Text of US SB 2474 (2012)

II 112TH CONGRESS 2D SESSION S. 2474 To improve the health of minority individuals, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 26, 2012 Mr. AKAKA (for himself and Mr. INOUYE) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To improve the health of minority individuals, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Accountability Act of 2012’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING Sec. 101. Amendment to the Public Health Service Act. VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 2 •S 2474 IS Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of race and ethnicity data by the Social Security Adminis- tration. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Is- landers and other underrepresented groups in Federal health surveys. Sec. 107. Geo-access study. Sec. 108. Racial, ethnic, and linguistic data collected by the Federal Govern- ment. Sec. 109. Data collection and analysis grants to minority-serving institutions. Sec. 110. Standards for measuring sexual orientation and gender identity in collection of health data. Sec. 111. Optional collection of health data on immigrants and individuals in their households. Sec. 112. GAO study on compliance with existing FDA requirements to present drug and device safety and effectiveness data by sex, age, and racial and ethnic subgroups. Sec. 113. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 114. Simplified administrative reporting requirement for nutrition assist- ance. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE Sec. 201. Definitions. Sec. 202. Amendment to the Public Health Service Act. Sec. 203. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 204. Increasing understanding of and improving health literacy. Sec. 205. Assurances for receiving Federal funds. Sec. 206. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 207. English for speakers of other languages. Sec. 208. Implementation. Sec. 209. Language access services. Sec. 210. Assistant Secretary of the Indian Health Service. Sec. 211. Reauthorization of the Native Hawaiian Health Care Improvement Act. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving health professions schools. Sec. 303. Loan repayment program of Centers for Disease Control and Preven- tion. Sec. 304. Cooperative agreements for online degree programs at schools of pub- lic health and schools of allied health. Sec. 305. Sense of Congress on the mission of the National Health Care Work- force Commission. Sec. 306. Scholarship and fellowship programs. Sec. 307. Advisory Committee on Health Professions Training for Diversity. VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 3 •S 2474 IS Sec. 308. McNair Postbaccalaureate Achievement Program. Sec. 309. Rules for determination of full-time equivalent residents for cost re- porting periods. Sec. 310. Developing and implementing strategies for local health equity. Sec. 311. Loan forgiveness for mental and behavioral health social workers. TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES Subtitle A—Health Empowerment Zones Sec. 401. Short title. Sec. 402. Findings. Sec. 403. Designation of health empowerment zones. Sec. 404. Assistance to those seeking designation. Sec. 405. Benefits of designation. Sec. 406. Definition. Subtitle B—Other Improvements of Health Care Services CHAPTER 1—EXPANSION OF COVERAGE Sec. 411. Amendment to the Public Health Service Act. Sec. 412. Removing barriers to unsubsidized purchase of private insurance in American Health Benefit Exchanges. Sec. 413. Study on the uninsured. Sec. 414. Medicaid payment parity for the territories. Sec. 415. Medicaid eligibility for citizens of Freely Associated States. Sec. 416. Extension of Medicare secondary payer. Sec. 417. Border health grants. Sec. 418. Removing Medicare barriers to health care. Sec. 419. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 420. 100 percent FMAP for medical assistance provided to a Native Ha- waiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program. CHAPTER 2—EXPANSION OF ACCESS Sec. 421. Grants for racial and ethnic approaches to community health. Sec. 422. Critical access hospital improvements. Sec. 423. Establishment of Rural Community Hospital (RCH) Program. Sec. 424. Medicare remote monitoring pilot projects. Sec. 425. Rural health quality advisory commission and demonstration projects. Sec. 426. Rural health care services. Sec. 427. Community health center collaborative access expansion. Sec. 428. Facilitating the provision of telehealth services across State lines. Sec. 429. Scoring of preventive health savings. Sec. 430. Sense of Congress. Sec. 431. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 432. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 433. Access for Native Americans under PPACA. Sec. 434. Study of DSH payments to ensure hospital access for low-income pa- tients. VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 4 •S 2474 IS TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Sec. 501. Grants to promote positive health behaviors in women and children. Sec. 502. Removing barriers to health care and nutrition assistance for chil- dren, pregnant women, and lawfully present individuals. Sec. 503. Repeal of denial of benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. Uniform State maternal mortality review committees on pregnancy- related deaths. Sec. 506. Eliminating disparities in maternity health outcomes. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Supporting healthy adolescent development. TITLE VI—MENTAL HEALTH Sec. 601. Community Mental Health and Addiction Safety Net Equity Act. Sec. 602. Minority Fellowship Program. Sec. 603. Integrated Health Care Demonstration Program. Sec. 604. Addressing racial and ethnic minority mental health disparities re- search gaps. TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 701. Lung Cancer Mortality Reduction. Sec. 702. Expanding Prostate Cancer Research, Outreach, Screening, Testing, Access, and Treatment Effectiveness. Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer pa- tients in the territories. Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 705. Reducing cancer treatment disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 711. Viral Hepatitis and Liver Cancer Control and Prevention. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 721. Acquired Bone Marrow Failure Diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease Issues Sec. 731. Guidelines for disease screening for minority patients. Sec. 732. Coverage of the shingles vaccine under the Medicare program. Sec. 733. CDC Wisewoman Screening Program. Sec. 734. Report on cardiovascular care for women and minorities. Sec. 735. Coverage of comprehensive tobacco cessation services in Medicaid. Sec. 736. Clinical research funding for oral health. Sec. 737. Participation by Medicaid beneficiaries in approved clinical trials. VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 5 •S 2474 IS Subtitle E—HIV/AIDS Sec. 741. Findings. Sec. 742. Addressing HIV/AIDS in communities of color. Sec. 743. HIV/AIDS reduction in racial and ethnic minority communities. Sec. 744. Repealing ineffective and incomplete abstinence-only education pro- gram. Sec. 745. Dental Education Loan Repayment Program. Sec. 746. Report on the implementation of the national HIV/AIDS strategy. Sec. 747. Addressing HIV/AIDS in the African-American community. Sec. 748. National Black Clergy for the Elimination of HIV/AIDS. Sec. 749. Reducing the spread of sexually transmitted infections in correctional facilities. Sec. 750. Stop AIDS in prison. Sec. 751. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 752. Health care professionals treating individuals with HIV/AIDS. Sec. 753. Report on impact of HIV/AIDS in racial and ethnic minority commu- nities. Sec. 754. Study on status of HIV/AIDS epidemic among African-Americans. Subtitle F—Diabetes Sec. 755. Treatment of diabetes in minority communities. Sec. 756. Eliminating disparities in diabetes prevention access and care. Subtitle G—Lung Disease Sec. 761. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 762. Asthma-related activities of the centers for disease control and pre- vention. Sec. 763. Influenza and pneumonia vaccination campaign. Sec. 764. Chronic obstructive pulmonary disease action plan. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Subtitle A—Reducing Health Disparities Through Health IT Sec. 801. HRSA assistance to health centers for promotion of Health IT. Sec. 802. Assessment of use of Health IT in racial and ethnic minority commu- nities. Subtitle B—Modifications to Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Prioritizing regional extension center assistance to racial and ethnic minority groups. Sec. 813. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Subtitle C—Additional Research and Studies Sec. 821. Data collection and assessments conducted in coordination with mi- nority-serving institutions. VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 6 •S 2474 IS Sec. 822. IOM study and report on privacy concerns of certain minority popu- lations. Sec. 823. Study of health information technology in medically underserved areas. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 831. Application of Medicare HITECH payments to hospitals in Puerto Rico. Sec. 832. Extending Physician Assistant Eligibility for Medicaid Electronic Health Record Incentive Payments. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status. Sec. 902. Treatment of Medicare payments under Title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Sec. 1001. Codification of Executive Order 12898. Sec. 1002. Implementation of recommendations by Environmental Protection Agency. Sec. 1003. Grant program. Sec. 1004. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1005. Environment and public health restoration. Sec. 1006. Healthy Food Financing Initiative. Sec. 1007. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 (1) The population of racial and ethnic minori- 3 ties is expected to increase over the next few dec- 4 ades, yet racial and ethnic minorities have the poor- 5 est health status and face substantial cultural, so- 6 cial, and economic barriers to obtaining quality 7 health care. 8 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 7 •S 2474 IS (2) Health disparities are a function of not only 1 access to health care, but also the social deter- 2 minants of health—including the environment, the 3 physical structure of communities, nutrition and 4 food options, educational attainment, employment, 5 race, ethnicity, sex, geography, language preference, 6 immigrant or citizenship status, sexual orientation, 7 gender identity, socioeconomic status, or disability 8 status—that directly and indirectly affect the health, 9 health care, and wellness of individuals and commu- 10 nities. 11 (3) By 2020, the Nation will face a shortage of 12 health care providers and allied health workers and 13 this shortage disproportionately affects health pro- 14 fessional shortage areas where many racial and eth- 15 nic minority populations reside. 16 (4) All efforts to reduce health disparities and 17 barriers to quality health services require better and 18 more consistent data. 19 (5) A full range of culturally and linguistically 20 appropriate health care and public health services 21 must be available and accessible in every community. 22 (6) Racial and ethnic minorities and under- 23 served populations must be included early and equi- 24 tably in health reform innovations. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 8 •S 2474 IS (7) Efforts to improve minority health have 1 been limited by inadequate resources in funding, 2 staffing, stewardship and accountability. Targeted 3 investments that are focused on disparities elimi- 4 nation must be made in providing care and services 5 that are community-based, including prevention and 6 policies addressing social determinants of health. 7 (8) In 2011, the Department of Health and 8 Human Services developed the HHS Action Plan to 9 Reduce Racial and Ethnic Health Disparities and 10 the National Stakeholder Strategy for Achieving 11 Health Equity, two strategic plans that represent 12 the country’s first coordinated roadmap to reducing 13 health disparities. Along with the National Preven- 14 tion Strategy and the National Health Care Quality 15 Strategy, these comprehensive plans will work to in- 16 crease the number of Americans who are healthy at 17 every stage of life. 18 (9) The Department of Health and Human 19 Services also developed other strategic planning doc- 20 uments to combat disease disparities with a high im- 21 pact on minority populations including the National 22 HIV/AIDS Strategy, and the Action Plan for the 23 Prevention, Care and Treatment of Viral Hepatitis. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 9 •S 2474 IS (10) The Patient Protection and Affordable 1 Care Act, as amended by the Health Care and Edu- 2 cation Reconciliation Act, represents the biggest ad- 3 vancement for minority health in the last 40 years. 4 TITLE I—DATA COLLECTION 5 AND REPORTING 6 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 7 ACT. 8 (a) PURPOSE.—It is the purpose of this section to 9 promote data collection, analysis, and reporting by race, 10 ethnicity, sex, primary language, sexual orientation, dis- 11 ability status, gender identity, and socioeconomic status 12 among federally supported health programs. 13 (b) AMENDMENT.—Title XXXIV of the Public 14 Health Service Act, as amended by titles II and III of 15 this Act, is further amended by inserting after subtitle A 16 the following: 17 ‘‘Subtitle B—Strengthening Data 18 Collection, Improving Data 19 Analysis, and Expanding Data 20 Reporting 21 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 22 ‘‘(a) REQUIREMENTS.