EDUCATIONAL AGENCIES.—Item (bb) of section 18 7003(b)(2)(B)(i)(III) of the Elementary and Secondary 19 Education Act of 1965 (20 U.S.C. 7703(b)(2)(B)(i)(III)) 20 is amended to read as follows: 21 ‘‘(bb) has an enrollment of 22 children described in subsection 23 (a)(1) that constitutes a percent- 24 age of the total student enroll- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01000 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1001 •HR 7585 IH ment of the agency that is not 1 less than 30 percent; or’’. 2 SEC. 5721. AMERICA COMPETES ACT. 3 Section 6122(3) of the America COMPETES Act (20 4 U.S.C. 9832(3)) is amended by striking ‘‘data on children 5 eligible for free or reduced-price lunches under the Rich- 6 ard B. Russell National School Lunch Act,’’. 7 SEC. 5722. WORKFORCE INNOVATION AND OPPORTUNITY 8 ACT. 9 Section 3(36)(A) of the Workforce Innovation and 10 Opportunity Act (29 U.S.C. 3102(36)(A)) is amended— 11 (1) by striking clause (iv); and 12 (2) by redesignating clauses (v) and (vi) as 13 clauses (iv) and (v), respectively. 14 SEC. 5723. NATIONAL SCIENCE FOUNDATION AUTHORIZA- 15 TION ACT OF 2002. 16 Section 4(8) of the National Science Foundation Au- 17 thorization Act of 2002 (42 U.S.C. 1862n note) is amend- 18 ed— 19 (1) by striking subparagraph (A); and 20 (2) by redesignating subparagraphs (B) and 21 (C) as subparagraphs (A) and (B), respectively. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01001 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1002 •HR 7585 IH SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT. 1 Section 658O(b) of the Child Care and Development 2 Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amend- 3 ed— 4 (1) in paragraph (1)(B), by striking ‘‘school 5 lunch factor’’ and inserting ‘‘identified students fac- 6 tor’’; and 7 (2) by striking paragraph (3) and inserting the 8 following: 9 ‘‘(3) IDENTIFIED STUDENTS FACTOR.—The 10 term ‘identified students factor’ means the ratio of 11 the number of children in the State who are identi- 12 fied students (as defined in paragraph (8) of section 13 1113(a) of the Elementary and Secondary Edu- 14 cation Act of 1965 (20 U.S.C. 6313(a))) to the 15 number of such children in all the States as deter- 16 mined annually by the Secretary of Education.’’. 17 SEC. 5725. CHILDREN’S HEALTH ACT OF 2000. 18 Section 1404(b) of the Children’s Health Act of 2000 19 (42 U.S.C. 9859c(b)) is amended— 20 (1) in paragraph (1)(B), by striking ‘‘school 21 lunch factor’’ and inserting ‘‘identified students fac- 22 tor’’; and 23 (2) by amending paragraph (3) to read as fol- 24 lows: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01002 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1003 •HR 7585 IH ‘‘(3) IDENTIFIED STUDENTS FACTOR.—In this 1 subsection, the term ‘identified students factor’ 2 means the ratio of the number of children in the 3 State who are identified students (as defined in 4 paragraph (8) of section 1113(a) of the Elementary 5 and Secondary Education Act of 1965 (20 U.S.C. 6 6313(a))) to the number of such children in all the 7 States as determined annually by the Secretary of 8 Education.’’. 9 SEC. 5726. JUVENILE JUSTICE AND DELINQUENCY PREVEN- 10 TION. 11 Section 252(i) of the Juvenile Justice and Delin- 12 quency Prevention Act of 1974 (34 U.S.C. 11162(i)) is 13 amended to read as follows: 14 ‘‘(i) FREE SCHOOL LUNCHES FOR INCARCERATED 15 JUVENILES.— 16 ‘‘(1) IN GENERAL.—A juvenile who is incarcer- 17 ated in an eligible juvenile detention center is eligible 18 to receive free lunch under the Richard B. Russell 19 National School Lunch Act (42 U.S.C. 1751 et 20 seq.). 21 ‘‘(2) GUIDANCE.—Not later than 1 year after 22 the date of the enactment of the Universal School 23 Meals Program Act of 2022, the Attorney General, 24 in consultation with the Secretary of Agriculture, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01003 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1004 •HR 7585 IH shall provide guidance to States relating to the op- 1 tions for school food authorities in the States to 2 apply for reimbursement for free lunches under the 3 Richard B. Russell National School Lunch Act (42 4 U.S.C. 1751 et seq.) for juveniles who are incarcer- 5 ated. 6 ‘‘(3) ELIGIBLE JUVENILE DETENTION CENTER 7 DEFINED.—In this subsection, the term ‘eligible ju- 8 venile detention center’ does not include any private, 9 for-profit detention center.’’. 10 Subtitle I—Elder Care 11 SEC. 5801. EXPENSES FOR HOUSEHOLD AND ELDER CARE 12 SERVICES NECESSARY FOR GAINFUL EM- 13 PLOYMENT. 14 (a) IN GENERAL.—Subpart A of part IV of sub- 15 chapter A of chapter 1 of the Internal Revenue Code of 16 1986 is amended by adding at the end the following new 17 section: 18 ‘‘SEC. 25E. EXPENSES FOR HOUSEHOLD AND ELDER CARE 19 SERVICES NECESSARY FOR GAINFUL EM- 20 PLOYMENT. 21 ‘‘(a) ALLOWANCE OF CREDIT.— 22 ‘‘(1) IN GENERAL.—In the case of an individual 23 for which there are one or more qualifying individ- 24 uals (as defined in subsection (b)(1)) with respect to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01004 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1005 •HR 7585 IH such individual, there shall be allowed as a credit 1 against the tax imposed by this chapter for the tax- 2 able year an amount equal to the applicable percent- 3 age of the employment-related expenses (as defined 4 in subsection (b)(2)) paid by such individual during 5 the taxable year. 6 ‘‘(2) APPLICABLE PERCENTAGE DEFINED.—For 7 purposes of paragraph (1), the term ‘applicable per- 8 centage’ means 35 percent reduced (but not below 9 20 percent) by 1 percentage point for each $2,000 10 (or fraction thereof) by which the taxpayer’s ad- 11 justed gross income for the taxable year exceeds 12 $15,000. 13 ‘‘(b) DEFINITIONS OF QUALIFYING INDIVIDUAL AND 14 EMPLOYMENT-RELATED EXPENSES.—For purposes of 15 this section— 16 ‘‘(1) QUALIFYING INDIVIDUAL.—The term 17 ‘qualifying individual’ means an individual who— 18 ‘‘(A) has attained age 50, and 19 ‘‘(B) is one of the following: 20 ‘‘(i) An individual who bears a rela- 21 tionship to the taxpayer described in sub- 22 paragraph (C) or (D) of section 152(d)(2) 23 (relating to fathers, mothers, and ances- 24 tors). 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01005 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1006 •HR 7585 IH ‘‘(ii) An individual would be a depend- 1 ent of the taxpayer (as defined in section 2 152, determined without regard to sub- 3 sections (b)(1) and (b)(2)) as a qualifying 4 relative described in section 152(d)(1) if— 5 ‘‘(I) in lieu of subparagraphs (B) 6 and (C) thereof the following applied 7 with respect to the individual: 8 ‘‘(aa) the taxpayer has pro- 9 vided over one-half of the individ- 10 ual’s support for the calendar 11 year in which such taxable year 12 begins and each of the preceding 13 4 taxable years, and 14 ‘‘(bb) the individual’s modi- 15 fied adjusted gross income for 16 the calendar year in which such 17 taxable year begins is less than 18 the exemption amount (as de- 19 fined in section 151(d)), 20 ‘‘(II) the individual is physically 21 or mentally incapable of caring for 22 himself or herself, and 23 ‘‘(III) the individual who has the 24 same principal place of abode as the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01006 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1007 •HR 7585 IH taxpayer for more than one-half of 1 such taxable year. 2 ‘‘(iii) The spouse of the taxpayer who 3 is physically or mentally incapable of car- 4 ing for himself or herself. 5 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.— 6 The term ‘modified adjusted gross income’ means 7 adjusted gross income determined without regard to 8 section 86. 9 ‘‘(3) EMPLOYMENT-RELATED EXPENSES.— 10 ‘‘(A) IN GENERAL.—The term ‘employ- 11 ment-related expenses’ means amounts paid for 12 the following expenses, but only if such ex- 13 penses are incurred to enable the taxpayer to be 14 gainfully employed for any period for which 15 there are one or more qualifying individuals 16 with respect to the taxpayer: 17 ‘‘(i) expenses for household services, 18 and 19 ‘‘(ii) expenses for the care of a quali- 20 fying individual, including expenses for res- 21 pite care and hospice care. 22 ‘‘(B) EXCEPTION.—Employment-related 23 expenses described in subparagraph (A) which 24 are incurred for services outside the taxpayer’s 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01007 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1008 •HR 7585 IH household shall be taken into account only if in- 1 curred for the care of— 2 ‘‘(i) a qualifying individual described 3 in paragraph (1)(A), or 4 ‘‘(ii) a qualifying individual (not de- 5 scribed in paragraph (1)(A)) who regularly 6 spends at least 8 hours each day in the 7 taxpayer’s household. 8 ‘‘(C) DEPENDENT CARE CENTERS.—Em- 9 ployment-related expenses described in subpara- 10 graph (A) which are incurred for services pro- 11 vided outside the taxpayer’s household by a de- 12 pendent care center (as defined in subpara- 13 graph (D)) shall be taken into account only if— 14 ‘‘(i) such center complies with all ap- 15 plicable laws and regulations of a State or 16 unit of local government, and 17 ‘‘(ii) the requirements of subpara- 18 graph (B) are met. 19 ‘‘(D) DEPENDENT CARE CENTER DE- 20 FINED.—For purposes of this paragraph, the 21 term ‘dependent care center’ means any facility 22 which— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01008 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1009 •HR 7585 IH ‘‘(i) provides care for more than six 1 individuals (other than individuals who re- 2 side at the facility), and 3 ‘‘(ii) receives a fee, payment, or grant 4 for providing services for any of the indi- 5 viduals (regardless of whether such facility 6 is operated for profit). 7 ‘‘(c) DOLLAR LIMIT ON AMOUNT CREDITABLE.—The 8 amount of the employment-related expenses incurred dur- 9 ing any taxable year which may be taken into account 10 under subsection (a) shall not exceed— 11 ‘‘(1) $3,000 if there is 1 qualifying individual 12 with respect to the taxpayer for such taxable year, 13 or 14 ‘‘(2) $6,000 if there are two or more qualifying 15 individuals with respect to the taxpayer for such tax- 16 able year. 17 The amount determined under paragraph (1) or (2) 18 (whichever is applicable) shall be reduced by the aggregate 19 amount excludable from gross income under section 129 20 for the taxable year. 21 ‘‘(d) EARNED INCOME LIMITATION.—Except as oth- 22 erwise provided in this subsection, the amount of the em- 23 ployment-related expenses incurred during any taxable 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01009 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1010 •HR 7585 IH year which may be taken into account under subsection 1 (a) shall not exceed— 2 ‘‘(1) in the case of an individual who is not 3 married at the close of such year, such individual’s 4 earned income for such year, or 5 ‘‘(2) in the case of an individual who is married 6 at the close of such year, the lesser of such individ- 7 ual’s earned income or the earned income of his 8 spouse for such year. 9 ‘‘(e) SPECIAL RULES.—For purposes of this sec- 10 tion— 11 ‘‘(1) PLACE OF ABODE.—An individual shall 12 not be treated as having the same principal place of 13 abode of the taxpayer if at any time during the tax- 14 able year of the taxpayer the relationship between 15 the individual and the taxpayer is in violation of 16 local law. 17 ‘‘(2) MARRIED COUPLES MUST FILE JOINT RE- 18 TURN.—If the taxpayer is married at the close of 19 the taxable year, the credit shall be allowed under 20 subsection (a) only if the taxpayer and his spouse 21 file a joint return for the taxable year. 22 ‘‘(3) MARITAL STATUS.—An individual legally 23 separated from his spouse under a decree of divorce 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01010 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1011 •HR 7585 IH or of separate maintenance shall not be considered 1 as married. 2 ‘‘(4) CERTAIN MARRIED INDIVIDUALS LIVING 3 APART.—If— 4 ‘‘(A) an individual who is married and who 5 files a separate return— 6 ‘‘(i) maintains as his home a house- 7 hold which constitutes for more than one- 8 half of the taxable year the principal place 9 of abode of a qualifying individual, and 10 ‘‘(ii) furnishes over half of the cost of 11 maintaining such household during the 12 taxable year, and 13 ‘‘(B) during the last 6 months of such tax- 14 able year such individual’s spouse is not a mem- 15 ber of such household, such individual shall not 16 be considered as married. 17 ‘‘(5) PAYMENTS TO RELATED INDIVIDUALS.— 18 No credit shall be allowed under subsection (a) for 19 any amount paid by the taxpayer to an individual— 20 ‘‘(A) with respect to whom, for the taxable 21 year, a deduction under section 151(c) (relating 22 to deduction for personal exemptions for de- 23 pendents) is allowable either to the taxpayer or 24 his spouse, or 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01011 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1012 •HR 7585 IH ‘‘(B) who is a child of the taxpayer (within 1 the meaning of section 152(f)(1)) who has not 2 attained the age of 19 at the close of the tax- 3 able year. 4 For purposes of this paragraph, the term ‘taxable 5 year’ means the taxable year of the taxpayer in 6 which the service is performed. 7 ‘‘(6) IDENTIFYING INFORMATION REQUIRED 8 WITH RESPECT TO SERVICE PROVIDER.—No credit 9 shall be allowed under subsection (a) for any amount 10 paid to any person unless— 11 ‘‘(A) the name, address, and taxpayer 12 identification number of such person are in- 13 cluded on the return claiming the credit, or 14 ‘‘(B) if such person is an organization de- 15 scribed in section 501(c)(3) and exempt from 16 tax under section 501(a), the name and address 17 of such person are included on the return 18 claiming the credit. 19 In the case of a failure to provide the information 20 required under the preceding sentence, the preceding 21 sentence shall not apply if it is shown that the tax- 22 payer exercised due diligence in attempting to pro- 23 vide the information so required. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01012 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1013 •HR 7585 IH ‘‘(7) IDENTIFYING INFORMATION REQUIRED 1 WITH RESPECT TO QUALIFYING INDIVIDUALS.—No 2 credit shall be allowed under this section with re- 3 spect to any qualifying individual unless the TIN of 4 such individual is included on the return claiming 5 the credit. 6 ‘‘(f) REGULATIONS.—The Secretary shall prescribe 7 such regulations as may be necessary to carry out the pur- 8 poses of this section.’’. 9 (b) CLERICAL AMENDMENT.—The table of sections 10 for subpart A of part IV of subchapter A of chapter 1 11 of the Internal Revenue Code of 1986 is amended by add- 12 ing at the end the following new item: 13 ‘‘Sec. 25E. Expenses for household and elder care services necessary for gainful employment.’’. (c) EFFECTIVE DATE.—The amendments made by 14 this section shall apply to taxable years beginning after 15 the date of the enactment of this Act. 16 Subtitle J—Miscellaneous 17 Provisions 18 SEC. 5901. CLARIFICATION SUPPORTING PERMISSIBLE USE 19 OF FUNDS FOR STILLBIRTH PREVENTION AC- 20 TIVITIES. 21 Section 501(a) of the Social Security Act (42 U.S.C. 22 701(a)) is amended— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01013 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1014 •HR 7585 IH (1) in paragraph (1)(B), by inserting ‘‘to re- 1 duce the incidence of stillbirth,’’ after ‘‘among chil- 2 dren,’’; and 3 (2) in paragraph (2), by inserting after ‘‘follow- 4 up services’’ the following: ‘‘, and for evidence-based 5 programs and activities and outcome research to re- 6 duce the incidence of stillbirth (including tracking 7 and awareness of fetal movements, improvement of 8 birth timing for pregnancies with risk factors, initia- 9 tives that encourage safe sleeping positions during 10 pregnancy, screening and surveillance for fetal 11 growth restriction, efforts to achieve smoking ces- 12 sation during pregnancy, community-based programs 13 that provide home visits or other types of support, 14 and any other research or evidence-based program- 15 ming to prevent stillbirths)’’. 16 TITLE VI—MENTAL HEALTH AND 17 SUBSTANCE USE DISORDERS 18 SEC. 6001. MENTAL HEALTH FINDINGS. 19 Congress finds the following: 20 (1) Despite the existence of effective treat- 21 ments, inequities lie in the availability, accessibility, 22 and quality of mental health services for racial and 23 ethnic minorities and people with disabilities. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01014 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1015 •HR 7585 IH (2) These inequities have powerful significance 1 for minority groups and for society as a whole. 2 (3) Racial and ethnic minorities bear a greater 3 burden from unmet mental health needs and thus 4 suffer a greater loss to their overall health and pro- 5 ductivity. 6 (4) Improving community conditions and one’s 7 home environment, paired with high-quality, acces- 8 sible, and culturally and linguistically tailored men- 9 tal health services, can reduce the likelihood, fre- 10 quency, and intensity of challenges to one’s mental 11 health. 12 (5) The presence of strong social connections 13 and trust, opportunities to experience and share cul- 14 tural identity, safe gathering places, and economic 15 opportunity are community factors that benefit men- 16 tal health. 17 (6) The social, physical, economic, and other 18 conditions, otherwise known as social determinants 19 of health, in communities can have tremendous in- 20 fluence on daily stressors that shape mental health 21 outcomes. 