— 23 ‘‘(1) IN GENERAL.—Each health-related pro- 24 gram operated by or that receives funding or reim- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 10 •S 2474 IS bursement, in whole or in part, either directly or in- 1 directly from the Department of Health and Human 2 Services shall— 3 ‘‘(A) require the collection, by the agency 4 or program involved, of data on the race, eth- 5 nicity, sex, primary language, sexual orienta- 6 tion, disability status, gender identity, and so- 7 cioeconomic status of each applicant for and re- 8 cipient of health-related assistance under such 9 program— 10 ‘‘(i) using, at a minimum, the stand- 11 ards for data collection on race, ethnicity, 12 sex, primary language, sexual orientation, 13 disability status, gender identity, and so- 14 cioeconomic status developed under section 15 3101; 16 ‘‘(ii) collecting data for additional 17 population groups if such groups can be 18 aggregated into the minimum race and 19 ethnicity categories; 20 ‘‘(iii) additionally referring, where 21 practicable, to the standards developed by 22 the Institute of Medicine in ‘Race, Eth- 23 nicity, and Language Data: Standardiza- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 11 •S 2474 IS tion for Health Care Quality Improve- 1 ment’; and 2 ‘‘(iv) where practicable, through self- 3 reporting; 4 ‘‘(B) with respect to the collection of the 5 data described in subparagraph (A), for appli- 6 cants and recipients who are minors, require 7 communication assistance in speech or writing, 8 and for applicants and recipients who are other- 9 wise legally incapacitated, require that— 10 ‘‘(i) such data be collected from the 11 parent or legal guardian of such an appli- 12 cant or recipient; and 13 ‘‘(ii) the primary language of the par- 14 ent or legal guardian of such an applicant 15 or recipient be collected; 16 ‘‘(C) systematically analyze such data 17 using the smallest appropriate units of analysis 18 feasible to detect racial and ethnic disparities, 19 as well as disparities along the lines of primary 20 language, sex, disability status, sexual orienta- 21 tion, gender identity, and socioeconomic status 22 in health and health care, and report the results 23 of such analysis to the Secretary, the Director 24 of the Office for Civil Rights, each agency listed 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 12 •S 2474 IS in section 3101(c)(1), the Committee on 1 Health, Education, Labor, and Pensions and 2 the Committee on Finance of the Senate, and 3 the Committee on Energy and Commerce and 4 the Committee on Ways and Means of the 5 House of Representatives; 6 ‘‘(D) provide such data to the Secretary on 7 at least an annual basis; and 8 ‘‘(E) ensure that the provision of assist- 9 ance to an applicant or recipient of assistance 10 is not denied or otherwise adversely affected be- 11 cause of the failure of the applicant or recipient 12 to provide race, ethnicity, primary language, 13 sex, sexual orientation, disability status, gender 14 identity, and socioeconomic status data. 15 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 16 this subsection shall be construed to— 17 ‘‘(A) permit the use of information col- 18 lected under this subsection in a manner that 19 would adversely affect any individual providing 20 any such information; and 21 ‘‘(B) diminish existing or future require- 22 ments on health care providers to collect data. 23 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 24 ensure (through the promulgation of regulations or other- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 13 •S 2474 IS wise) that all data collected pursuant to subsection (a) are 1 protected— 2 ‘‘(1) under the same privacy protections as the 3 Secretary applies to other health data under the reg- 4 ulations promulgated under section 264(c) of the 5 Health Insurance Portability and Accountability Act 6 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 7 lating to the privacy of individually identifiable 8 health information and other protections; and 9 ‘‘(2) from all inappropriate internal use by any 10 entity that collects, stores, or receives the data, in- 11 cluding use of such data in determinations of eligi- 12 bility (or continued eligibility) in health plans, and 13 from other inappropriate uses, as defined by the 14 Secretary. 15 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 16 Secretary shall develop and implement a national plan to 17 ensure the collection of data in a culturally appropriate 18 and competent manner, to improve the collection, analysis, 19 and reporting of racial, ethnic, sex, primary language, sex- 20 ual orientation, disability status, gender identity, and so- 21 cioeconomic status data at the Federal, State, territorial, 22 tribal, and local levels, including data to be collected under 23 subsection (a), and to ensure that data collection activities 24 carried out under this section are in compliance with the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 14 •S 2474 IS standards developed under section 3101. The Data Coun- 1 cil of the Department of Health and Human Services, in 2 consultation with the National Committee on Vital Health 3 Statistics, the Office of Minority Health, Office on Wom- 4 en’s Health, and other appropriate public and private enti- 5 ties, shall make recommendations to the Secretary con- 6 cerning the development, implementation, and revision of 7 the national plan. Such plan shall include recommenda- 8 tions on how to— 9 ‘‘(1) implement subsection (a) while minimizing 10 the cost and administrative burdens of data collec- 11 tion and reporting; 12 ‘‘(2) expand awareness among Federal agencies, 13 States, territories, Indian tribes, health providers, 14 health plans, health insurance issuers, and the gen- 15 eral public that data collection, analysis, and report- 16 ing by race, ethnicity, primary language, sexual ori- 17 entation, disability status, gender identity, and socio- 18 economic status is legal and necessary to assure eq- 19 uity and nondiscrimination in the quality of health 20 care services; 21 ‘‘(3) ensure that future patient record systems 22 have data code sets for racial, ethnic, primary lan- 23 guage, sexual orientation, disability status, gender 24 identity, and socioeconomic status identifiers and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 15 •S 2474 IS that such identifiers can be retrieved from clinical 1 records, including records transmitted electronically; 2 ‘‘(4) improve health and health care data collec- 3 tion and analysis for more population groups if such 4 groups can be aggregated into the minimum race 5 and ethnicity categories, including exploring the fea- 6 sibility of enhancing collection efforts in States for 7 racial and ethnic groups that comprise a significant 8 proportion of the population of the State; 9 ‘‘(5) provide researchers with greater access to 10 racial, ethnic, primary language, sexual orientation, 11 disability status, gender identity, and socioeconomic 12 status data, subject to privacy and confidentiality 13 regulations; and 14 ‘‘(6) safeguard and prevent the misuse of data 15 collected under subsection (a). 16 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 17 lected under subsection (a) shall be obtained, maintained, 18 and presented (including for reporting purposes) in ac- 19 cordance with the 1997 Office of Management and Budget 20 Standards for Maintaining, Collecting, and Presenting 21 Federal Data on Race and Ethnicity (at a minimum). 22 ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION 23 AND REPORTING OF DATA.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 16 •S 2474 IS ‘‘(1) IN GENERAL.—The Secretary may, either 1 directly or through grant or contract, provide tech- 2 nical assistance to enable a health care program or 3 an entity operating under such program to comply 4 with the requirements of this section. 5 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro- 6 vided under this subsection may include assistance 7 to— 8 ‘‘(A) enhance or upgrade computer tech- 9 nology that will facilitate racial, ethnic, primary 10 language, sexual orientation, disability status, 11 gender identity, and socioeconomic status data 12 collection and analysis; 13 ‘‘(B) improve methods for health data col- 14 lection and analysis including additional popu- 15 lation groups beyond the Office of Management 16 and Budget categories if such groups can be 17 aggregated into the minimum race and ethnicity 18 categories; 19 ‘‘(C) develop mechanisms for submitting 20 collected data subject to existing privacy and 21 confidentiality regulations; and 22 ‘‘(D) develop educational programs to in- 23 form health insurance issuers, health plans, 24 health providers, health-related agencies, and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 17 •S 2474 IS the general public that data collection and re- 1 porting by race, ethnicity, primary language, 2 sexual orientation, disability status, gender 3 identity, and socioeconomic status are legal and 4 essential for eliminating health and health care 5 disparities. 6 ‘‘(f) ANALYSIS OF HEALTH DISPARITY DATA.—The 7 Secretary, acting through the Director of the Agency for 8 Healthcare Research and Quality and in coordination with 9 the Administrator of the Centers for Medicare & Medicaid 10 Services, shall provide technical assistance to agencies of 11 the Department of Health and Human Services in meeting 12 Federal standards for health disparity data collection and 13 for analysis of racial and ethnic disparities in health and 14 health care in public programs by— 15 ‘‘(1) identifying appropriate quality assurance 16 mechanisms to monitor for health disparities; 17 ‘‘(2) specifying the clinical, diagnostic, or thera- 18 peutic measures which should be monitored; 19 ‘‘(3) developing new quality measures relating 20 to racial and ethnic disparities and their overlap 21 with other disparity factors in health and health 22 care; 23 ‘‘(4) identifying the level at which data analysis 24 should be conducted; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 18 •S 2474 IS ‘‘(5) sharing data with external organizations 1 for research and quality improvement purposes. 2 ‘‘(g) DEFINITION.—In this section, the term ‘health- 3 related program’ mean a program— 4 ‘‘(1) under the Social Security Act (42 U.S.C. 5 301 et seq.) that pays for health care and services; 6 and 7 ‘‘(2) under this Act that provides Federal finan- 8 cial assistance for health care, biomedical research, 9 or health services research and or is designed to im- 10 prove the public’s health. 11 ‘‘SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS. 12 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN- 13 TERS.—The Secretary shall establish an epidemiology cen- 14 ter in each service area to carry out the functions de- 15 scribed in subsection (b). Any new center established after 16 the date of the enactment of the Health Equity and Ac- 17 countability Act of 2012 may be operated under a grant 18 authorized by subsection (d), but funding under such a 19 grant shall not be divisible. 20 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 21 and upon the request of Indian tribes, tribal organizations, 22 and urban indian organizations, each service area epidemi- 23 ology center established under this subsection shall, with 24 respect to such service area— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 19 •S 2474 IS ‘‘(1) collect data relating to, and monitor 1 progress made toward meeting, each of the health 2 status objectives of the service, the Indian tribes, 3 tribal organizations, and urban indian organizations 4 in the service area; 5 ‘‘(2) evaluate existing delivery systems, data 6 systems, and other systems that impact the improve- 7 ment of Indian health; 8 ‘‘(3) assist Indian tribes, tribal organizations, 9 and urban indian organizations in identifying their 10 highest priority health status objectives and the 11 services needed to achieve such objectives, based on 12 epidemiological data; 13 ‘‘(4) make recommendations for the targeting 14 of services needed by the populations served; 15 ‘‘(5) make recommendations to improve health 16 care delivery systems for Indians and urban Indians; 17 ‘‘(6) provide requested technical assistance to 18 Indian tribes, tribal organizations, and urban indian 19 organizations in the development of local health 20 service priorities and incidence and prevalence rates 21 of disease and other illness in the community; and 22 ‘‘(7) provide disease surveillance and assist In- 23 dian tribes, tribal organizations, and urban Indian 24 organizations to promote public health. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 20 •S 2474 IS ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 1 Centers for Disease Control and Prevention shall provide 2 technical assistance to the centers in carrying out the re- 3 quirements of this subsection. 4 ‘‘(d) GRANTS FOR STUDIES.— 5 ‘‘(1) IN GENERAL.—The Secretary may make 6 grants to Indian tribes, tribal organizations, urban 7 indian organizations, and eligible intertribal con- 8 sortia to conduct epidemiological studies of Indian 9 communities. 10 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 11 intertribal consortium is eligible to receive a grant 12 under this subsection if— 13 ‘‘(A) the intertribal consortium is incor- 14 porated for the primary purpose of improving 15 Indian health; and 16 ‘‘(B) the intertribal consortium is rep- 17 resentative of the Indian tribes or urban Indian 18 communities in which the intertribal consortium 19 is located. 20 ‘‘(3) APPLICATIONS.