22 (7) Significant barriers include the cost of and 23 access to quality care, societal stigma, mental health 24 workforce shortages, the fragmented organization of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01015 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1016 •HR 7585 IH services and needed social supports, and the history 1 of racism and discrimination in the mental health 2 system. 3 (8) People with severe and persistent mental ill- 4 ness who are racial or ethnic minorities often have 5 co-occurring health and mental health conditions 6 and experience direct inequities in access to nec- 7 essary supports, resources, and services which, with- 8 out proper accommodations and support, further 9 stigmatize them and limit their participation in soci- 10 ety. 11 (9) African-American, Latinx, Asian American, 12 Pacific Islander, Native, Middle Eastern and North 13 African (MENA), and other people of color commu- 14 nities are more likely to experience systemic dis- 15 crimination by health care and social service pro- 16 viders and may be reluctant to seek mental health 17 care and other health interventions. 18 (10) Mental health conditions and substance 19 abuse disorders retain considerable stigma in many 20 communities of color and seeking treatment is not 21 always encouraged. 22 (11) Addressing mental health stigma and in- 23 creasing access to culturally and linguistically appro- 24 priate treatments and supports in communities will 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01016 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1017 •HR 7585 IH help to increase utilization of mental health services 1 for people who have functional difficulties because of 2 mental health challenges. 3 (12) There is a link between a 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 is one that fosters and finances 8 protective factors in racial and ethnic communities 9 that support mental health. 10 (14) Approaches to mental health and trauma 11 must keep in mind the historical and present day 12 and cultural trauma that impacts many communities 13 of color, including trauma and loss caused by ad- 14 verse weather events and structural violence. 15 (15) Culturally and linguistically appropriate 16 treatments and supports must keep approaches of 17 individual communities to mental health in mind, in- 18 cluding by considering— 19 (A) approaches to cultural healing prac- 20 tices; and 21 (B) the diverse mental health professionals 22 needed for such practices, such as peer support 23 specialists. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01017 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1018 •HR 7585 IH (16) Approaches to mental health and address- 1 ing trauma must keep in mind the concept of 2 intersectionality of individuals; that individuals may 3 experience many inequities that shape the way they 4 process and experience everyday life. 5 SEC. 6002. SENSE OF CONGRESS. 6 It is the sense of the Congress that it is imperative 7 that a comprehensive public health approach to addressing 8 trauma and mental health care be focused on care delivery 9 that is culturally and linguistically appropriate. 10 Subtitle A—Access to Care and 11 Funding Streams 12 SEC. 6011. COVERAGE OF MARRIAGE AND FAMILY THERA- 13 PIST SERVICES, MENTAL HEALTH COUN- 14 SELOR SERVICES, SUBSTANCE ABUSE COUN- 15 SELOR SERVICES, AND PEER SUPPORT SPE- 16 CIALIST SERVICES UNDER PART B OF THE 17 MEDICARE PROGRAM. 18 (a) COVERAGE OF SERVICES.— 19 (1) IN GENERAL.—Section 1861(s)(2) of the 20 Social Security Act (42 U.S.C. 1395x(s)(2)), as 21 amended by the previous provisions, is amended— 22 (A) in subparagraph (HH), by striking 23 ‘‘and’’ at the end; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01018 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1019 •HR 7585 IH (B) in subparagraph (II), by adding ‘‘and’’ 1 after the semicolon at the end; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(JJ) marriage and family therapist services 5 (as defined in subsection (nnn)(1)), mental health 6 counselor services (as defined in subsection 7 (nnn)(3)), substance abuse counselor services (as de- 8 fined in subsection (nnn)(5)), and peer support spe- 9 cialist services (as defined in subsection (nnn)(7));’’. 10 (2) DEFINITIONS.—Section 1861 of the Social 11 Security Act (42 U.S.C. 1395x), as amended by the 12 previous provisions, is amended by adding at the end 13 the following new subsection: 14 ‘‘Marriage and Family Therapist Services; Marriage and 15 Family Therapist; Mental Health Counselor Serv- 16 ices; Mental Health Counselor; Substance Abuse 17 Counselor Services; Substance Abuse Counselor; 18 Peer Support Specialist Services; Peer Support Spe- 19 cialist. 20 ‘‘(nnn)(1) The term ‘marriage and family therapist 21 services’ means services performed by a marriage and 22 family therapist (as defined in paragraph (2)) for the diag- 23 nosis and treatment of mental illnesses, which the mar- 24 riage and family therapist is legally authorized to perform 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01019 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1020 •HR 7585 IH under State law (or the State regulatory mechanism pro- 1 vided by State law) of the State in which such services 2 are performed, as would otherwise be covered if furnished 3 by a physician or as an incident to a physician’s profes- 4 sional service, but only if no facility or other provider 5 charges or is paid any amounts with respect to the fur- 6 nishing of such services. 7 ‘‘(2) The term ‘marriage and family therapist’ means 8 an individual who— 9 ‘‘(A) possesses a master’s or doctoral degree 10 that qualifies for licensure or certification as a mar- 11 riage and family therapist pursuant to State law, in- 12 cluding but not limited to, clinical social workers and 13 occupational therapists; 14 ‘‘(B) after obtaining such degree has performed 15 at least 2 years of clinical supervised experience in 16 marriage and family therapy; and 17 ‘‘(C) in the case of an individual performing 18 services in a State that provides for licensure or cer- 19 tification of marriage and family therapists, is li- 20 censed or certified as a marriage and family thera- 21 pist in such State. 22 ‘‘(3) The term ‘mental health counselor services’ 23 means services performed by a mental health counselor (as 24 defined in paragraph (4)) for the diagnosis and treatment 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01020 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1021 •HR 7585 IH of mental health conditions and disabilities that the men- 1 tal health counselor is legally authorized to perform under 2 State law (or the State regulatory mechanism provided by 3 the State law) of the State in which such services are per- 4 formed, as would otherwise be covered if furnished by a 5 physician or as incident to a physician’s professional serv- 6 ice, but only if no facility or other provider charges or is 7 paid any amounts with respect to the furnishing of such 8 services. 9 ‘‘(4) The term ‘mental health counselor’ means an 10 individual who— 11 ‘‘(A) possesses a master’s or doctor’s degree in 12 mental health counseling or a related field, including 13 clinical social workers and occupational therapists; 14 ‘‘(B) after obtaining such a degree has per- 15 formed at least 2 years of supervised mental health 16 counselor practice; and 17 ‘‘(C) in the case of an individual performing 18 services in a State that provides for licensure or cer- 19 tification of mental health counselors or professional 20 counselors, is licensed or certified as a mental health 21 counselor or professional counselor in such State. 22 ‘‘(5) The term ‘substance abuse counselor services’ 23 means services performed by a substance abuse counselor 24 (as defined in paragraph (6)) for the diagnosis and treat- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01021 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1022 •HR 7585 IH ment of substance abuse and addiction that the substance 1 abuse counselor is legally authorized to perform under 2 State law (or the State regulatory mechanism provided by 3 the State law) of the State in which such services are per- 4 formed, as would otherwise be covered if furnished by a 5 physician or as incident to a physician’s professional serv- 6 ice, but only if no facility or other provider charges or is 7 paid any amounts with respect to the furnishing of such 8 services. 9 ‘‘(6) The term ‘substance abuse counselor’ means an 10 individual who— 11 ‘‘(A) has performed at least 2 years of super- 12 vised substance abuse counselor practice; 13 ‘‘(B) in the case of an individual performing 14 services in a State that provides for licensure or cer- 15 tification of substance abuse counselors or profes- 16 sional counselors, is licensed or certified as a sub- 17 stance abuse counselor or professional counselor in 18 such State; or 19 ‘‘(C) is a drug and alcohol counselor as defined 20 in section 40.281 of title 49, Code of Federal Regu- 21 lations. 22 ‘‘(7) The term ‘peer support specialist services’ 23 means services performed by a peer support specialist (as 24 defined in paragraph (8)) for the well-being of individuals 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01022 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1023 •HR 7585 IH needing mental health support that the peer support spe- 1 cialist is legally authorized to perform under State law (or 2 the State regulatory mechanism provided by the State 3 law) of the State in which such services are performed, 4 as would otherwise be covered if furnished by a physician 5 or as incident to a physician’s professional service, but 6 only if no facility or other provider charges or is paid any 7 amounts with respect to the furnishing of such services. 8 ‘‘(8) The term ‘peer support specialist’ means an in- 9 dividual who— 10 ‘‘(A) is an individual living in recovery with 11 mental illness, addiction, or systems involvement; 12 ‘‘(B) has skills learned in formal training; 13 ‘‘(C) uses assets-based framing in speaking 14 about mental health, recovery, and well-being; and 15 ‘‘(D) delivers services in behavioral health set- 16 tings to promote mind-body recovery and resil- 17 iency.’’. 18 (3) PROVISION FOR PAYMENT UNDER PART 19 B.—Section 1832(a)(2)(B) of the Social Security 20 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 21 (A) by striking ‘‘and’’ at the end of clause 22 (iv); and 23 (B) by adding at the end the following new 24 clause: 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01023 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1024 •HR 7585 IH ‘‘(v) marriage and family therapist 1 services, mental health counselor services, 2 substance abuse counselor services, and 3 peer support specialist services; and’’. 4 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 5 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 6 as amended by section 431(c)(3), is amended— 7 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 8 (B) by inserting before the semicolon at 9 the end the following: ‘‘, and (EE) with respect 10 to marriage and family therapist services, men- 11 tal health counselor services, substance abuse 12 counselor services, and peer support specialist 13 services under section 1861(s)(2)(JJ), the 14 amounts paid shall be 80 percent of the lesser 15 of the actual charge for the services or 75 per- 16 cent of the amount determined for payment of 17 a psychologist under subparagraph (L)’’. 18 (5) EXCLUSION OF MARRIAGE AND FAMILY 19 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR 20 SERVICES, AND PEER SUPPORT SPECIALIST SERV- 21 ICES FROM SKILLED NURSING FACILITY PROSPEC- 22 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 23 of the Social Security Act (42 U.S.C. 24 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01024 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1025 •HR 7585 IH riage and family therapist services (as defined in 1 section 1861(nnn)(1)), mental health counselor serv- 2 ices (as defined in section 1861(nnn)(3)), and peer 3 support specialist services (as defined in section 4 1861(nnn)(7))’’ after ‘‘qualified psychologist serv- 5 ices,’’. 6 (6) INCLUSION OF MARRIAGE AND FAMILY 7 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 8 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 9 FOR ASSIGNMENT OF CLAIMS.—Section 10 1842(b)(18)(C) of the Social Security Act (42 11 U.S.C. 1395u(b)(18)(C)) is amended by adding at 12 the end the following new clauses: 13 ‘‘(vii) A marriage and family therapist (as de- 14 fined in section 1861(nnn)(2)). 15 ‘‘(viii) A mental health counselor (as defined in 16 section 1861(nnn)(4)). 17 ‘‘(ix) A substance abuse counselor (as defined 18 in section 1861(nnn)(6)). 19 ‘‘(x) A peer support specialist (as defined in 20 section 1861(nnn)(8)).’’. 21 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 22 ICES PROVIDED IN CERTAIN SETTINGS.— 23 (1) RURAL HEALTH CLINICS AND FEDERALLY 24 QUALIFIED HEALTH CENTERS.—Section 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01025 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1026 •HR 7585 IH 1861(aa)(1)(B) of the Social Security Act (42 1 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 2 by a clinical social worker (as defined in subsection 3 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 4 (as defined in subsection (hh)(1)), by a marriage 5 and family therapist (as defined in subsection 6 (nnn)(2)), or by a mental health counselor (as de- 7 fined in subsection (nnn)(4)), or by a substance 8 abuse counselor (as defined in section 1861 9 (nnn)(6)), or by a peer support specialist (as defined 10 in section 1861(nnn)(8)).’’. 11 (2) HOSPICE PROGRAMS.—Section 12 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 13 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in- 14 serting ‘‘or one marriage and family therapist (as 15 defined in subsection (nnn)(2))’’ after ‘‘social work- 16 er’’. 17 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 18 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 19 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 20 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 21 amended by inserting ‘‘marriage and family therapist (as 22 defined in subsection (nnn)(2)),’’ after ‘‘social worker,’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01026 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1027 •HR 7585 IH (d) EFFECTIVE DATE.—The amendments made by 1 this section shall apply with respect to services furnished 2 on or after January 1, 2023. 3 SEC. 6012. REAUTHORIZATION OF MINORITY FELLOWSHIP 4 PROGRAM. 5 Section 597(c) of the Public Health Service Act (42 6 U.S.C. 297ll(c)) is amended by striking ‘‘$12,669,000 for 7 each of fiscal years 2018 through 2022’’ and inserting 8 ‘‘$25,000,000 for each of fiscal years 2023 through 9 2027’’. 10 SEC. 6013. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES 11 OF HEALTH. 12 (a) IN GENERAL.—In addition to amounts otherwise 13 authorized to be appropriated to the National Institutes 14 of Health, there is authorized to be appropriated to such 15 Institutes $100,000,000 for each of fiscal years 2023 16 through 2027 to build relations with communities and con- 17 duct or support clinical research, including clinical re- 18 search on racial or ethnic disparities in physical and men- 19 tal health. 20 (b) DEFINITION.—In this section, the term ‘‘clinical 21 research’’ has the meaning given to such term in section 22 409 of the Public Health Service Act (42 U.S.C. 284d). 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01027 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1028 •HR 7585 IH SEC. 6014. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE 1 ON MINORITY HEALTH AND HEALTH DISPARI- 2 TIES. 3 In addition to amounts otherwise authorized to be ap- 4 propriated to the National Institute on Minority Health 5 and Health Disparities, there is authorized to be appro- 6 priated to such Institute $650,000,000 for each of fiscal 7 years 2023 through 2027. 8 SEC. 6015. GRANTS FOR INCREASING RACIAL AND ETHNIC 9 MINORITY ACCESS TO HIGH-QUALITY TRAU- 10 MA SUPPORT SERVICES AND MENTAL 11 HEALTH CARE. 12 (a) IN GENERAL.—The Secretary of Health and 13 Human Services (in this section referred to as the ‘‘Sec- 14 retary’’), acting through the Assistant Secretary for Men- 15 tal Health and Substance Use, shall award grants to eligi- 16 ble entities to establish or expand programs for the pur- 17 pose of increasing racial and ethnic minority access to 18 high-quality trauma support services and mental health 19 care. 20 (b) ELIGIBLE ENTITIES.—To seek a grant under this 21 section, an entity shall be a community-based program or 22 organization that— 23 (1) provides culturally and linguistically appro- 24 priate programs and resources that are aligned with 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01028 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1029 •HR 7585 IH evidence-based practices for trauma-informed care; 1 and 2 (2) has demonstrated expertise in serving com- 3 munities of color or can partner with a program that 4 has such demonstrated expertise. 5 (c) USE OF FUNDS.—As a condition on receipt of a 6 grant under this section, a grantee shall agree to use the 7 grant to increase racial and ethnic minority access to high- 8 quality trauma support services and mental health care, 9 such as by— 10 (1) establishing and maintaining community- 11 based programs providing evidence-based services in 12 trauma-informed care and culturally specific services 13 and other resources; 14 (2) developing innovative, culturally specific 15 strategies and projects to enhance access to trauma- 16 informed care and resources for racial and ethnic 17 minorities who face obstacles to using more tradi- 18 tional services and resources (such as obstacles in 19 geographic access to providers, insurance coverage, 20 and access to audio and video technologies); 21 (3) working with State and local governments 22 and social service agencies to develop and enhance 23 effective strategies to provide culturally specific serv- 24 ices to racial and ethnic minorities; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01029 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1030 •HR 7585 IH (4) increasing communities’ capacity to provide 1 culturally specific resources and support for commu- 2 nities of color; 3 (5) working in cooperation with the community 4 to develop education and prevention strategies high- 5 lighting culturally specific issues and resources re- 6 garding racial and ethnic minorities; 7 (6) providing culturally specific programs for 8 racial and ethnic minorities exposed to law enforce- 9 ment violence; and 10 (7) examining the dynamics of culture and its 11 impact on victimization and healing. 12 (d) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to eligible entities 14 proposing to serve communities that have faced high rates 15 of community trauma, including from exposure to law en- 16 forcement violence, intergenerational poverty, civil unrest, 17 discrimination, or oppression. 18 (e) GRANT PERIOD.—The period of a grant under 19 this section shall be 4 years. 20 (f) EVALUATION.—Not later than 6 months after the 21 end of the period of all grants under this section, the Sec- 22 retary shall— 23 (1) conduct an evaluation of the programs 24 funded by a grant under this section; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01030 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1031 •HR 7585 IH (2) include in such evaluation an assessment of 1 the outcomes of each such program; and 2 (3) submit a report on the results of such eval- 3 uation to the Congress. 4 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 5 out this section, there is authorized to be appropriated 6 $20,000,000 for each of fiscal years 2023 through 2027. 7 SEC. 6016. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO- 8 GRAMS. 9 Part D of title V of the Public Health Service Act, 10 as amended by sections 6022, 6023, and 6052, is further 11 amended adding at the end the following new section: 12 ‘‘SEC. 556. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO- 13 GRAMS. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Assistant Secretary for Mental Health and Substance 16 Use, may award grants to States, territories, political sub- 17 divisions of States and territories, Tribal governments, 18 and consortia of Tribal governments to establish an un- 19 armed 9–1–1 response program under which nonviolent 9– 20 1–1 calls are referred to unarmed professional service pro- 21 viders for response, instead of to a law enforcement agen- 22 cy. 23 ‘‘(b) PROGRAM REQUIREMENTS.—An unarmed 9–1– 24 1 response program funded under this section shall— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01031 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1032 •HR 7585 IH ‘‘(1) dispatch unarmed professional service pro- 1 viders in groups of two or more in a timely manner; 2 ‘‘(2) be capable of providing screening, assess- 3 ment, de-escalation, trauma-informed culturally and 4 linguistically appropriate services, referrals to treat- 5 ment providers, and transportation to immediately 6 necessary treatment; 7 ‘‘(3) when necessary, coordinate with health or 8 social services; 9 ‘‘(4) not be subject to oversight of State or local 10 law enforcement agencies; and 11 ‘‘(5) clearly outline the scope of calls that must 12 or may be referred to the unarmed 9–1–1 response 13 program. 14 ‘‘(c) USES OF FUNDS.—A grant under this section 15 may be used for— 16 ‘‘(1) hiring unarmed professional service pro- 17 viders and 9–1–1 dispatchers; 18 ‘‘(2) training unarmed professional service pro- 19 viders to respond to 9–1–1 calls by identifying, un- 20 derstanding, and responding to signs of mental ill- 21 nesses, developmental or intellectual disabilities, and 22 substance use disorders, including by means of— 23 ‘‘(A) de-escalation; 24 ‘‘(B) crisis intervention; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01032 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1033 •HR 7585 IH ‘‘(C) connecting individuals to local social 1 service providers, health care providers, commu- 2 nity-based organizations, and the full range of 3 other available providers and resources, with a 4 focus on culturally and linguistically appro- 5 priate service providers; 6 ‘‘(3) updating 9–1–1 response systems to en- 7 able triage between nonviolent 9–1–1 calls and those 8 that require a response from law enforcement; 9 ‘‘(4) training 9–1–1 dispatchers on call diver- 10 sion; 11 ‘‘(5) building the capacity— 12 ‘‘(A) to coordinate with local social service 13 providers, health care providers, suicide hotline 14 operators, and community-based organizations; 15 and 16 ‘‘(B) to provide multilingual and culturally 17 and linguistically appropriate services; and 18 ‘‘(6) collecting data for reports to the Sec- 19 retary. 20 ‘‘(d) APPLICATION.—An applicant seeking a grant 21 under this section shall submit to the Secretary an appli- 22 cation at such time, in such manner, and containing such 23 information as the Secretary may reasonably require, in- 24 cluding the applicant’s plan to train 9–1–1 dispatchers to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01033 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1034 •HR 7585 IH determine when a call should be diverted to the unarmed 1 9–1–1 response program. 2 ‘‘(e) REPORTS TO SECRETARY.—A recipient of a 3 grant under this section shall submit to the Secretary, on 4 a biannual basis, a report on the following: 5 ‘‘(1) The number of calls placed to 9–1–1 that 6 were diverted to the grantee’s unarmed 9–1–1 re- 7 sponse program. 8 ‘‘(2) Demographic information on the individ- 9 uals served by the grantee’s unarmed 9–1–1 re- 10 sponse program, disaggregated by race, ethnicity, 11 age, sex, sexual orientation, gender identity, and lo- 12 cation. 13 ‘‘(3) The effects of the grantee’s unarmed 9–1– 14 1 response program on emergency room visits, hos- 15 pitalizations, use of ambulances, and involvement of 16 law enforcement in mental health or substance use 17 disorder crises. 18 ‘‘(4) An assessment of the types of events and 19 crises to which the grantee’s unarmed 9–1–1 re- 20 sponse program responded and the services provided, 21 including— 22 ‘‘(A) the number of individuals to whom 23 services were provided who were involuntarily 24 committed for treatment; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01034 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1035 •HR 7585 IH ‘‘(B) the number of individuals successfully 1 transferred to an alternative destination; 2 ‘‘(C) the time between notification by a 9– 3 1–1 dispatcher and arrival at the scene by a 4 provider; and 5 ‘‘(D) the time spent by providers at scene. 6 ‘‘(5) A cost analysis of the grantee’s unarmed 7 9–1–1 response program. 8 ‘‘(6) An assessment of data sharing limitations 9 or problems associated with adherence to— 10 ‘‘(A) Federal regulations (concerning the 11 privacy of individually identifiable health infor- 12 mation) promulgated under section 264(c) of 13 the Health Insurance Portability and Account- 14 ability Act of 1996; and 15 ‘‘(B) part II of title 42, Code of Federal 16 Regulations. 17 ‘‘(f) REPORTS TO CONGRESS.—The Secretary shall 18 submit to the Congress, on a biannual basis, a report on 19 the program under this section, including a summary of 20 the reports submitted by grantees pursuant to subsection 21 (e). 22 ‘‘(g) GRANT AMOUNT.—The Secretary may make 23 grants to applicants that do not meet all of the criteria 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01035 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1036 •HR 7585 IH under subsection (b)(1), but applicants that do not meet 1 all such criteria may not receive the full grant amount. 2 ‘‘(h) DEFINITIONS.—In this section: 3 ‘‘(1) The term ‘alternative destination’— 4 ‘‘(A) means any service- or care-providing 5 site other than a hospital emergency depart- 6 ment or jail; and 7 ‘‘(B) includes a clinic, primary care office, 8 crisis center, and community care center. 9 ‘‘(2) The term ‘nonviolent 9–1–1 call’ means a 10 9–1–1 call that— 11 ‘‘(A) relates to mental health, homeless- 12 ness, addiction problems, social services, tru- 13 ancy, intellectual and developmental disabilities, 14 or public intoxication; and 15 ‘‘(B) does not involve obvious violent be- 16 havior. 17 ‘‘(3) The term ‘unarmed professional service 18 provider’ means a professional (which may include a 19 nurse, social worker, emergency medical technician, 20 counselor, community health worker, trauma-in- 21 formed personnel, social service provider, or peer 22 support specialist) who— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01036 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1037 •HR 7585 IH ‘‘(A) is trained to deal with mental health 1 or substance abuse crises or intellectual and de- 2 velopmental disabilities; and 3 ‘‘(B) does not carry a firearm.’’. 4 Subtitle B—Interprofessional Care 5 SEC. 6021. HEALTH PROFESSIONS COMPETENCIES TO AD- 6 DRESS RACIAL AND ETHNIC MENTAL HEALTH 7 INEQUITIES. 8 (a) IN GENERAL.—The Secretary of Health and 9 Human Services, acting through the Assistant Secretary 10 for Mental Health and Substance Use, shall award grants 11 to qualified national organizations for the purposes of— 12 (1) developing, and disseminating to health pro- 13 fessional educational programs culturally and lin- 14 guistically appropriate curricula or core com- 15 petencies addressing mental health inequities among 16 racial and ethnic minority groups for use in the 17 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 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01037 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1038 •HR 7585 IH health care and community-based settings to address 1 mental health inequities among racial and ethnic mi- 2 nority groups. 3 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 4 tions receiving funds under subsection (a) may use the 5 funds to engage in the following activities related to the 6 development and dissemination of curricula or core com- 7 petencies described in subsection (a)(1): 8 (1) Formation of committees or working groups 9 comprised of experts from accredited health profes- 10 sions schools to identify core competencies relating 11 to mental health inequities among racial and ethnic 12 minority groups. 13 (2) Planning of workshops in collaboration with 14 community-based organizations and communities of 15 color in national fora to directly facilitate public 16 input, including input from communities of color 17 with lived experience, into the educational needs as- 18 sociated with mental health inequities among racial 19 and ethnic minority groups. 20 (3) Dissemination and promotion of the use of 21 curricula or core competencies in undergraduate and 22 graduate health professions training programs na- 23 tionwide. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01038 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1039 •HR 7585 IH (4) Establishing external stakeholder advisory 1 boards to provide meaningful input into policy and 2 program development and best practices to reduce 3 mental health inequities among racial and ethnic 4 groups, including participation and leadership from 5 communities of color with lived experience of the im- 6 pacts of mental health inequities. 7 (c) DEFINITIONS.—In this section: 8 (1) QUALIFIED NATIONAL ORGANIZATION.—The 9 term ‘‘qualified national organization’’ means a na- 10 tional organization that focuses on the education of 11 students in programs of social work, occupational 12 therapy, psychology, psychiatry, substance use coun- 13 seling, and marriage and family therapy. 14 (2) RACIAL AND ETHNIC MINORITY GROUP.— 15 The term ‘‘racial and ethnic minority group’’ has the 16 meaning given to such term in section 1707(g) of 17 the Public Health Service Act (42 U.S.C. 300u– 18 6(g)), as amended by title I of this Act. 19 (d) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2023 through 2027. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01039 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1040 •HR 7585 IH SEC. 6022. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 1 BEHAVIORAL HEALTH CARE. 2 Part D of title V of the Public Health Service Act 3 (42 U.S.C. 290dd et seq.) is amended by adding at the 4 end the following: 5 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 6 PROVISION OF BEHAVIORAL HEALTH CARE 7 IN PRIMARY CARE SETTINGS. 8 ‘‘(a) GRANTS.—The Secretary, acting through the 9 Assistant Secretary for Mental Health and Substance Use, 10 shall award grants to eligible entities for the purpose of 11 establishing interprofessional health care teams that pro- 12 vide behavioral health care. 13 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 14 a grant under this section, an entity shall be a Federally 15 qualified health center (as defined in section 1861(aa) of 16 the Social Security Act), rural health clinic, women’s 17 health clinic, or behavioral health program (including any 18 such program operated by a community-based organiza- 19 tion) serving a high proportion of individuals from racial 20 and ethnic minority groups (as defined in section 21 1707(g)). 22 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 23 and diverse allied health professionals to enter the mental 24 health field, an eligible entity receiving a grant under this 25 section shall agree to use not less than $10,000 of the 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01040 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1041 •HR 7585 IH grant funds on a loan forgiveness program for practi- 1 tioners who commit to working in the mental health field 2 for a period of 2 years. 3 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 4 Integrated health care funded through this section shall 5 be scientifically and culturally based, taking into consider- 6 ation the results of the most recent peer-reviewed research 7 available, including information on language accessibility, 8 cultural humility, diversity of practitioners, and consider- 9 ation of social determinants of health. 10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 11 carry out this section, there is authorized to be appro- 12 priated $20,000,000 for each of fiscal years 2023 through 13 2027.’’. 14 SEC. 6023. INTEGRATED HEALTH CARE DEMONSTRATION 15 PROGRAM. 16 Part D of title V of the Public Health Service Act 17 (42 U.S.C. 290dd et seq.), as amended by sections 6022 18 and 6052, is further amended by adding at the end the 19 following: 20 ‘‘SEC. 555. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 21 PROVISION OF BEHAVIORAL HEALTH CARE 22 IN PRIMARY CARE SETTINGS. 23 ‘‘(a) GRANTS.—The Secretary shall award grants to 24 eligible entities for the purpose of establishing interprofes- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01041 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1042 •HR 7585 IH sional health care teams that provide behavioral health 1 care. 2 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 3 a grant under this section, an entity shall be a Federally 4 qualified health center (as defined in section 1861(aa) of 5 the Social Security Act), rural health clinic, or behavioral 6 health program, serving a high proportion of individuals 7 from racial and ethnic minority groups (as defined in sec- 8 tion 1707(g)). 9 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 10 care funded through this section shall be scientifically 11 based, taking into consideration the results of the most 12 recent peer-reviewed research available. 13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this section, there is authorized to be appro- 15 priated $20,000,000 for each of the first 5 fiscal years 16 following the date of enactment of the Pursuing Equity 17 in Mental Health Act.’’. 18 Subtitle C—Workforce 19 Development 20 SEC. 6031. BUILDING AN EFFECTIVE WORKFORCE IN MEN- 21 TAL HEALTH. 22 (a) IN GENERAL.—The Secretary of Health and 23 Human Services, in coordination with the Assistant Sec- 24 retary for Mental Health and Substance Use, the Adminis- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01042 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1043 •HR 7585 IH trator of the Health Resources and Services Administra- 1 tion, the Secretary of Labor, and advocacy and behavioral 2 and mental health organizations serving vulnerable popu- 3 lations, including youth and young adults, people with low 4 incomes, and people of color, shall— 5 (1) develop, strengthen, and implement strate- 6 gies to bolster career pathways for diverse mental 7 health professionals; 8 (2) identify the breadth of settings where men- 9 tal health care and behavioral health care can take 10 place; and 11 (3) identify current mental health professional 12 workforce shortages, inclusive of shortages of diverse 13 mental health professionals. 14 (b) CONTENTS.