—An application for a 21 grant under this subsection shall be submitted in 22 such manner and at such time as the Secretary shall 23 prescribe. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 21 •S 2474 IS ‘‘(4) REQUIREMENTS.—An applicant for a 1 grant under this subsection shall— 2 ‘‘(A) demonstrate the technical, adminis- 3 trative, and financial expertise necessary to 4 carry out the functions described in paragraph 5 (5); 6 ‘‘(B) consult and cooperate with providers 7 of related health and social services in order to 8 avoid duplication of existing services; and 9 ‘‘(C) demonstrate cooperation from Indian 10 tribes or urban Indian organizations in the area 11 to be served. 12 ‘‘(5) USE OF FUNDS.—A grant awarded under 13 paragraph (1) may be used— 14 ‘‘(A) to carry out the functions described 15 in subsection (b); 16 ‘‘(B) to provide information to and consult 17 with tribal leaders, urban Indian community 18 leaders, and related health staff on health care 19 and health service management issues; and 20 ‘‘(C) in collaboration with Indian tribes, 21 tribal organizations, and urban Indian commu- 22 nities, to provide the service with information 23 regarding ways to improve the health status of 24 Indians. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 22 •S 2474 IS ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 1 center operated by a grantee pursuant to a grant awarded 2 under subsection (d) shall be treated as a public health 3 authority for purposes of the Health Insurance Portability 4 and Accountability Act of 1996 (Public Law 104–191; 110 5 Stat. 2033), as such entities are defined in part 164.501 6 of title 45, Code of Federal Regulations (or a successor 7 regulation). The Secretary shall grant such grantees ac- 8 cess to and use of data, data sets, monitoring systems, 9 delivery systems, and other protected health information 10 in the possession of the Secretary.’’. 11 SEC. 102. 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) is amended— 16 (1) by striking subsection (h); and 17 (2) by redesignating subsection (i) as subsection 18 (h). 19 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 20 THE SOCIAL SECURITY ADMINISTRATION. 21 Part A of title XI of the Social Security Act (42 22 U.S.C. 1301 et seq.) is amended by adding at the end 23 the following: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 23 •S 2474 IS ‘‘SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA 1 BY THE SOCIAL SECURITY ADMINISTRATION. 2 ‘‘(a) REQUIREMENT.—The Commissioner of Social 3 Security, in consultation with the Administrator of the 4 Centers for Medicare & Medicaid Services, shall— 5 ‘‘(1) require the collection of data on the race, 6 ethnicity, primary language, sex, and disability sta- 7 tus of all applicants for Social Security account 8 numbers or benefits under title II or part A of title 9 XVIII and all individuals with respect to whom the 10 Commissioner maintains records of wages and self- 11 employment income in accordance with reports re- 12 ceived by the Commissioner or the Secretary of the 13 Treasury— 14 ‘‘(A) using, at a minimum, the standards 15 for data collection on race, ethnicity, primary 16 language, sex, and disability status developed 17 under section 3101 of the Public Health Service 18 Act; 19 ‘‘(B) where practicable, collecting data for 20 additional population groups if such groups can 21 be aggregated into the minimum race and eth- 22 nicity categories; and 23 ‘‘(C) additionally referring, where prac- 24 ticable, to the standards developed by the Insti- 25 tute of Medicine in ‘Race, Ethnicity, and Lan- 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 24 •S 2474 IS guage Data: Standardization for Health Care 1 Quality Improvement’ (released August 31, 2 2009); 3 ‘‘(2) with respect to the collection of the data 4 described in paragraph (1) for applicants who are 5 under 18 years of age or otherwise legally incapaci- 6 tated, require that— 7 ‘‘(A) such data be collected from the par- 8 ent or legal guardian of such an applicant; and 9 ‘‘(B) the primary language of the parent 10 or legal guardian of such an applicant or recipi- 11 ent be used; 12 ‘‘(3) require that such data be uniformly ana- 13 lyzed and reported at least annually to the Commis- 14 sioner of Social Security; 15 ‘‘(4) be responsible for storing the data re- 16 ported under paragraph (3); 17 ‘‘(5) ensure transmission to the Centers for 18 Medicare & Medicaid Services and other Federal 19 health agencies; 20 ‘‘(6) provide such data to the Secretary on at 21 least an annual basis; and 22 ‘‘(7) ensure that the provision of assistance to 23 an applicant is not denied or otherwise adversely af- 24 fected because of the failure of the applicant to pro- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 25 •S 2474 IS vide race, ethnicity, primary language, sex, and dis- 1 ability status data. 2 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 3 Social Security shall ensure (through the promulgation of 4 regulations or otherwise) that all data collected pursuant 5 to subsection (a) are protected— 6 ‘‘(1) under the same privacy protections as the 7 Secretary applies to health data under the regula- 8 tions promulgated under section 264(c) of the 9 Health Insurance Portability and Accountability Act 10 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 11 lating to the privacy of individually identifiable 12 health information and other protections; and 13 ‘‘(2) from all inappropriate internal use by any 14 entity that collects, stores, or receives the data, in- 15 cluding use of such data in determinations of eligi- 16 bility (or continued eligibility) in health plans, and 17 from other inappropriate uses, as defined by the 18 Secretary. 19 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec- 20 tion shall be construed to permit the use of information 21 collected under this section in a manner that would ad- 22 versely affect any individual providing any such informa- 23 tion. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 26 •S 2474 IS ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 1 either directly or by grant or contract, provide technical 2 assistance to enable any health entity to comply with the 3 requirements of this section.’’. 4 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 5 (a) IN GENERAL.—Not later than 1 year after the 6 date of enactment of this Act, the Secretary of Health and 7 Human Services shall revise the regulations promulgated 8 under part C of title XI of the Social Security Act (42 9 U.S.C. 1320d et seq.), relating to the collection of data 10 on race, ethnicity, and primary language in a health-re- 11 lated transaction, to require— 12 (1) the use, at a minimum, of the standards for 13 data collection on race, ethnicity, primary language, 14 disability, and sex developed under section 3101 of 15 the Public Health Service Act (42 U.S.C. 300kk); 16 and 17 (2) the designation of the racial, ethnic, pri- 18 mary language, disability, and sex code sets as re- 19 quired for claims and enrollment data. 20 (b) DISSEMINATION.