—Strategies under subsection (a) 15 shall include— 16 (1) the variety of settings where mental health 17 professionals are needed, including community-based 18 organizations, women’s centers, shelters, organiza- 19 tions focused on youth development, workforce agen- 20 cies, job placement and development centers, emer- 21 gency rooms, the special supplemental nutrition pro- 22 gram for women, infants, and children under section 23 17 of the Child Nutrition Act of 1966 (42 U.S.C. 24 1786), food banks, legal aid, and benefit issuers as 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01043 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1044 •HR 7585 IH defined in section 3 of the Food and Nutrition Act 1 of 2008 (7 U.S.C. 2012); 2 (2) defining career pathways in mental and be- 3 havioral health, to help diverse communities under- 4 stand the variety of careers in mental and behavioral 5 health that are available; 6 (3) building career pathways in mental and be- 7 havioral health as part of the curriculum at the 8 postsecondary education level; 9 (4) providing accessible training and certifi- 10 cation pathways for diverse lay health workers such 11 as community health workers and other peer support 12 specialists to ensure that careers pay a living wage; 13 (5) creating incentives for students in the fields 14 of occupational therapy, social work, psychology, 15 medicine, and nursing to learn more about mental 16 health, and to include a mental health rotation, with 17 a particular focus in racially and ethnically diverse 18 communities, as a part of the health professional 19 curricula; 20 (6) including training and education for teach- 21 ers about the basics of section 504 of the Rehabilita- 22 tion Act of 1973 (29 U.S.C. 794) and individualized 23 education programs (as defined in section 614(d) of 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01044 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1045 •HR 7585 IH the Individuals with Disabilities Education Act (20 1 U.S.C. 1414(d))); 2 (7) researching, developing, and implementing 3 programs for mental and behavioral health profes- 4 sionals to prevent burnout; and 5 (8) finding better and increased avenues to en- 6 sure equity by providing better loan forgiveness pro- 7 grams, including a focus area within the National 8 Health Service Corps focused on community trauma. 9 (c) USE OF FUNDS.—Programs and activities funded 10 under this section shall be consistent with section (a)(1) 11 and must include the following: 12 (1) Subgrants to entities serving youth and 13 young adults which demonstrate a need for an in- 14 creased mental health workforce, using strategies 15 mentioned in subsection (a)(1). 16 (2) Funding towards the Health Resources and 17 Services Administration’s Behavioral Health Work- 18 force Education and Training Program. 19 (3) Funding towards the development and im- 20 plementation of a National Health Service Corps 21 program focused on community trauma. 22 (d) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section, 24 $50,000,000 for each of fiscal years 2023 through 2033. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01045 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1046 •HR 7585 IH SEC. 6032. PILOT PROGRAM TO INCREASE LANGUAGE AC- 1 CESS AT FEDERALLY QUALIFIED HEALTH 2 CENTERS. 3 (a) LOAN REPAYMENTS TO QUALIFIED HEALTH 4 CARE PROFESSIONALS.— 5 (1) IN GENERAL.—For the purpose of increas- 6 ing language access to mental health services, the 7 Secretary shall carry out a demonstration project 8 under which— 9 (A) the Secretary matches qualified mental 10 health professionals with Federally qualified 11 health centers; 12 (B) the qualified mental health profes- 13 sionals each agree to a period of obligated serv- 14 ice at a Federally qualified health center with 15 which they are so matched; and 16 (C) the Secretary agrees to make loan re- 17 payments under section 338B of the Public 18 Health Service Act (42 U.S.C. 254l–1) on be- 19 half of such qualified mental health profes- 20 sionals. 21 (2) PREFERENCE.—In matching qualified men- 22 tal health professionals with Federally qualified 23 health centers under paragraph (1), the Secretary 24 shall give preference to placement at Federally quali- 25 fied health centers at which at least 20 percent of 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01046 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1047 •HR 7585 IH the patients are best served in a language other than 1 English, as indicated by data in the Uniform Data 2 System (or any successor database). 3 (3) ENHANCED COMPENSATION.—For each 4 year of obligated service that a qualified mental 5 health professional contracts to serve under para- 6 graph (1) at a Federally qualified health center at 7 which at least 20 percent of the patients are best 8 served in a language other than English, as indi- 9 cated by data in the Uniform Data System (or any 10 successor database), the Secretary may pay the 11 higher of— 12 (A) $10,000 above the maximum amount 13 otherwise applicable under section 14 338B(g)(2)(A) of the Public Health Service Act 15 (42 U.S.C. 254l–1(g)(2)(A)); or 16 (B) if the qualified health professional is 17 fluent in a language other than English that is 18 needed by such Federally qualified health cen- 19 ter, $15,000 above such maximum amount. 20 (4) ACHIEVING FLUENCY.—A qualified mental 21 health professional eligible to receive the enhanced 22 pay amount specified in paragraph (3)(A) at the be- 23 ginning of the professional’s period of obligated serv- 24 ice may transition to being eligible to receive the en- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01047 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1048 •HR 7585 IH hanced higher pay amount specified in paragraph 1 (3)(B) if the professional is determined by the Fed- 2 erally qualified health center at which the profes- 3 sional serves to have achieved fluency in a language 4 other than English needed by that health center. 5 (b) GRANTS TO HEALTH CENTERS.— 6 (1) IN GENERAL.—The Secretary shall carry 7 out a demonstration program consisting of awarding 8 grants under section 330 of the Public Health Serv- 9 ice Act (42 U.S.C. 254b) to Federally qualified 10 health centers to recruit, hire, employ, and supervise 11 qualified mental health professionals who are fluent 12 in a language other than English to provide mental 13 health services in such other language. 14 (2) PREFERENCE.—In selecting grant recipi- 15 ents under paragraph (1), the Secretary shall give 16 preference to Federally qualified health centers at 17 which at least 20 percent of the patients are best 18 served in a language other than English, as indi- 19 cated by data in the Uniform Data System (or any 20 successor database). 21 (3) MARKETING.—A Federally qualified health 22 center receiving a grant under this subsection shall 23 use a portion of the grant funds to disseminate in- 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01048 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1049 •HR 7585 IH formation about, and otherwise market, the mental 1 health services supported through the grant. 2 (c) REPORTS.— 3 (1) INITIAL REPORT.—Not later than 6 months 4 after awarding loan repayment agreements under 5 subsection (a) and grants under subsection (b), the 6 Secretary shall submit to the Committees on Appro- 7 priations of the House of Representatives and the 8 Senate, and to other appropriate congressional com- 9 mittees, a report on the implementation of the pro- 10 grams under this section. Such report shall in- 11 clude— 12 (A) the languages spoken by the qualified 13 mental health professionals receiving loan re- 14 payments pursuant to subsection (a) or re- 15 cruited pursuant to a grant under subsection 16 (b); 17 (B) the Federally qualified health centers 18 at which such professionals were placed; 19 (C) how many Federally qualified health 20 centers received funding through the grant pro- 21 gram under subsection (b); 22 (D) an analysis, conducted in consultation 23 with the Federally qualified health centers re- 24 ceiving grants under section (b), of the effec- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01049 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1050 •HR 7585 IH tiveness of such grants at increasing language 1 access to mental health services; and 2 (E) best practices, developed in consulta- 3 tion with Federally qualified health centers re- 4 ceiving grants under section (b), for the recruit- 5 ment and retention of mental health profes- 6 sionals at Federally qualified health centers. 7 (2) FINAL REPORT.—Not later than the end of 8 fiscal year 2027, the Secretary shall submit to the 9 Committees on Appropriations of the House of Rep- 10 resentatives and the Senate, and to other appro- 11 priate congressional committees, a final report on 12 the implementation of the programs under this sec- 13 tion, including the information, analysis, and best 14 practices listed in subparagraphs (A) through (E) of 15 paragraph (1). 16 (d) DEFINITIONS.—In this section: 17 (1) The term ‘‘Federally qualified health cen- 18 ter’’ has the meaning given the term in section 19 1861(aa) of the Social Security Act (42 U.S.C. 20 1395x(aa)). 21 (2) The term ‘‘qualified mental health profes- 22 sional’’ means— 23 (A) physicians, allopathic physicians, osteo- 24 pathic physicians, nurse practitioners, and phy- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01050 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1051 •HR 7585 IH sician assistants with a specialty in mental 1 health and psychiatry; 2 (B) health service psychologists; 3 (C) licensed clinical social workers; 4 (D) psychiatric nurse specialists; 5 (E) marriage and family therapists; 6 (F) licensed professional counselors; 7 (G) substance use disorder counselors; 8 (H) occupational therapists; and 9 (I) other individuals who— 10 (i) have not yet been licensed or cer- 11 tified to serve as a professional listed in 12 any of subparagraphs (A) through (H); 13 and 14 (ii) will serve at the Federally quali- 15 fied health center under the supervision of 16 a licensed individual or certified profes- 17 sional so listed. 18 (3) The term ‘‘Secretary’’ means the Secretary 19 of Health and Human Services. 20 (e) AUTHORIZATION OF APPROPRIATIONS.— 21 (1) IN GENERAL.—To carry out this section, 22 there is authorized to be appropriated $75,000,000 23 for each of fiscal years 2023 through 2027. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01051 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1052 •HR 7585 IH (2) SUPPLEMENT, NOT SUPPLANT.—Amounts 1 made available to carry out this section shall be in 2 addition to amounts otherwise available to provide 3 mental health services at Federally qualified health 4 centers pursuant to sections 338B and 330 of the 5 Public Health Service Act (42 U.S.C. 254l–1, 254b). 6 SEC. 6033. HEALTH PROFESSIONS COMPETENCIES TO AD- 7 DRESS RACIAL AND ETHNIC MINORITY MEN- 8 TAL HEALTH DISPARITIES. 9 (a) IN GENERAL.—The Secretary of Health and 10 Human Services may award grants to qualified national 11 organizations for the purposes of— 12 (1) developing, and disseminating to health pro- 13 fessional educational programs, best practices or 14 core competencies addressing mental health dispari- 15 ties among racial and ethnic minority groups for use 16 in the training of students in the professions of so- 17 cial work, psychology, psychiatry, marriage and fam- 18 ily therapy, mental health counseling, and substance 19 abuse counseling; and 20 (2) certifying community health workers and 21 peer wellness specialists with respect to such best 22 practices and core competencies and integrating and 23 expanding the use of such workers and specialists 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01052 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1053 •HR 7585 IH into health care to address mental health disparities 1 among racial and ethnic minority groups. 2 (b) BEST PRACTICES; CORE COMPETENCIES.—Orga- 3 nizations receiving funds under subsection (a) may use the 4 funds to engage in the following activities related to the 5 development and dissemination of best practices or core 6 competencies described in subsection (a)(1): 7 (1) Formation of committees or working groups 8 comprised of experts from accredited health profes- 9 sions schools to identify best practices and core com- 10 petencies relating to mental health disparities among 11 racial and ethnic minority groups. 12 (2) Planning of workshops at the national level 13 to allow for public input into the educational needs 14 associated with mental health disparities among ra- 15 cial and ethnic minority groups. 16 (3) Dissemination and promotion of the use of 17 best practices or core competencies for culturally 18 and linguistically appropriate mental health services 19 in undergraduate and graduate health professions 20 training programs nationwide. 21 (4) Establishing external stakeholder advisory 22 boards to provide meaningful input into policy and 23 program development and best practices to reduce 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01053 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1054 •HR 7585 IH mental health disparities among racial and ethnic 1 minority groups. 2 (c) DEFINITIONS.—In this section: 3 (1) QUALIFIED NATIONAL ORGANIZATION.—The 4 term ‘‘qualified national organization’’ means a na- 5 tional organization that focuses on the education of 6 students in one or more of the professions of social 7 work, psychology, psychiatry, marriage and family 8 therapy, mental health counseling, and substance 9 misuse counseling. 10 (2) RACIAL AND ETHNIC MINORITY GROUP.— 11 The term ‘‘racial and ethnic minority group’’ has the 12 meaning given to such term in section 1707(g) of 13 the Public Health Service Act (42 U.S.C. 300u– 14 6(g)). 15 Subtitle D—Children’s Mental 16 Health 17 SEC. 6041. PEDIATRIC BEHAVIORAL HEALTH CARE. 18 Subpart V of part D of title III of the Public Health 19 Service Act (42 U.S.C. 256 et seq.) is amended by adding 20 at the end the following: 21 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01054 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1055 •HR 7585 IH ‘‘SEC. 340A–1. GRANTS TO SUPPORT PEDIATRIC BEHAV- 1 IORAL HEALTH CARE INTEGRATION AND CO- 2 ORDINATION. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Administrator of the Health Resources and Services 5 Administration, shall award grants to eligible entities for 6 the purpose of supporting pediatric behavioral health care 7 integration and coordination within communities to meet 8 local community needs. 9 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 10 grants under subsection (a) include— 11 ‘‘(1) pediatricians; 12 ‘‘(2) children’s hospitals; 13 ‘‘(3) pediatric behavioral health providers with 14 the capacity to organize and implement activities 15 working with community organizations and pro- 16 viders; and 17 ‘‘(4) other entities as determined appropriate by 18 the Secretary. 19 ‘‘(c) PRIORITIZATION.—In awarding grants under 20 subsection (a), the Secretary shall prioritize applicants 21 that demonstrate the highest needs at the local level along 22 the care continuum for strengthening children’s behavioral 23 health crisis care and access. 24 ‘‘(d) USE OF FUNDS.—Activities that may be funded 25 through a grant under subsection (a) include— 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01055 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1056 •HR 7585 IH ‘‘(1) the recruitment and retention of commu- 1 nity health workers or navigators to coordinate fam- 2 ily access to pediatric mental, emotional, and behav- 3 ioral health services; 4 ‘‘(2) training the pediatric mental, emotional, 5 and behavioral health care workforce, relevant stake- 6 holders, and community members; 7 ‘‘(3) expanding evidence-based, integrated mod- 8 els of care for pediatric mental, emotional, and be- 9 havioral health services; 10 ‘‘(4) pediatric practice integration for the provi- 11 sion of pediatric mental, emotional, and behavioral 12 health services; 13 ‘‘(5) addressing surge capacity for pediatric 14 mental, emotional, and behavioral health needs; 15 ‘‘(6) providing pediatric mental, emotional, and 16 behavioral health services to children as delivered by 17 behavioral, emotional, and mental health profes- 18 sionals utilizing telehealth services; 19 ‘‘(7) establishing or maintaining initiatives to 20 decompress emergency departments, including par- 21 tial hospitalization, step down residency programs, 22 and intensive outpatient programs; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01056 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1057 •HR 7585 IH ‘‘(8) supporting, enhancing, or expanding pedi- 1 atric mental, emotional, and behavioral health pre- 2 ventive and crisis intervention services; 3 ‘‘(9) establishing or maintaining pediatric men- 4 tal, emotional, and behavioral health urgent care; 5 ‘‘(10) establishing or maintaining community- 6 based initiatives, such as school-based partnerships; 7 and 8 ‘‘(11) addressing other access and coordination 9 gaps to mental, emotional, and behavioral health 10 services in the community for children. 11 ‘‘(e) FUNDING.—To carry out this section, there is 12 hereby appropriated, out of amounts in the Treasury not 13 otherwise obligated, $500,000,000 for each of fiscal years 14 2023 through 2027. 15 ‘‘SEC. 340A–2. PEDIATRIC BEHAVIORAL HEALTH WORK- 16 FORCE TRAINING PROGRAM. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Administrator of the Health Resources and Services 19 Administration, shall award grants to eligible entities for 20 the purpose of supporting evidence-based pediatric behav- 21 ioral health workforce training. 22 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 23 grants under subsection (a) include— 24 ‘‘(1) children’s hospitals; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01057 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1058 •HR 7585 IH ‘‘(2) other pediatric health care providers as de- 1 termined appropriate by the Secretary. 2 ‘‘(c) USE OF FUNDS.—The training that may be sup- 3 ported through a grant under subsection (a) includes ex- 4 panded training in pediatric behavioral health for physi- 5 cians and nonphysician practitioners, including the fol- 6 lowing practitioner types: 7 ‘‘(1) Child and adolescent psychiatrists. 8 ‘‘(2) Psychiatric nurses. 9 ‘‘(3) Psychologists. 10 ‘‘(4) Advanced practice nurses. 11 ‘‘(5) Family therapists. 12 ‘‘(6) Social workers. 13 ‘‘(7) Mental health counselors. 14 ‘‘(8) Other practitioner types as determined ap- 15 propriate by the Secretary. 16 ‘‘(d) FUNDING.—To carry out this section, there is 17 hereby appropriated, out of amounts in the Treasury not 18 otherwise obligated, $100,000,000 for each of fiscal years 19 2023 through 2027.’’. 20 SEC. 6042. MENTAL HEALTH IN SCHOOLS. 21 (a) PURPOSE.— It is the purpose of this section to— 22 (1) revise, increase funding for, and expand the 23 scope of the Project AWARE State Educational 24 Agency Grant Program carried out by the Secretary 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01058 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1059 •HR 7585 IH of Health and Human Services, in order to provide 1 access to more comprehensive school-based mental 2 health services and supports; 3 (2) provide for comprehensive staff development 4 for school and community service personnel working 5 in the school; 6 (3) provide for comprehensive training to im- 7 prove health and academic outcomes for children 8 with, or who have a high likelihood of developing, 9 mental health conditions, for parents or guardians, 10 siblings, and other family members of such children, 11 and for concerned members of the community; 12 (4) provide for comprehensive, universal, evi- 13 dence-based screening to identify children and ado- 14 lescents with potential mental health conditions or 15 unmet emotional health needs; 16 (5) recognize best practices for the delivery of 17 mental health care in school-based settings, includ- 18 ing school-based health centers; 19 (6) provide for comprehensive training for par- 20 ents or guardians, siblings, other family members, 21 and concerned members of the community on behalf 22 of children and adolescents experiencing mental 23 health trauma, disorders, cooccurring conditions, or 24 disabilities; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01059 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1060 •HR 7585 IH (7) establish formal working relationships 1 among health, human service, and educational enti- 2 ties that support the mental and emotional health of 3 children and adolescents in the school setting or that 4 have a child or youth focus. 5 (b) TECHNICAL AMENDMENTS.—The second part G 6 (relating to services provided through religious organiza- 7 tions) of title V of the Public Health Service Act (42 8 U.S.C. 290kk et seq.) is amended— 9 (1) by redesignating such part as part J; and 10 (2) by redesignating sections 581 through 584 11 as sections 596 through 596C, respectively. 12 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 13 DREN AND VIOLENCE.—Section 581 of the Public Health 14 Service Act (42 U.S.C. 290hh) (relating to children and 15 violence) is amended to read as follows: 16 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 17 AND ADOLESCENTS. 18 ‘‘(a) IN GENERAL.—The Secretary, in consultation 19 with the Secretary of Education, shall, through grants, 20 contracts, or cooperative agreements awarded to eligible 21 entities described in subsection (b), provide comprehensive 22 school-based mental health services and supports to assist 23 children in local communities and schools (including 24 schools funded by the Bureau of Indian Education) deal- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01060 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1061 •HR 7585 IH ing with traumatic experiences, grief, bereavement, risk of 1 suicide, and the risk of experiencing community or inter- 2 personal violence, such as abuse or neglect. All services 3 and supports provided under such a grant, contract, or 4 cooperative agreement shall be— 5 ‘‘(1) developmentally, linguistically, and cul- 6 turally appropriate; 7 ‘‘(2) trauma-informed; and 8 ‘‘(3) incorporate positive behavioral interven- 9 tions and supports. 10 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 11 agreements awarded under subsection (a), shall, as appro- 12 priate, be used for— 13 ‘‘(1) implementation of school and community- 14 based mental health programs that— 15 ‘‘(A) build awareness of individual trauma 16 and the intergenerational continuum of impacts 17 of trauma on populations; 18 ‘‘(B) train appropriate staff to identify, 19 and screen for, signs of trauma exposure, men- 20 tal health and cooccurring conditions, or risk of 21 suicide; and 22 ‘‘(C) incorporate positive behavioral inter- 23 ventions, family engagement, student treatment, 24 and multigenerational supports to foster the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01061 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1062 •HR 7585 IH health and development of children, prevent 1 mental health disorders, and ameliorate the im- 2 pact of trauma; 3 ‘‘(2) technical assistance to local communities 4 with respect to the development of programs de- 5 scribed in paragraph (1); 6 ‘‘(3) facilitating diverse community partnerships 7 among families, students, education agencies, mental 8 health and substance use disorder service systems, 9 family-based mental health service systems, child 10 welfare agencies, health care providers (including 11 primary care physicians, mental health professionals, 12 and other professionals who specialize in children’s 13 mental health such as child and adolescent psychia- 14 trists), institutions of higher education, faith-based 15 programs, trauma networks, and other community- 16 based systems to address child and adolescent trau- 17 ma, as well as unmet mental health needs; and 18 ‘‘(4) establishing and promoting best practices 19 that are either evidence-based or culturally based for 20 children and adolescents to share their experiences 21 of individual and community trauma, including their 22 exposure to community and domestic violence, with 23 trusted adults. 24 ‘‘(c) REQUIREMENTS.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01062 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1063 •HR 7585 IH ‘‘(1) IN GENERAL.—To be eligible for a grant, 1 contract, or cooperative agreement under subsection 2 (a), an entity shall be a partnership that includes— 3 ‘‘(A) a State educational agency, as de- 4 fined in section 8101 of the Elementary and 5 Secondary Education Act of 1965, in coordina- 6 tion with one or more local educational agen- 7 cies, as defined in section 8101 of the Elemen- 8 tary and Secondary Education Act of 1965, or 9 a consortium of any entities described in sub- 10 paragraph (B), (C), (D), or (E) of section 11 8101(30) of such Act; and 12 ‘‘(B) at least 1 community-based mental 13 health provider, including a public or private 14 mental health entity, health care entity, family- 15 based mental health entity, trauma network, or 16 other community-based entity, as determined by 17 the Secretary (and which may include addi- 18 tional entities such as a human services agency, 19 child welfare agency, an institution of higher 20 education, or another entity, as determined by 21 the Secretary). 22 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 23 records developed by covered entities through activi- 24 ties under the grant shall meet the regulations pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01063 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1064 •HR 7585 IH mulgated under section 264(c) of the Health Insur- 1 ance Portability and Accountability Act of 1996. 2 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 3 of the General Education Provisions Act (commonly 4 known as the ‘Family Educational Rights and Pri- 5 vacy Act of 1974’) shall apply to any entity that is 6 a member of the partnership in the same manner 7 that such section applies to an educational agency or 8 institution (as that term is defined in such section). 9 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 10 shall ensure that grants, contracts, or cooperative agree- 11 ments under subsection (a) will be distributed equitably 12 among the regions of the country and among urban and 13 rural areas. 14 ‘‘(e) DURATION OF AWARDS.—With respect to a 15 grant, contract, or cooperative agreement under sub- 16 section (a), the period during which payments under such 17 an award will be made to the recipient shall be 5 years, 18 with options for renewal. 19 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 20 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist- 21 ant Secretary shall develop a fiscally appropriate 22 process for evaluating activities carried out under 23 this section. Such process shall include— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01064 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1065 •HR 7585 IH ‘‘(A) the development of guidelines for the 1 submission of program data by grant, contract, 2 or cooperative agreement recipients; 3 ‘‘(B) the development of measures of out- 4 comes (in accordance with paragraph (2)) to be 5 applied by such recipients in evaluating pro- 6 grams carried out under this section; and 7 ‘‘(C) the submission of annual reports by 8 such recipients concerning the effectiveness of 9 programs carried out under this section. 10 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 11 Secretary shall develop measures of outcomes to be 12 applied by recipients of assistance under this section 13 to evaluate the effectiveness of programs carried out 14 under this section, including outcomes related to the 15 student, family, and local educational systems sup- 16 ported by this Act. 17 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 18 ble entity described in subsection (c) that receives a 19 grant, contract, or cooperative agreement under this 20 section shall annually submit to the Assistant Sec- 21 retary a report that includes data to evaluate the 22 success of the program carried out by the entity 23 based on whether such program is achieving the pur- 24 poses of the program. Such reports shall utilize the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01065 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1066 •HR 7585 IH measures of outcomes under paragraph (2) in a rea- 1 sonable manner to demonstrate the progress of the 2 program in achieving such purposes. 3 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 4 Based on the data submitted under paragraph (3), 5 the Assistant Secretary shall annually submit to 6 Congress a report concerning the results and effec- 7 tiveness of the programs carried out with assistance 8 received under this section. 9 ‘‘(5) LIMITATION.—An eligible entity shall use 10 not more than 20 percent of amounts received under 11 a grant under this section to carry out evaluation 12 activities under this subsection. 13 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 14 retary shall disseminate best practices based on findings 15 made pursuant to this section. 16 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 17 APPROPRIATIONS.— 18 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 19 section shall be in an amount that is not more than 20 $2,000,000 for each of the first 5 fiscal years fol- 21 lowing the date of enactment of this section. The 22 Secretary shall determine the amount of each such 23 grant based on the population of children up to age 24 21 of the area to be served under the grant. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01066 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1067 •HR 7585 IH ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 1 There is authorized to be appropriated to carry out 2 this section, $130,000,000 for each of fiscal years 3 2023 through 2026.’’. 4 (d) CONFORMING AMENDMENT.—Part G of title V 5 of the Public Health Service Act (42 U.S.C. 290hh et 6 seq.), as amended by this section, is further amended, in 7 the part heading by striking ‘‘PROJECTS FOR CHIL- 8 DREN AND VIOLENCE’’ and inserting the following: 9 ‘‘SCHOOL-BASED MENTAL HEALTH’’. 10 (e) SCHOOL-BASED MENTAL HEALTH SERVICES.— 11 (1) IN GENERAL.—The Secretary of Education 12 shall award grants to State educational agencies to 13 support services provided by school-based mental 14 health services providers at schools receiving funds 15 under part A of title I of the Elementary and Sec- 16 ondary Education Act of 1965 (20 U.S.C. 6311 et 17 seq.). 18 (2) USE OF FUNDS.—Grants under this sub- 19 section shall be used to help meet the recommended 20 ratios of— 21 (A) 250 students per school counselor; 22 (B) 500 students per school psychologist; 23 and 24 (C) 250 students per school social worker. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01067 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1068 •HR 7585 IH (3) CONDITION.—The Secretary shall ensure 1 that funds made available under this subsection are 2 used to provide services that are developmentally, 3 linguistically, and culturally appropriate, trauma-in- 4 formed, and incorporate positive behavioral interven- 5 tions and supports. 6 (4) DEFINITIONS.—For purposes of this sub- 7 section: 8 (A) The term ‘‘school-based mental health 9 service provider’’ has the meaning given such 10 term in section 4102 of the Elementary and 11 Secondary Education Act of 1965 (20 U.S.C. 12 7112). 13 (B) The term ‘‘State educational agency’’ 14 has the meaning given such term in section 15 8101 of the Elementary and Secondary Edu- 16 cation Act of 1965 (20 U.S.C. 7801). 17 SEC. 6043. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG 18 ADULT MENTAL HEALTH SERVICE PROVI- 19 SION. 20 Section 1903 of the Social Security Act (42 U.S.C. 21 1396b) is amended by adding at the end the following new 22 subsection: 23 ‘‘(cc) YOUTH AND YOUNG ADULT INTERVENTION 24 SERVICES.— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01068 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1069 •HR 7585 IH ‘‘(1) IN GENERAL.—Notwithstanding section 1 1902(a)(1) (relating to Statewideness), section 2 1902(a)(10)(B) (relating to comparability), section 3 1902(a)(23)(A) (relating to freedom of choice of 4 providers), or section 1902(a)(27) (relating to pro- 5 vider agreements), a State may, during the 5-year 6 period beginning on the first day of the fiscal year 7 quarter that begins on or after January 1, 2024, 8 provide medical assistance for qualifying youth and 9 young adult mental health and substance use inter- 10 vention services (as defined in paragraph (2)(C)) 11 under a State plan amendment or waiver approved 12 under section 1115 or 1915(c). 13 ‘‘(2) DEFINITIONS.—For the purposes of this 14 subsection: 15 ‘‘(A) PRIORITY SERVICE.—The term ‘pri- 16 ority service’ means any of the following if vol- 17 untarily received and provided in a manner that 18 maintains the privacy and confidentiality of pa- 19 tient information consistent with Federal and 20 State requirements: 21 ‘‘(i) Community based mobile crisis 22 intervention services, as defined in section 23 1947. 24 ‘‘(ii) Telehealth. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01069 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1070 •HR 7585 IH ‘‘(iii) Youth peer support. 1 ‘‘(iv) Screening for adverse childhood 2 experiences. 3 ‘‘(v) Trauma responsive care. 4 ‘‘(vi) Other priority services for youth, 5 as defined by the Secretary. 6 ‘‘(B) QUALIFIED MENTAL HEALTH PRO- 7 VIDERS.—The term ‘qualified mental health 8 providers’ means a behavioral health care pro- 9 fessional who is capable of conducting an as- 10 sessment of the individual, in accordance with 11 the professional’s permitted scope of practice 12 under State law, and other professionals or 13 paraprofessionals with appropriate expertise in 14 youth and young adult behavioral health or 15 mental health, including social workers, peer 16 support specialists, recovery coaches, commu- 17 nity health workers, mental health clinicians, 18 and others, as designated by the State and ap- 19 proved by the Secretary. 20 ‘‘(C) QUALIFYING YOUTH AND YOUNG 21 ADULT MENTAL HEALTH AND SUBSTANCE USE 22 INTERVENTION SERVICES DEFINED.—The term 23 ‘qualifying youth and young adult mental health 24 and substance use intervention services’ means, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01070 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1071 •HR 7585 IH with respect to a State, items and services for 1 which medical assistance is available under the 2 State plan under this title or a waiver of such 3 plan, that are— 4 ‘‘(i) furnished to an individual 16 to 5 25 years of age who is— 6 ‘‘(I) experiencing a mental health 7 or substance use disorder crisis; 8 ‘‘(II) subject to the juvenile or 9 adult justice system as defined in sec- 10 tion 3102 of title 29, United States 11 Code; 12 ‘‘(III)(aa) experiencing homeless- 13 ness (as defined in section 41403(6) 14 of the Violence Against Women Act of 15 1994 (42 U.S.C. 14043e–2(6))); 16 ‘‘(bb) a homeless child or youth 17 (as defined in section 725(2) of the 18 McKinney-Vento Homeless Assistance 19 Act (42 U.S.C. 11434a(2))); 20 ‘‘(cc) a runaway, in foster care, 21 or has aged out of the foster care sys- 22 tem; 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01071 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1072 •HR 7585 IH ‘‘(dd) a child eligible for assist- 1 ance under section 477 of the Social 2 Security Act (42 U.S.C. 677); or 3 ‘‘(ee) in an out-of-home place- 4 ment; 5 ‘‘(IV) pregnant or parenting as 6 defined in section 3102 of title 29, 7 United States Code; 8 ‘‘(V) a youth who is an individual 9 with a disability as defined in section 10 3102 of title 29, United States Code; 11 ‘‘(VI) a low income youth requir- 12 ing additional assistance to enter or 13 complete an educational program or 14 to secure or hold employment as de- 15 fined in section 3102 of title 29, 16 United States Code; or 17 ‘‘(VII) living in a community that 18 has faced acute or long-term exposure 19 to substantial discrimination, histor- 20 ical oppression, intergenerational pov- 21 erty, civil unrest, or a high rate of vio- 22 lence or drug overdose deaths; 23 ‘‘(ii) furnished by qualified mental 24 health providers; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01072 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1073 •HR 7585 IH ‘‘(iii) a priority service. 