—The Secretary of Health and 21 Human Services shall disseminate the new standards de- 22 veloped under subsection (a) to all health entities that are 23 subject to the regulations described in such subsection and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 27 •S 2474 IS provide technical assistance with respect to the collection 1 of the data involved. 2 (c) COMPLIANCE.—The Secretary of Health and 3 Human Services shall require that health entities comply 4 with the new standards developed under subsection (a) not 5 later than 2 years after the final promulgation of such 6 standards. 7 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 8 Section 306(n) of the Public Health Service Act (42 9 U.S.C. 242k(n)) is amended— 10 (1) in paragraph (1), by striking ‘‘2003’’ and 11 inserting ‘‘2016’’; 12 (2) in paragraph (2), in the first sentence, by 13 striking ‘‘2003’’ and inserting ‘‘2016’’; and 14 (3) in paragraph (3), by striking ‘‘2002’’ and 15 inserting ‘‘2016’’. 16 SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 17 HAWAIIANS, OR PACIFIC ISLANDERS AND 18 OTHER UNDERREPRESENTED GROUPS IN 19 FEDERAL HEALTH SURVEYS. 20 Part B of title III of the Public Health Service Act 21 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 22 tion 317T the following: 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 28 •S 2474 IS ‘‘SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 1 HAWAIIANS, OR PACIFIC ISLANDERS AND 2 OTHER UNDERREPRESENTED GROUPS IN 3 FEDERAL HEALTH SURVEYS. 4 ‘‘(a) NATIONAL STRATEGY.— 5 ‘‘(1) IN GENERAL.—The Secretary of Health 6 and Human Services, acting through the Director of 7 the National Center for Health Statistics (referred 8 to in this section as ‘NCHS’) of the Centers for Dis- 9 ease Control and Prevention, and other agencies 10 within the Department of Health and Human Serv- 11 ices as the Secretary determines appropriate, shall 12 develop and implement an ongoing and sustainable 13 national strategy for oversampling Asian-Americans, 14 Native Hawaiians, or Pacific Islanders, and other 15 underrepresented populations as determined appro- 16 priate by the Secretary in Federal health surveys. 17 ‘‘(2) CONSULTATION.—In developing and imple- 18 menting a national strategy, as described in para- 19 graph (1), not later than 180 days after the date of 20 the enactment of the this section, the Secretary— 21 ‘‘(A) shall consult with representatives of 22 community groups, nonprofit organizations, 23 nongovernmental organizations, and govern- 24 ment agencies working with Asian-Americans, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 29 •S 2474 IS Native Hawaiians, or Pacific Islanders, and 1 other underrepresented populations; and 2 ‘‘(B) may solicit the participation of rep- 3 resentatives from other Federal departments 4 and agencies. 5 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 6 after the date of the enactment of this section, the Sec- 7 retary shall submit to the Congress a progress report, 8 which shall include the national strategy described in sub- 9 section (a)(1).’’. 10 SEC. 107. GEO-ACCESS STUDY. 11 The Administrator of the Substance Abuse and Men- 12 tal Health Services Administration shall— 13 (1) conduct a study to— 14 (A) determine which geographic areas of 15 the United States have shortages of specialty 16 mental health providers; and 17 (B) assess the preparedness of speciality 18 mental health providers to deliver culturally and 19 linguistically appropriate, affordable, and acces- 20 sible services; and 21 (2) submit a report to the Congress on the re- 22 sults of such study. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 30 •S 2474 IS SEC. 108. RACIAL, ETHNIC, AND LINGUISTIC DATA COL- 1 LECTED BY THE FEDERAL GOVERNMENT. 2 (a) COLLECTION; SUBMISSION.—Not later than 90 3 days after the date of the enactment of this Act, and Jan- 4 uary 31 of each year thereafter, each department, agency, 5 and office of the Federal Government that has collected 6 racial, ethnic, or linguistic data during the preceding cal- 7 endar year shall submit such data to the Secretary of 8 Health and Human Services. 9 (b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 10 Not later than April 30, 2012, and each April 30 there- 11 after, the Secretary of Health and Human Services, acting 12 through the Director of the National Institute on Minority 13 Health and Health Disparities and the Deputy Assistant 14 Secretary for Minority Health, shall— 15 (1) collect and analyze the racial, ethnic, and 16 linguistic data, including by stratifying such data by 17 sex, submitted under subsection (a) for the pre- 18 ceding calendar year; 19 (2) make publicly available such data and the 20 results of such analysis; and 21 (3) submit a report to the Congress on such 22 data and analysis. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 31 •S 2474 IS SEC. 109. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 1 NORITY-SERVING INSTITUTIONS. 2 (a) AUTHORITY.—The Secretary of Health and 3 Human Services, acting through the National Institute on 4 Minority Health and Health Disparities and the Office of 5 Minority Health, may award grants to access and analyze 6 racial and ethnic, and where possible other health dis- 7 parity data, to monitor and report on progress to reduce 8 and eliminate disparities in health and health care. Such 9 analysis under the preceding sentence shall include strati- 10 fying such data by sex. 11 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 12 igible entity’’ means a historically Black college or univer- 13 sity, an Hispanic-serving institution, a tribal college or 14 university, or an Asian-American, Native American, or Pa- 15 cific Islander-serving institution with an accredited public 16 health, health policy, or health services research program. 17 SEC. 110. STANDARDS FOR MEASURING SEXUAL ORIENTA- 18 TION AND GENDER IDENTITY IN COLLECTION 19 OF HEALTH DATA. 20 Section 3101(a) of the Public Health Service Act (42 21 U.S.C. 300kk(a)) is amended— 22 (1) in paragraph (1)(A), by inserting ‘‘sexual 23 orientation, gender identity,’’ before ‘‘and disability 24 status’’; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 32 •S 2474 IS (2) in paragraph (1)(C), by inserting ‘‘sexual 1 orientation, gender identity,’’ before ‘‘and disability 2 status’’; and 3 (3) in paragraph (2)(B), by inserting ‘‘sexual 4 orientation, gender identity,’’ before ‘‘and disability 5 status’’. 6 SEC. 111. OPTIONAL COLLECTION OF HEALTH DATA ON IM- 7 MIGRANTS AND INDIVIDUALS IN THEIR 8 HOUSEHOLDS. 9 Section 3101(a) of the Public Health Service Act (42 10 U.S.C. 300k(a)) is amended by adding at the end the fol- 11 lowing: 12 ‘‘(4) OPTIONAL UNIFORM CATEGORIES.