1 ‘‘(D) TELEHEALTH.—The term ‘telehealth’ 2 means use of electronic information and tele- 3 communications technologies, including voice 4 only audio, text, remote patient monitoring, and 5 mHealth via applications, to support clinical 6 mental health care, patient and professional 7 health-related education, public health, and 8 health administration. 9 ‘‘(3) PAYMENTS.—Notwithstanding section 10 1905(b), beginning January 1, 2024, during each of 11 the first 20 fiscal quarters that a State meets the 12 requirements described in paragraph (4), the Fed- 13 eral medical assistance percentage applicable to 14 amounts expended by the State for medical assist- 15 ance for qualifying youth and young adult mental 16 health and substance use intervention services fur- 17 nished during such quarter shall be equal to 100 18 percent. 19 ‘‘(4) REQUIREMENTS.—The requirements de- 20 scribed in this paragraph are the following: 21 ‘‘(A) The State demonstrates, to the satis- 22 faction of the Secretary— 23 ‘‘(i) that it will be able to support the 24 provision of qualifying youth and young 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01073 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1074 •HR 7585 IH adult mental health and substance use 1 intervention services that meet the condi- 2 tions specified in paragraphs (1) and (2)); 3 and 4 ‘‘(ii) how it will support coordination 5 between qualified mental health providers 6 and substance use teams and community 7 partners, including health care providers, 8 to enable the provision of services, needed 9 referrals, and other activities identified by 10 the Secretary. 11 ‘‘(B) The State provides assurances satis- 12 factory to the Secretary that— 13 ‘‘(i) any additional Federal funds re- 14 ceived by the State for qualifying youth 15 and young adult mental health and sub- 16 stance use intervention services provided 17 under this subsection that are attributable 18 to the increased Federal medical assistance 19 percentage under paragraph (3)(A) will be 20 used to supplement, and not supplant, the 21 level of State funds expended for such 22 services for fiscal year 2024; 23 ‘‘(ii) if the State made qualifying 24 youth and young adult mental health and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01074 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1075 •HR 7585 IH substance use intervention services avail- 1 able in a region of the State in fiscal year 2 2023 the State will continue to make such 3 services available in such region under this 4 subsection at the same level that the State 5 made such services available in such fiscal 6 year; and 7 ‘‘(iii) the State will conduct the eval- 8 uation and assessment, and submit the re- 9 port required under paragraph (5). 10 ‘‘(5) STATE EVALUATION AND REPORT.— 11 ‘‘(A) STATE EVALUATION.—Not later than 12 4 fiscal quarters after a State begins providing 13 qualifying youth and young adult mental health 14 and substance use intervention services in ac- 15 cordance with this subsection, the State shall 16 enter into a contract with an independent entity 17 or organization to conduct an evaluation for the 18 purposes of— 19 ‘‘(i) determining the effect of the pro- 20 vision of such services on— 21 ‘‘(I) emergency room visits; 22 ‘‘(II) use of ambulatory services; 23 ‘‘(III) hospitalizations; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01075 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1076 •HR 7585 IH ‘‘(IV) the involvement of law en- 1 forcement in mental health or sub- 2 stance use disorder crisis events; and 3 ‘‘(V) the diversion of individuals 4 from jails or similar settings; and 5 ‘‘(ii) assessing— 6 ‘‘(I) the types of services pro- 7 vided to individuals; 8 ‘‘(II) the types of events re- 9 sponded to; 10 ‘‘(III) cost savings or cost-effec- 11 tiveness attributable to such services; 12 ‘‘(IV) the experiences of individ- 13 uals who receive qualifying youth and 14 young adult mental health and sub- 15 stance use intervention services; 16 ‘‘(V) the successful connection of 17 individuals with follow-up services; 18 and 19 ‘‘(VI) other relevant outcomes 20 identified by the Secretary. 21 ‘‘(B) COMPARISON TO HISTORICAL MEAS- 22 URES.—The contract described in subparagraph 23 (A) shall specify that the evaluation is based on 24 a comparison of the historical measures of 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01076 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1077 •HR 7585 IH State performance with respect to the outcomes 1 specified under such subparagraph to the 2 State’s performance with respect to such out- 3 comes during the period beginning with the 4 first quarter in which the State begins pro- 5 viding qualifying youth and young adult mental 6 health and substance use intervention services 7 in accordance with this subsection. 8 ‘‘(C) REPORT.—Not later than 2 years 9 after a State begins to provide qualifying youth 10 and young adult mental health and substance 11 use intervention services in accordance with this 12 subsection, the State shall submit a report to 13 the Secretary on the following: 14 ‘‘(i) The results of the evaluation car- 15 ried out under subparagraph (A). 16 ‘‘(ii) The number of individuals who 17 received qualifying youth and young adult 18 mental health and substance use interven- 19 tion services. 20 ‘‘(iii) Demographic information re- 21 garding such individuals when available, 22 including the race and ethnicity, age, sex, 23 sexual orientation, gender identity, and ge- 24 ographic location of such individuals. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01077 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1078 •HR 7585 IH ‘‘(iv) The processes and models devel- 1 oped by the State to provide qualifying 2 youth and young adult mental health and 3 substance use intervention services under 4 such the State plan or waiver, including 5 the processes developed to provide referrals 6 for, or coordination with, follow-up care 7 and services. 8 ‘‘(v) Lessons learned regarding the 9 provision of such services. 10 ‘‘(D) PUBLIC AVAILABILITY.—The State 11 shall make the report required under subpara- 12 graph (C) publicly available, including on the 13 website of the appropriate State agency, upon 14 submission of such report to the Secretary. 15 ‘‘(6) BEST PRACTICES REPORT.— 16 ‘‘(A) IN GENERAL.—Not later than 3 years 17 after the first State begins to provide qualifying 18 youth and young adult mental health and sub- 19 stance use intervention services in accordance 20 with this subsection, the Secretary shall submit 21 a report to Congress that— 22 ‘‘(i) identifies the States that elected 23 to provide services in accordance with this 24 subsection; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01078 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1079 •HR 7585 IH ‘‘(ii) summarizes the information re- 1 ported by such States under paragraph 2 (5)(C); and 3 ‘‘(iii) identifies best practices for the 4 effective delivery of youth and young adult 5 mental health and substance use interven- 6 tion services. 7 ‘‘(B) PUBLIC AVAILABILITY.—The report 8 required under subparagraph (A) shall be made 9 publicly available, including on the website of 10 the Department of Health and Human Services, 11 upon submission to Congress. 12 ‘‘(7) NONDISCRIMINATION.— 13 ‘‘(A) FEDERALLY FUNDED ACTIVITIES.— 14 (i) For the purpose of applying the prohibitions 15 against discrimination on the basis of age under 16 the Age Discrimination Act of 1975 (42 U.S.C. 17 6101 et seq.), on the basis of handicap under 18 section 504 of the Rehabilitation Act of 1973 19 (29 U.S.C. 794), on the basis of sex under title 20 IX of the Education Amendments of 1972 (20 21 U.S.C. 1681 et seq.), or on the basis of race, 22 color, or national origin under title VI of the 23 Civil Rights Act of 1964 (42 U.S.C. 2000d et 24 seq.), programs and activities funded in whole 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01079 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1080 •HR 7585 IH or in part with funds made available under this 1 subchapter are considered to be programs and 2 activities receiving Federal financial assistance. 3 ‘‘(ii) No person shall on the ground of sex 4 or religion be excluded from participation in, be 5 denied the benefits of, or be subjected to dis- 6 crimination under, any program or activity 7 funded in whole or in part with funds made 8 available under this title. 9 ‘‘(B) COMPLIANCE.—Whenever the Sec- 10 retary finds that a State, or an entity that has 11 received a payment from an allotment to a 12 State under section 702(c) of this title, has 13 failed to comply with a provision of law referred 14 to in subsection (a)(1), with subsection (a)(2), 15 or with an applicable regulation (including one 16 prescribed to carry out subsection (a)(2)), he 17 shall notify the chief executive officer of the 18 State and shall request him to secure compli- 19 ance. If within a reasonable period of time, not 20 to exceed 60 days, the chief executive officer 21 fails or refuses to secure compliance, the Sec- 22 retary may— 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01080 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1081 •HR 7585 IH ‘‘(i) refer the matter to the Attorney 1 General with a recommendation that an 2 appropriate civil action be instituted; 3 ‘‘(ii) exercise the powers and functions 4 provided by title VI of the Civil Rights Act 5 of 1964 (42 U.S.C. 2000d et seq.), the 6 Age Discrimination Act of 1975 (42 7 U.S.C. 6101 et seq.), or section 504 of the 8 Rehabilitation Act of 1973 (29 U.S.C. 9 794), as may be applicable; or 10 ‘‘(iii) take such other action as may 11 be provided by law. 12 ‘‘(C) AUTHORITY OF ATTORNEY GENERAL; 13 CIVIL ACTIONS.—When a matter is referred to 14 the Attorney General pursuant to subsection 15 (b)(1), or whenever he has reason to believe 16 that the entity is engaged in a pattern or prac- 17 tice in violation of a provision of law referred 18 to in subsection (a)(1) or in violation of sub- 19 section (a)(2), the Attorney General may bring 20 a civil action in any appropriate district court 21 of the United States for such relief as may be 22 appropriate, including injunctive relief.’’. 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01081 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1082 •HR 7585 IH SEC. 6044. EARLY INTERVENTION AND PREVENTION PRO- 1 GRAMS FOR TRANSITION-AGE YOUTH. 2 (a) IN GENERAL.—Section 1912(b)(1) of the Public 3 Health Service Act (42 U.S.C. 300x–1(b)(1)) is amend- 4 ed— 5 (1) by redesignating subparagraph (E) as (F); 6 and 7 (2) by inserting after subparagraph (D) the fol- 8 lowing: 9 ‘‘(E) EARLY INTERVENTION AND PREVEN- 10 TION PROGRAMS FOR TRANSITION-AGE 11 YOUTH.—The plan shall describe the State’s 12 plans to carry out demonstration grants or con- 13 tracts for early intervention and prevention pro- 14 grams for transition-age youth of 16 to 25 15 years of age who meet one or more of the cri- 16 teria specified in section 129(1)(B) of the 17 Workforce Innovation and Opportunity Act to 18 be considered out-of-school youth.’’. 19 (b) SET-ASIDE.—Section 1920 of the Public Health 20 Service Act (42 U.S.C. 300x–9) is amended by adding at 21 the end the following: 22 ‘‘(d) EARLY INTERVENTION AND PREVENTION PRO- 23 GRAMS FOR TRANSITION-AGE YOUTH.— 24 ‘‘(1) IN GENERAL.—Except as provided in para- 25 graph (2), a State shall expend at least 15 percent 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01082 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1083 •HR 7585 IH of the amount of the allotment of the State pursuant 1 to a funding agreement under section 1911 for each 2 fiscal year to support programs described in section 3 1912(b)(1)(E). 4 ‘‘(2) STATE FLEXIBILITY.—In lieu of expending 5 15 percent of the amount the allotment for a fiscal 6 year as required by paragraph (1), a State may elect 7 to expend not less than 30 percent of such amount 8 to support such programs by the end of two consecu- 9 tive fiscal years.’’. 10 SEC. 6045. STRATEGIES TO INCREASE ACCESS TO TELE- 11 HEALTH UNDER MEDICAID AND CHILDREN’S 12 HEALTH INSURANCE PROGRAM. 13 (a) GUIDANCE.—Not later than 1 year after the date 14 of the enactment of this Act, the Secretary of Health and 15 Human Services shall issue and disseminate guidance to 16 States to clarify strategies to overcome existing barriers 17 and increase access to telehealth under the Medicaid pro- 18 gram under title XIX of the Social Security Act (42 19 U.S.C. 1396 et seq.) and the Children’s Health Insurance 20 Program under title XXI of such Act (42 U.S.C. 1397aa 21 et seq.). Such guidance shall include technical assistance 22 and best practices regarding— 23 (1) telehealth delivery of covered services; 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01083 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1084 •HR 7585 IH (2) recommended voluntary billing codes, modi- 1 fiers, and place-of-service designations for telehealth 2 and other virtual health care services; 3 (3) the simplification or alignment (including 4 through reciprocity) of provider licensing, 5 credentialing, and enrollment protocols with respect 6 to telehealth across States, State Medicaid plans 7 under such title XIX, and Medicaid managed care 8 organizations, including during national public 9 health emergencies; 10 (4) existing strategies States can use to inte- 11 grate telehealth and other virtual health care serv- 12 ices into value-based health care models; and 13 (5) examples of States that have used waivers 14 under the Medicaid program to test expanded access 15 to telehealth, including during the emergency period 16 described in section 1135(g)(1)(B) of the Social Se- 17 curity Act (42 U.S.C. 1320b–5(g)(1)(B)). 18 (b) STUDIES.— 19 (1) TELEHEALTH IMPACT ON HEALTH CARE 20 ACCESS.—Not later than 1 year after the date of the 21 enactment of this Act, the Medicaid and CHIP Pay- 22 ment and Access Commission shall conduct a study, 23 with respect to a minimum of 10 States across geo- 24 graphic regions of the United States, and submit to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01084 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1085 •HR 7585 IH Congress a report, on the impact of telehealth on 1 health care access, utilization, cost, and outcomes, 2 broken down by race, ethnicity, sex, age, disability 3 status, and zip code. Such report shall— 4 (A) evaluate cost, access, utilization, out- 5 comes, and patient experience data from across 6 the health care field, including States, Medicaid 7 managed care organizations, provider organiza- 8 tions, and other organizations that provide or 9 pay for telehealth under the Medicaid program 10 and Children’s Health Insurance Program; 11 (B) identify barriers and potential solu- 12 tions to provider entry and participation in tele- 13 health that States are experiencing, as well as 14 barriers to providing telehealth across State 15 lines, including during times of public health 16 crisis or public health emergency; 17 (C) determine the frequency at which out- 18 of-State telehealth is provided to patients en- 19 rolled in the Medicaid program and the poten- 20 tial impact on access to telehealth if State Med- 21 icaid policies were more aligned; and 22 (D) identify and evaluate opportunities for 23 more alignment among such policies to promote 24 access to telehealth across all States, State 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01085 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1086 •HR 7585 IH Medicaid plans under title XIX of the Social 1 Security Act (42 U.S.C. 1396 et seq.), State 2 child health plans under title XXI of such Act 3 (42 U.S.C. 1397aa et seq.), and Medicaid man- 4 aged care organizations, including the potential 5 for regional compacts or reciprocity agreements. 6 (2) FEDERAL AGENCY TELEHEALTH COLLABO- 7 RATION.—Not later than 1 year after the date of the 8 enactment of this Act, the Comptroller General of 9 the United States shall conduct a study and submit 10 to Congress a report evaluating collaboration be- 11 tween Federal agencies with respect to telehealth 12 services furnished under the Medicaid or CHIP pro- 13 gram to individuals under the age of 18, including 14 such services furnished to such individuals in early 15 care and education settings. Such report shall in- 16 clude recommendations on— 17 (A) opportunities for Federal agencies to 18 improve collaboration with respect to such tele- 19 health services; and 20 (B) opportunities for collaboration between 21 Federal agencies to expand telehealth access to 22 such individuals enrolled under the Medicaid or 23 CHIP program, including in early care and 24 education settings. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01086 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1087 •HR 7585 IH SEC. 6046. YOUTH AND YOUNG ADULT MENTAL HEALTH 1 PROMOTION, PREVENTION, INTERVENTION, 2 AND TREATMENT. 3 Title III of the Public Health Service Act is amended 4 by inserting after section 399Z–2 (42 U.S.C. 280h–5) the 5 following: 6 ‘‘SEC. 399Z–3. YOUTH AND YOUNG ADULT MENTAL HEALTH 7 PROMOTION, PREVENTION, INTERVENTION, 8 AND TREATMENT. 9 ‘‘(a) GRANTS.—The Secretary shall— 10 ‘‘(1) award grants to eligible entities to develop, 11 maintain, or enhance youth and young adult mental 12 health promotion, prevention, intervention, and 13 treatment programs, including— 14 ‘‘(A) programs for youth and young adults 15 who may be likely to develop, are showing early 16 signs of, or have been diagnosed with a mental 17 health condition, including a serious emotional 18 disturbance; and 19 ‘‘(B) infrastructure and organization 20 change at a State, tribal, or territorial level to 21 improve cross-system collaboration, service ca- 22 pacity and expertise related to youth and young 23 adults; and 24 ‘‘(2) ensure that programs funded through 25 grants under this section use community-driven, evi- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01087 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1088 •HR 7585 IH dence-informed, or evidence-based models, practices, 1 and methods that are, as appropriate, culturally and 2 linguistically appropriate, and can be replicated in 3 other appropriate settings. 4 ‘‘(b) ELIGIBLE TRANSITION AGE YOUTH AND ENTI- 5 TIES.—In this section: 6 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 7 tity’ means— 8 ‘‘(A) a local educational agency; 9 ‘‘(B) a State educational agency; 10 ‘‘(C) an institution of higher education (or 11 consortia of such institutions), which may in- 12 clude a recovery program at an institution of 13 higher education; 14 ‘‘(D) a local board, or a one-stop operator 15 as defined in section 3 of the Workforce Inno- 16 vation and Opportunity Act; 17 ‘‘(E) a nonprofit organization with appro- 18 priate expertise in providing services or pro- 19 grams for children, adolescents, or young 20 adults, excluding a school; 21 ‘‘(F) a State, political subdivision of a 22 State, Indian tribe, or tribal organization; or 23 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01088 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1089 •HR 7585 IH ‘‘(G) a high school or dormitory serving 1 high school students that receives funding from 2 the Bureau of Indian Education. 3 ‘‘(2) ELIGIBLE TRANSITION AGE YOUTH.—The 4 term ‘eligible transition age youth’ means a youth or 5 young adult from age 16 to not more than 25 years 6 of age who is— 7 ‘‘(A) an out-of-school youth as defined in 8 section 129(a)(1)(B) of the Workforce Innova- 9 tion and Opportunity Act; 10 ‘‘(B) a homeless individual (as defined in 11 section 41403(6) of the Violence Against 12 Women Act of 1994), a homeless child or youth 13 (as defined in section 725(2) of the McKinney- 14 Vento Homeless Assistance Act) a runaway, in 15 foster care or has aged out of the foster care 16 system, a child eligible for assistance under sec- 17 tion 477 of the Social Security Act, or in an 18 out-of-home placement; 19 ‘‘(C) an individual who is pregnant or par- 20 enting, as referred to in section 129(a)(1)(B) of 21 the Workforce Innovation and Opportunity Act; 22 ‘‘(D) a youth who is an individual with a 23 disability, as referred to in section 129(a)(1)(B) 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01089 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1090 •HR 7585 IH of the Workforce Innovation and Opportunity 1 Act; 2 ‘‘(E) a low-income individual who requires 3 additional assistance to enter or complete an 4 educational program or to secure or hold em- 5 ployment, as referred to in section 129(a)(1)(B) 6 of the Workforce Innovation and Opportunity 7 Act; or 8 ‘‘(F) living in a community that has faced 9 acute or long-term exposure to substantial dis- 10 crimination, historical oppression, intergenera- 11 tional poverty, civil unrest, a high rate of vio- 12 lence, or drug overdose deaths. 13 ‘‘(c) APPLICATION.—An eligible entity seeking a 14 grant under subsection (a) shall submit to the Secretary 15 an application at such time, in such manner, and con- 16 taining such information as the Secretary may require. 17 ‘‘(d) USE OF FUNDS FOR MENTAL HEALTH PRO- 18 MOTION, PREVENTION, INTERVENTION AND TREATMENT 19 PROGRAMS.—An eligible entity may use amounts awarded 20 under a grant under subsection (a)(1) to carry out the 21 following: 22 ‘‘(1) Creation, implementation, and expansion 23 of services and supports that are culturally and lin- 24 guistically appropriate and youth-guided, involve and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01090 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1091 •HR 7585 IH include family and community members (including 1 business leaders and faith-based organizations), and 2 provide for continuity of care between child- and 3 adult-serving systems to ensure seamless transition. 4 ‘‘(2) Infrastructure and organization change at 5 a State, Tribal, or territorial level to improve cross- 6 system collaboration, service capacity, and expertise 7 related to youth and young adults with, or at-risk of, 8 mental health conditions and substance use dis- 9 orders as they transition into adult roles and respon- 10 sibilities. 11 ‘‘(3) Public awareness and cross-system pro- 12 vider training for individuals employed at institu- 13 tions of higher education and community colleges, 14 behavioral health providers, individuals working in 15 the criminal justice system, primary care providers, 16 vocational service providers, and child welfare work- 17 ers. 18 ‘‘(e) MATCHING FUNDS.—The Secretary may not 19 award a grant under this section to an eligible entity un- 20 less the eligible entity agrees, with respect to the costs to 21 be incurred by the eligible entity in carrying out the activi- 22 ties described in subsection (d), to make available non- 23 Federal contributions (in cash or in kind) toward such 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01091 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1092 •HR 7585 IH costs in an amount that is not less than 10 percent of 1 the total amount of Federal funds provided in the grant. 2 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 3 carry out this section, there are authorized to be appro- 4 priated $25,000,000 for each of fiscal years 2024 through 5 2033.’’. 6 SEC. 6047. STUDY ON THE EFFECTS OF SMARTPHONE AND 7 SOCIAL MEDIA USE ON ADOLESCENTS. 8 (a) IN GENERAL.—Not later than 1 year after the 9 date of enactment of this Act, the Secretary of Health and 10 Human Services shall conduct or support research on— 11 (1) smartphone and social media use by adoles- 12 cents; and 13 (2) the effects of such use on— 14 (A) emotional, behavioral, and physical 15 health and development; and 16 (B) disparities in minority and under- 17 served populations. 18 (b) REPORT.—Not later than 5 years after the date 19 of the enactment of this Act, the Secretary shall submit 20 to the Congress, and make publicly available, a report on 21 the findings of research described in this section. 22 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01092 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1093 •HR 7585 IH Subtitle E—Community-Based Care 1 SEC. 6051. MENTAL HEALTH AT THE BORDER. 2 (a) SHORT TITLE.—This section may be cited as the 3 ‘‘Immigrants’ Mental Health Act of 2022’’. 4 (b) TRAINING FOR CERTAIN CBP PERSONNEL IN 5 MENTAL HEALTH ISSUES.— 6 (1) TRAINING TO IDENTIFY RISK FACTORS AND 7 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 8 (A) IN GENERAL.—The Commissioner of 9 U.S. Customs and Border Protection, in con- 10 sultation with the Assistant Secretary for Men- 11 tal Health and Substance Use, the Adminis- 12 trator of the Health Resources and Services Ad- 13 ministration, and nongovernmental experts in 14 the delivery of health care in humanitarian cri- 15 ses and in the delivery of health care to chil- 16 dren, shall develop and implement a training 17 curriculum for U.S. Customs and Border Pro- 18 tection agents and officers assigned to U.S. 19 Customs and Border Protection facilities to en- 20 able such agents and officers to identify the 21 risk factors and warning signs in immigrants 22 and refugees of mental health issues relating to 23 trauma. 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01093 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1094 •HR 7585 IH (B) REQUIREMENTS.—The training cur- 1 riculum described in subparagraph (A) shall— 2 (i) apply to all U.S. Customs and 3 Border Protection agents and officers 4 working at U.S. Customs and Border Pro- 5 tection facilities; 6 (ii) provide for crisis intervention 7 using a trauma-informed approach; and 8 (iii) provide for mental health 9 screenings for immigrants and refugees ar- 10 riving at the border in their preferred lan- 11 guage or with appropriate language assist- 12 ance. 13 (2) TRAINING TO ADDRESS MENTAL HEALTH 14 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 15 (A) IN GENERAL.—The Commissioner of 16 U.S. Customs and Border Protection, in con- 17 sultation with the Assistant Secretary for Men- 18 tal Health and Substance Use, the Adminis- 19 trator of the Health Resources and Services Ad- 20 ministration, and nongovernmental experts in 21 the delivery of mental health care, shall develop 22 and implement a training curriculum for U.S. 23 Customs and Border Protection agents and offi- 24 cers assigned to U.S. Customs and Border Pro- 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01094 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1095 •HR 7585 IH tection facilities to address the mental health 1 and wellness of individuals working at such fa- 2 cilities. 3 (B) REQUIREMENT.—The training cur- 4 riculum described in subparagraph (A) shall be 5 designed to help U.S. Customs and Border Pro- 6 tection agents and officers working at U.S. 7 Customs and Border Protection facilities to— 8 (i) better manage their own stress and 9 the stress of their coworkers; and 10 (ii) be more aware of the psychological 11 pressures experienced during their jobs. 12 (3) ANNUAL REVIEW OF TRAINING.—Beginning 13 with respect to fiscal year 2023, the Assistant Sec- 14 retary for Mental Health and Substance Use shall— 15 (A) conduct an annual review of the train- 16 ing implemented pursuant to paragraphs (1) 17 and (2); and 18 (B) submit the results of each such review, 19 including any recommendations for improve- 20 ment of such training, to— 21 (i) the Commissioner of U.S. Customs 22 and Border Protection; and 23 (ii) the Committees on Appropria- 24 tions, Energy and Commerce, Homeland 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01095 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1096 •HR 7585 IH Security, and the Judiciary of the House 1 of Representatives and the Committees on 2 Appropriations, Health, Education, Labor, 3 and Pensions, and Homeland Security and 4 Governmental Affairs of the Senate. 5 (4) AUTHORIZATION OF APPROPRIATIONS.—To 6 carry out this subsection, there is authorized to be 7 appropriated— 8 (A) for fiscal year 2023, $50,000 to de- 9 velop the training under paragraphs (1) and 10 (2); and 11 (B) for each of fiscal years 2024 through 12 2028— 13 (i) $20,000 to implement such train- 14 ing pursuant to paragraphs (1) and (2); 15 and 16 (ii) such sums as may be necessary to 17 review and make recommendations for 18 such training pursuant to paragraph (3). 19 (c) STAFFING BORDER FACILITIES AND DETENTION 20 CENTERS.— 21 (1) IN GENERAL.—To adequately evaluate the 22 mental health needs of immigrants, refugees, border 23 patrol agents, and staff, the Commissioner of U.S. 24 Customs and Border Protection shall assign at least 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01096 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1097 •HR 7585 IH one qualified mental or behavioral health expert to 1 each U.S. Customs and Border Protection facility. 2 (2) QUALIFICATIONS.—To be qualified for pur- 3 poses of paragraph (1), a mental or behavioral 4 health expert shall be— 5 (A) bilingual; 6 (B) well-versed in culturally and linguis- 7 tically appropriate and trauma-informed inter- 8 ventions; and 9 (C) have particular expertise in child or 10 adolescent mental health or family mental 11 health. 12 (3) AUTHORIZATION OF APPROPRIATIONS.—To 13 carry out this subsection, there is authorized to be 14 appropriated $3,000,000 for each of fiscal years 15 2023 through 2027. 16 (d) NO SHARING OF DEPARTMENT OF HEALTH AND 17 HUMAN SERVICES MENTAL HEALTH INFORMATION FOR 18 ASYLUM DETERMINATIONS, IMMIGRATION HEARINGS, OR 19 DEPORTATION PROCEEDINGS.—The officers, employees, 20 and agents of the Department of Health and Human Serv- 21 ices, including the Office of Refugee Resettlement, may 22 not share with the Department of Homeland Security, and 23 the officers, employees, and agents of the Department of 24 Homeland Security may not request or receive from the 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01097 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1098 •HR 7585 IH Department of Health and Human Services, for the pur- 1 poses of an asylum determination, immigration hearing, 2 or deportation proceeding, any information or record 3 that— 4 (1) concerns the mental health of an alien; and 5 (2) was obtained or produced by a mental or 6 behavioral health professional while the alien was in 7 a shelter or otherwise in the custody of the Federal 8 Government. 9 (e) DEFINITIONS.—In this section: 10 (1) The term ‘‘forward operating base’’ means 11 a permanent facility established by U.S. Customs 12 and Border Protection in forward or remote loca- 13 tions, and designated as such by U.S. Customs and 14 Border Protection. 15 (2) The term ‘‘U.S. Customs and Border Pro- 16 tection facility’’ means any of the following facilities 17 that typically detain migrants on behalf of U.S. Cus- 18 toms and Border Protection: 19 (A) U.S. Border Patrol stations. 20 (B) Ports of entry. 21 (C) Checkpoints. 22 (D) Forward operating bases. 23 (E) Secondary inspection areas. 24 (F) Short-term custody facilities. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01098 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1099 •HR 7585 IH SEC. 6052. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE 1 HAWAIIAN, PACIFIC ISLANDER, INDIGENOUS, 2 MIDDLE EASTERN AND NORTH AFRICAN, AND 3 HISPANIC AND LATINO BEHAVIORAL AND 4 MENTAL HEALTH OUTREACH AND EDU- 5 CATION STRATEGY. 6 Part D of title V of the Public Health Service Act 7 (42 U.S.C. 290dd et seq.), as amended by section 6022, 8 is further amended by adding at the end the following new 9 section: 10 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 11 AND EDUCATION STRATEGY. 12 ‘‘(a) IN GENERAL.—The Secretary, acting through 13 the Assistant Secretary for Mental Health and Substance 14 Use, shall, in coordination with advocacy and behavioral 15 and mental health organizations serving populations of 16 Asian American, African American, Native Hawaiian, Pa- 17 cific Islander, Indigenous, Middle Eastern and North Afri- 18 can (in this section referred to as ‘MENA’), and Hispanic 19 and Latino/a/x individuals or communities, develop and 20 implement an outreach and education strategy to promote 21 behavioral and mental health, emphasize that behavioral 22 and mental health conditions are treatable and that rea- 23 sonable accommodations under section 504 of the Reha- 24 bilitation Act of 1973 and titles II and III of the Ameri- 25 cans with Disabilities Act of 1990 are necessary and may 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01099 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1100 •HR 7585 IH help, as well as reduce stigma associated with mental 1 health conditions and substance abuse among the Asian 2 American, African American, Native Hawaiian, Pacific Is- 3 lander, Indigenous, MENA, and Hispanic and Latino/a/ 4 x populations. Such strategy shall— 5 ‘‘(1) be designed to— 6 ‘‘(A) meet the diverse cultural and lan- 7 guage needs of the various Asian American, Af- 8 rican American, Indigenous, MENA, Native 9 Hawaiian, Pacific Islander, and Hispanic and 10 Latino/a/x populations; and 11 ‘‘(B) ensure that approaches recommended 12 in the strategy are developmentally (with re- 13 spect to the beneficiary’s relative age and expe- 14 rience) and age appropriate, as well as cog- 15 nitively accessible to persons with cognitive dis- 16 abilities; 17 ‘‘(2) increase awareness of symptoms of mental 18 illnesses common among such populations, taking 19 into account differences within subgroups (such as 20 gender, gender identity, age, sexual orientation, dis- 21 ability, and ethnicity) of such populations; 22 ‘‘(3) provide information on evidence-based, cul- 23 turally and linguistically appropriate and adapted 24 interventions and treatments; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01100 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1101 •HR 7585 IH ‘‘(4) ensure full participation of, and engage, 1 both consumers and community members rep- 2 resenting the communities of focus in the develop- 3 ment and implementation of materials; and 4 ‘‘(5) seek to broaden the perspective among 5 both individuals in such communities and stake- 6 holders serving such communities to use a com- 7 prehensive public health approach to promoting be- 8 havioral and mental health that addresses a holistic 9 view of health by focusing on the intersection be- 10 tween behavioral and physical health. 11 ‘‘(b) REPORTS.—Beginning not later than 1 year 12 after the date of the enactment of this section and annu- 13 ally thereafter, the Secretary, acting through the Assistant 14 Secretary, shall submit to the Congress, and make publicly 15 available, a report on the extent to which the strategy de- 16 veloped and implemented under subsection (a) increased 17 behavioral and mental health outcomes associated with 18 mental health conditions and substance abuse among 19 Asian American, African American, Native Hawaiian, Pa- 20 cific Islander, Indigenous, MENA, and Hispanic and 21 Latino/a/x populations. 