—Not 13 later than 12 months after the date of the enact- 14 ment of this paragraph, the Secretary shall— 15 ‘‘(A) enter into an arrangement with the 16 Institute of Medicine of the National Academies 17 (or, if the Institute of Medicine declines to 18 enter into such an arrangement, another appro- 19 priate entity) to— 20 ‘‘(i) conduct a study and develop rec- 21 ommended standards for the optional col- 22 lection of data in major health surveys and 23 research on citizens, noncitizens, and citi- 24 zens living in noncitizen households, in- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 33 •S 2474 IS cluding standards protecting the confiden- 1 tiality and security of personal information 2 of respondents and research subjects, to 3 the full extent permitted by law, in order 4 to measure disparities in health coverage, 5 health care access and quality, and health 6 status among these populations; 7 ‘‘(ii) in carrying out clause (i), ad- 8 dress how the protection of confidentiality 9 and security of personal information under 10 such clause interacts with immigration 11 laws; and 12 ‘‘(iii) include ensuing study results 13 and recommended standards in a report to 14 the Secretary; 15 ‘‘(B) promulgate standards based on the 16 recommendations and results of subparagraph 17 (A) for the optional collection of data in major 18 health surveys and research; and 19 ‘‘(C) provide clear guidance that such data 20 categories are optional uniform categories and, 21 if collected, the entity and any person con- 22 ducting the survey or research shall— 23 ‘‘(i) adhere to the standards under 24 subparagraph (B); 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 34 •S 2474 IS ‘‘(ii) use the information only for the 1 purposes of measuring disparities in health 2 coverage, health care access and quality, 3 and health status among these populations; 4 ‘‘(iii) comply with all applicable laws 5 and policies regarding privacy, confiden- 6 tiality and security of the personal infor- 7 mation of the respondent or research sub- 8 ject and of the family members of the re- 9 spondent or research subject; and 10 ‘‘(iv) not share that information with 11 other individuals or entities without the ex- 12 press consent of the respondent or research 13 subject.’’. 14 SEC. 112. GAO STUDY ON COMPLIANCE WITH EXISTING FDA 15 REQUIREMENTS TO PRESENT DRUG AND DE- 16 VICE SAFETY AND EFFECTIVENESS DATA BY 17 SEX, AGE, AND RACIAL AND ETHNIC SUB- 18 GROUPS. 19 (a) IN GENERAL.—The Comptroller General of the 20 United States shall conduct a study investigating the ex- 21 tent to which sponsors of clinical studies of investigational 22 drugs, biologics, and devices and sponsors of applications 23 for approval or licensure of new drugs, biologics, and de- 24 vices comply with Food and Drug Administration require- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 35 •S 2474 IS ments and follow guidance for presentation of clinical 1 study safety and effectiveness data by sex, age, and racial 2 and ethnic subgroups. 3 (b) REPORT BY GAO.— 4 (1) SUBMISSION.—Not later than 18 months 5 after the date of the enactment of this Act, the 6 Comptroller General shall complete the study under 7 subsection (a) and submit to the Committee on En- 8 ergy and Commerce of the House of Representatives 9 and the Committee on Health, Education, Labor, 10 and Pensions of the Senate a report on the results 11 of such study. 12 (2) CONTENTS.—The report required by para- 13 graph (1) shall include each of the following: 14 (A) An assessment of the extent to which 15 the Food and Drug Administration assists 16 sponsors in complying with the requirements 17 and following the guidance referred to in sub- 18 section (a). 19 (B) An assessment of the effectiveness of 20 the Food and Drug Administration’s enforce- 21 ment of compliance with such requirements. 22 (C) An analysis of the extent to which fe- 23 males, racial and ethnic minorities, and adults 24 of all ages are adequately represented in Food 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 36 •S 2474 IS and Drug Administration-approved clinical 1 studies (at all phases) so that product safety 2 and effectiveness data can be evaluated by sex, 3 age, and racial and ethnic subgroup. 4 (D) An analysis of the extent to which a 5 summary of product safety and effectiveness 6 data disaggregated by sex, age, and racial and 7 ethnic subgroup is readily available to the pub- 8 lic in a timely manner by means of the product 9 label or the Food and Drug Administration’s 10 Web site. 11 (E) Recommendations for— 12 (i) modifications to the requirements 13 and guidance referred to in subsection (a); 14 or 15 (ii) oversight by the Food and Drug 16 Administration of such requirements. 17 (c) REPORT BY HHS.—Not later than 6 months 18 after the submission by the Comptroller General of the 19 report required under subsection (b), the Secretary of 20 Health and Human Services shall submit to the Com- 21 mittee on Energy and Commerce of the House of Rep- 22 resentatives and the Committee on Health, Education, 23 Labor, and Pensions of the Senate a response to that re- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 37 •S 2474 IS port, including a corrective action plan as needed to re- 1 spond to the recommendations in that report. 2 (d) DEFINITIONS.—In this section: 3 (1) The term ‘‘biologic’’ has the meaning given 4 to the term ‘‘biological product’’ in section 351(i) of 5 the Public Health Service Act (42 U.S.C. 262(i)). 6 (2) The term ‘‘device’’ has the meaning given to 7 such term in section 201(h) of the Federal Food, 8 Drug, and Cosmetic Act (21 U.S.C. 321(h)). 9 (3) The term ‘‘drug’’ has the meaning given to 10 such term in section 201(g) of the Federal Food, 11 Drug, and Cosmetic Act (21 U.S.C. 321(g)). 12 SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE 13 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 14 Part B of title III of the Public Health Service Act 15 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 16 tion 317U, as added, the following: 17 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 18 LANDER HEALTH DATA. 19 ‘‘(a) FINDINGS.—Congress makes the following find- 20 ings: 21 ‘‘(1) Native Hawaiians and Other Pacific Is- 22 landers (referred to in this subsection as ‘NHOPI’) 23 are identified as 1 of 6 specific racial or ethnic cat- 24 egories in the United States Census. The other cat- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 38 •S 2474 IS egories are African Americans, American Indians/ 1 Alaska Natives, Asians, Caucasians, and Latinos/ 2 Hispanics. 3 ‘‘(2) Native Hawaiians and the Pacific Jurisdic- 4 tions have a special legal relationship with the 5 United States, which requires careful consideration 6 of consultation rights and expectations that are 7 based upon formal United States policy, special trea- 8 ties with the United States, and international law. 9 ‘‘(3) The NHOPI population is unique in that 10 its peoples have homelands in the Pacific yet many 11 have moved to reside in the continental United 12 States and today are living in every state of the 13 United States. Yet, NHOPI are often ‘invisible’ in 14 current Federal data collection, analysis, and report- 15 ing, particularly those identifying health status. 