22 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 $10,000,000 for each of fiscal years 2024 through 2028.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01101 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1102 •HR 7585 IH Subtitle F—Reports 1 SEC. 6061. ADDRESSING RACIAL AND ETHNIC MENTAL 2 HEALTH INEQUITIES RESEARCH GAPS. 3 (a) IN GENERAL.—Not later than 6 months after the 4 date of the enactment of this Act— 5 (1) the Director of the National Institute on 6 Minority Health and Health Disparities shall enter 7 into an arrangement with the National Academy of 8 Sciences to carry out the activities under subsection 9 (b); or 10 (2) if the National Academy of Sciences de- 11 clines to enter into such an arrangement, the Direc- 12 tor of the National Institute on Minority Health and 13 Health Disparities, in cooperation with the Agency 14 for Healthcare Research and Quality, shall carry out 15 the activities under subsection (b). 16 (b) ACTIVITIES.—The applicable entity under sub- 17 section (a) shall— 18 (1) conduct a study with respect to mental 19 health inequities in racial and ethnic minority 20 groups (as defined in section 1707(g) of the Public 21 Health Service Act (42 U.S.C. 300u–6(g)), as 22 amended by title I of this Act); and 23 (2) submit to the Congress a report on the re- 24 sults of such study, including— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01102 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1103 •HR 7585 IH (A) a compilation of information on the dy- 1 namics of mental health outcomes in such racial 2 and ethnic minority groups; 3 (B) the degree and impacts of the co-oc- 4 currence of mental conditions with other dis- 5 abilities in such racial and ethnic groups, in- 6 cluding physical disabilities, mental disabilities, 7 substance use disorders, severe and persistent 8 mental illness, and mental disorders or mental 9 health conditions which co-occur with one an- 10 other; 11 (C) a compilation of information on the 12 impact of community violence, community trau- 13 ma, adverse childhood experiences, weather ex- 14 tremes worsened by climate change (such as 15 heat waves, flooding, hurricanes, and wildfires), 16 substance use, and other psychological traumas, 17 on mental disorders in such racial and ethnic 18 minority groups, stratified by household income 19 level; 20 (D) a compilation of information on the 21 impact of the intersectionality of transgender 22 individuals, gender nonbinary individuals, sex- 23 ual orientation, and age in racial and ethnic mi- 24 nority groups; and 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01103 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1104 •HR 7585 IH (E) a description of how protective factors 1 contrast and compare among different commu- 2 nities of color, identifying cultural strengths. 3 SEC. 6062. RESEARCH ON ADVERSE HEALTH EFFECTS AS- 4 SOCIATED WITH INTERACTIONS WITH LAW 5 ENFORCEMENT. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services (in this section referred to as the ‘‘Sec- 8 retary’’), acting through the Director of the Office of Mi- 9 nority Health of the Centers for Disease Control and Pre- 10 vention (established pursuant to section 1707A of the 11 Public Health Service Act (42 U.S.C. 300u–6a)), shall 12 conduct research on the adverse health effects associated 13 with interactions with law enforcement. 14 (b) EFFECTS AMONG RACIAL AND ETHNIC MINORI- 15 TIES.—The research under subsection (a) shall include re- 16 search on— 17 (1) the health consequences, both individual 18 and community-wide, of trauma related to violence 19 committed by law enforcement among racial and 20 ethnic minorities; and 21 (2) the disproportionate burden of morbidity 22 and mortality associated with such trauma. 23 (c) REPORT.—Not later than 1 year after the date 24 of enactment of this Act, the Secretary shall— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01104 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1105 •HR 7585 IH (1) complete the research under this section; 1 and 2 (2) submit to the Congress a report on the find- 3 ings, conclusions, and recommendations resulting 4 from such research. 5 SEC. 6063. GEOACCESS STUDY. 6 The Assistant Secretary for Mental Health and Sub- 7 stance Use shall— 8 (1) conduct a study to— 9 (A) determine which geographic areas of 10 the United States have shortages of racially and 11 ethnically diverse mental health providers, as 12 well as mental health providers trained to work 13 with racially and ethnically diverse clients and 14 clients with multiple mental health, cognitive, 15 and developmental disabilities; and 16 (B) assess the preparedness of mental 17 health providers to deliver culturally and lin- 18 guistically appropriate, affordable, and acces- 19 sible services; and 20 (2) submit a report to Congress on the results 21 of such study. 22 SEC. 6064. COOCCURRING CONDITIONS. 23 (a) GAO REPORT.—Not later than two years after 24 the date of enactment of this Act, the Comptroller General 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01105 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1106 •HR 7585 IH of the United States shall submit to Congress a report 1 on barriers to care for persons with cooccurring conditions 2 and access to care in the United States. Such report shall 3 include the information and recommendations described in 4 subsection (b). 5 (b) CONTENT OF REPORT.—The report under sub- 6 section (a) shall include— 7 (1) an assessment of current barriers to behav- 8 ioral health and substance use disorder treatment 9 for low-income, uninsured, and Medicaid-enrolled 10 adults, and recommendations for addressing such 11 barriers, particularly for women and diverse racial 12 and ethnic groups; 13 (2) an assessment of— 14 (A) how many adults have a behavioral 15 health condition and options for adults to re- 16 ceive behavioral health and substance use dis- 17 order treatment in nonexpansion States; 18 (B) Medicaid expansion States who provide 19 behavioral health coverage for newly eligible en- 20 rollees; 21 (C) how enrollment in coverage affects 22 treatment availability; and 23 (D) the impacts of COVID–19 to receiving 24 and accessing treatment for behavioral health, 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01106 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1107 •HR 7585 IH substance use disorders, diverse racial and eth- 1 nic groups, and recommendations for address- 2 ing such barriers; 3 (3) an assessment of current barriers, inclusive 4 of social determinants of health and cultural bar- 5 riers, that prevent adults from receiving behavioral 6 health and substance use disorder treatment, rec- 7 ommendations for addressing such barriers, particu- 8 larly for low-income women and adults from racial 9 and ethnic groups; 10 (4) an assessment of disparities in access to ad- 11 diction counselors, mental or behavioral health care 12 providers acting in accordance with State law, strati- 13 fied by race, ethnicity, gender identity, geographic 14 location, and insurance type and recommendations 15 to promote greater access equity; and 16 (5) recommendations to promote greater equity 17 in access to care for behavioral services and sub- 18 stance use disorders, particularly for low-income 19 women and adults from diverse racial and ethnic 20 groups. 21 SEC. 6065. TECHNICAL CORRECTION. 22 Title V of the Public Health Service Act (42 U.S.C. 23 290aa et seq.) is amended— 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01107 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1108 •HR 7585 IH (1) by redesignating the second section 550 (42 1 U.S.C. 290ee–10) (relating to Sobriety Treatment 2 And Recovery Teams) as section 552A; and 3 (2) by moving such section, as so redesignated, 4 so as to appear after section 552 (42 U.S.C. 290ee– 5 7). 6 Subtitle G—Miscellaneous 7 Provisions 8 SEC. 6071. CHILDREN’S MENTAL HEALTH INFRASTRUC- 9 TURE ACT. 10 Part D of title III of the Public Health Service Act 11 (42 U.S.C. 254b et seq.) is amended by inserting after 12 subpart V the following new subpart: 13 ‘‘Subpart VI—Increasing Investment in Pediatric 14 Behavioral Health Services 15 ‘‘SEC. 340A–1. GRANTS TO CHILDREN’S HOSPITALS. 16 ‘‘(a) IN GENERAL.—The Secretary, acting through 17 the Administrator of the Health Resources and Services 18 Administration, shall make grants to eligible entities for 19 the purpose of improving their ability to provide pediatric 20 behavioral health services, including by— 21 ‘‘(1) constructing or modernizing sites of care 22 for pediatric behavioral health services; 23 ‘‘(2) expanding capacity to provide pediatric be- 24 havioral health services, including enhancements to 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01108 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1109 •HR 7585 IH digital infrastructure, telehealth capabilities, or other 1 improvements to patient care infrastructure; and 2 ‘‘(3) supporting the reallocation of existing re- 3 sources to accommodate pediatric behavioral health 4 patients, including by— 5 ‘‘(A) converting or adding a sufficient 6 number of beds to establish or increase the hos- 7 pital’s inventory of licensed and operational, 8 short-term psychiatric and substance use inpa- 9 tient beds; and 10 ‘‘(B) ensuring compliance with safety 11 standards. 12 ‘‘(b) ELIGIBILITY.—To be eligible to seek a grant 13 under this section, an entity shall be a hospital that pre- 14 dominantly treats individuals under the age of 21, includ- 15 ing any hospital that receives funds under section 340E. 16 ‘‘(c) FUNDING.—To carry out this section, there is 17 hereby appropriated, out of amounts in the Treasury not 18 otherwise obligated, $2,000,000,000 for each of fiscal 19 years 2022 through 2026.’’. 20 SEC. 6072. MENTAL HEALTH FOR LATINOS. 21 Part D of title V of the Public Health Service Act 22 (42 U.S.C. 290dd et seq.) is amended by adding at the 23 end the following new section: 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01109 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1110 •HR 7585 IH ‘‘SEC. 553. BEHAVIORAL AND MENTAL HEALTH OUTREACH 1 AND EDUCATION STRATEGY. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Assistant Secretary, shall, in coordination with advo- 4 cacy and behavioral and mental health organizations serv- 5 ing populations of Hispanic and Latino individuals or 6 communities, develop and implement an outreach and edu- 7 cation strategy to promote behavioral and mental health 8 and reduce stigma associated with mental health condi- 9 tions and substance abuse among the Hispanic and Latino 10 populations. Such strategy shall— 11 ‘‘(1) be designed to— 12 ‘‘(A) meet the diverse cultural and lan- 13 guage needs of the various Hispanic and Latino 14 populations; and 15 ‘‘(B) be developmentally and age-appro- 16 priate; 17 ‘‘(2) increase awareness of symptoms of mental 18 illnesses common among such populations, taking 19 into account differences within subgroups, such as 20 gender, gender identity, age, sexual orientation, or 21 ethnicity, of such populations; 22 ‘‘(3) provide information on evidence-based, cul- 23 turally and linguistically appropriate and adapted 24 interventions and treatments; 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01110 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1111 •HR 7585 IH ‘‘(4) ensure full participation of, and engage, 1 both consumers and community members in the de- 2 velopment and implementation of materials; 3 ‘‘(5) seek to broaden the perspective among 4 both individuals in these communities and stake- 5 holders serving these communities to use a com- 6 prehensive public health approach to promoting be- 7 havioral health that addresses a holistic view of 8 health by focusing on the intersection between be- 9 havioral and physical health; and 10 ‘‘(6) address the impact of the SARS–CoV–2 11 pandemic on the mental and behavioral health of the 12 Hispanic and Latino populations. 13 ‘‘(b) REPORTS.—Beginning not later than 1 year 14 after the date of the enactment of this section and annu- 15 ally thereafter, the Secretary, acting through the Assistant 16 Secretary, shall submit to Congress, and make publicly 17 available, a report on the extent to which the strategy de- 18 veloped and implemented under subsection (a) improved 19 behavioral and mental health outcomes associated with 20 mental health conditions and substance abuse among His- 21 panic and Latino populations. 22 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 $1,000,000 for each of fiscal years 2023 through 2025.’’. 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01111 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1112 •HR 7585 IH SEC. 6073. STRENGTHENING MENTAL HEALTH SUPPORTS 1 FOR BIPOC COMMUNITIES. 2 (a) IN GENERAL.—Section 1942(a) of the Public 3 Health Service Act (42 U.S.C. 300x–52(a)) is amended— 4 (1) in paragraph (1), by striking ‘‘and’’ at the 5 end; 6 (2) by redesignating paragraph (2) as para- 7 graph (5); and 8 (3) by inserting after paragraph (1) the fol- 9 lowing: 10 ‘‘(2) services provided by the State to adults 11 with a serious mental illness and children with a se- 12 rious emotional disturbance who are members of his- 13 torically racial and ethnic minority groups, includ- 14 ing— 15 ‘‘(A) the extent to which such services are 16 provided to such adults and children; and 17 ‘‘(B) the outcomes experienced by such 18 adults and children as a result of the provision 19 of such services, including with respect to— 20 ‘‘(i) diversions from hospitalization 21 and criminal justice system involvement; 22 ‘‘(ii) treatment for first episode psy- 23 chosis or undefined psychosis; 24 ‘‘(iii) reductions in suicide and in- 25 creased utilization of appropriate treat- 26 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01112 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1113 •HR 7585 IH ments and interventions for suicidal idea- 1 tion; 2 ‘‘(iv) response through crisis services, 3 including mobile crisis services; 4 ‘‘(v) treatment of individuals who are 5 experiencing homelessness or housing inse- 6 curity and individuals residing in rural 7 communities; and 8 ‘‘(vi) increased patient family and 9 caregiver engagement and education on se- 10 rious mental illness to reduce social stigma 11 and promote healthy social support for pa- 12 tients; 13 ‘‘(3) any outreach by the State to, and the hir- 14 ing of, providers of mental health services from mul- 15 tiple disciplines (such as a psychologist, psychiatrist, 16 peer support provider, or social worker) who are 17 members of historically racial and ethnic minority 18 groups; 19 ‘‘(4) any outreach by the State to providers 20 from multiple disciplines of mental health services— 21 ‘‘(A) to provide training on culturally ef- 22 fective, culturally affirming, and linguistically 23 competent services; and 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01113 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1114 •HR 7585 IH ‘‘(B) to increase awareness of community- 1 defined practices by practitioners of historically 2 racial and ethnic minority groups; and’’. 3 (b) APPLICABILITY.—The amendments made by sub- 4 section (a) shall apply with respect to funding agreements 5 entered into under section 1911 or 1921 of the Public 6 Health Service Act (42 U.S.C. 300x; 42 U.S.C. 300x–21) 7 on or after the date of the enactment of this Act. 8 SEC. 6074. STRONG SUPPORT FOR CHILDREN. 9 (a) DATA ANALYSIS AND STRATEGY IMPLEMENTA- 10 TION TO PREVENT AND MITIGATE CHILDHOOD TRAU- 11 MA.—Title XXXI of the Public Health Service Act (42 12 U.S.C. 300kk) is amended by adding at the end the fol- 13 lowing: 14 ‘‘SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTA- 15 TION TO PREVENT AND MITIGATE CHILD- 16 HOOD TRAUMA. 17 ‘‘(a) IN GENERAL.—The Secretary shall establish a 18 program— 19 ‘‘(1) to support the development and implemen- 20 tation of programs that use data analysis methods 21 to identify and facilitate strategies for early inter- 22 vention and prevention, in order to prevent and miti- 23 gate childhood trauma and support communities and 24 families, including— 25 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01114 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1115 •HR 7585 IH ‘‘(A) improving connections through care 1 coordination; 2 ‘‘(B) aligning community initiatives in tar- 3 geted areas of need; and 4 ‘‘(C) expanding community capacity 5 through cross-sector collaboration; and 6 ‘‘(2) to evaluate the effectiveness of these pro- 7 grams in improving outcomes for children. 8 ‘‘(b) GRANTS.—The Secretary shall award grants to 9 up to 5 eligible entities to carry out the activities described 10 in subsection (a). 11 ‘‘(c) USE OF FUNDS.—A grant for activities under 12 this section shall be used to support the development and 13 implementation of programs that use data analysis meth- 14 ods to identify and facilitate strategies for early interven- 15 tion and prevention, in order to prevent and mitigate 16 childhood trauma and support communities and families, 17 including as follows: 18 ‘‘(1) Utilize data analysis methods to— 19 ‘‘(A) identify specific geographic areas, 20 such as census tracts, with a high prevalence of 21 adverse childhood experiences and significant 22 risk factors for poor outcomes for children 23 (such as increased risk of experiencing adverse 24 VerDate Sep 11 2014 20:42 Jun 23, 2022 Jkt 029200 PO 00000 Frm 01115 Fmt 6652 Sfmt 6201 E:\BILLS\H7585.IH H7585 pbinns on DSKJLVW7X2PROD with $$_JOB 1116 •HR 7585 IH childhood experiences), including areas with 1 high rates of— 2 ‘‘(i) poor public health outcomes in- 3