16 ‘‘(b) DEFINITIONS.—In this section: 17 ‘‘(1) COMMUNITY GROUPS.—The term ‘commu- 18 nity groups’ means groups of people which are orga- 19 nized at the community level and are specific to 20 NHOPI populations such as church groups, social 21 service groups, and cultural groups. 22 ‘‘(2) DESIGNATED ORGANIZATIONS.—The term 23 ‘designated organizations’ means organizations 24 which are constituted to represent NHOPI popu- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 39 •S 2474 IS lations and which have statutory responsibilities or 1 community support for aspects of health and health 2 care. 3 ‘‘(3) GOVERNMENT REPRESENTATIVES.—The 4 term ‘government representatives’ mean government 5 representatives from Pacific Island Jurisdictions in- 6 cluding American Samoa, Commonwealth of the 7 Northern Mariana Islands, Federated States of Mi- 8 cronesia, Guam, Republic of Belau, and Republic of 9 the Marshall Islands. 10 ‘‘(4) NATIVE HAWAIIAN AND OTHER PACIFIC IS- 11 LANDER; NHOPI.—The terms ‘Native Hawaiian and 12 Other Pacific Islander’ and ‘NHOPI’ mean people 13 having origins in any of the original peoples of 14 American Samoa, Commonwealth of the Northern 15 Mariana Islands, Federated States of Micronesia, 16 Guam, Hawai‘i, Republic of the Marshall Islands, 17 Republic of Belau, or any other Pacific Islands. 18 ‘‘(c) REPORT.— 19 ‘‘(1) IN GENERAL.—The Secretary shall submit 20 to Congress a report that describes factors that af- 21 fect NHOPI health. Such report shall describe— 22 ‘‘(A) the health disparities that affect such 23 population; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 40 •S 2474 IS ‘‘(B) an assessment of the needs of such 1 population; and 2 ‘‘(C) an evaluation of the impact of such 3 disparities, and of efforts to address such dis- 4 parities, on the health of such population. 5 ‘‘(2) RESOURCES; PARTNERSHIP.—In compiling 6 the report under paragraph (1), the Secretary shall 7 use data available from the National Center for 8 Health Statistics. The report shall be complied in 9 partnership with the Native Hawaiian Epidemiology 10 Center. 11 ‘‘(d) NATIONAL STRATEGY.— 12 ‘‘(1) IN GENERAL.—Not later than 10 months 13 after the date of enactment of the Health Equity 14 and Accountability Act of 2012, the Secretary, in 15 consultation with representatives from community 16 groups, designated organizations, government rep- 17 resentatives of NHOPI populations, and other Fed- 18 eral department representatives as determined ap- 19 propriate by the Secretary, shall develop, implement, 20 and make public an ongoing and sustainable na- 21 tional strategy for identifying and evaluating the 22 health status and health care needs of NHOPI living 23 on the continental United States, in Hawai‘i, and in 24 the various Pacific Island Jurisdictions. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 41 •S 2474 IS ‘‘(2) CONTENT.—The national strategy devel- 1 oped under paragraph (1) shall— 2 ‘‘(A) address gaps in quality, efficiency, 3 comparative effectiveness information, and 4 health outcomes measures and data aggregation 5 techniques; and 6 ‘‘(B) enhance the use of health care data 7 to improve quality, efficiency, transparency, and 8 outcomes. 9 ‘‘(e) IMPLEMENTATION.—The Secretary shall ask the 10 National Center for Health Statistics, in partnership with 11 the Native Hawaiian Epidemiology Center, to develop and 12 implement the national strategy developed under sub- 13 section (d). The Secretary shall require other agencies 14 within the Department of Health and Human Services to 15 assist the National Center for Health Statistics in car- 16 rying out the preceding sentence. 17 ‘‘(f) REPORT.—Not later than 2 years after the date 18 of enactment of the Health Equity and Accountability Act 19 of 2012, the Secretary shall submit to Congress a progress 20 report on the activities conducted under this section, in- 21 cluding the national strategy for identifying and evalu- 22 ating the health status and health care needs of NHOPI 23 populations.’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 42 •S 2474 IS SEC. 114. SIMPLIFIED ADMINISTRATIVE REPORTING RE- 1 QUIREMENT FOR NUTRITION ASSISTANCE. 2 Section 11(a) of the Food and Nutrition Act of 2008 3 (7 U.S.C. 2020(a)) is amended by adding at the end the 4 following: 5 ‘‘(5) ADMINISTRATIVE REPORTING REQUIRE- 6 MENT RELATING TO THE INDIGENCE EXCEPTION 7 FOR ALIENS.—In satisfaction of the administrative 8 reporting requirement under section 421(e)(2) of the 9 Personal Responsibility and Work Opportunity Rec- 10 onciliation Act of 1996 (8 U.S.C. 1631(e)(2)), the 11 Secretary shall accept from the Attorney General for 12 each fiscal year an aggregate report that describes 13 the quantity of exceptions granted in that fiscal year 14 under that section.’’. 15 TITLE II—CULTURALLY AND LIN- 16 GUISTICALLY APPROPRIATE 17 HEALTH CARE 18 SEC. 201. DEFINITIONS. 19 In this title, the definitions contained in section 3400 20 of the Public Health Service Act, as added by section 202, 21 shall apply. 22 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 23 ACT. 24 (a) FINDINGS.—Congress finds the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 43 •S 2474 IS (1) Effective communication is essential to 1 meaningful access to quality physical and mental 2 health care. 3 (2) Research indicates that the lack of appro- 4 priate language services creates languages barriers 5 that result in increased risk of misdiagnosis, ineffec- 6 tive treatment plans and poor health outcomes for 7 limited-English-proficient individuals and individuals 8 with communication disabilities such as hearing, vi- 9 sion or print impairments. 10 (3) The number of limited-English-speaking 11 residents in the United States who speak English 12 less than very well and, therefore, cannot effectively 13 communicate with health and social service providers 14 continues to increase significantly. 15 (4) The responsibility to fund language services 16 in the provision of health care and health care-re- 17 lated services to limited-English-proficient individ- 18 uals and individuals with communication disabilities 19 such as hearing, vision, or print impairments is a so- 20 cietal one that cannot fairly be visited solely upon 21 the health care, public health or social services com- 22 munity. 23 (5) Title VI of the Civil Rights Act of 1964 24 prohibits discrimination based on the grounds of 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 44 •S 2474 IS race, color or national origin by any entity receiving 1 Federal financial assistance. In order to avoid dis- 2 crimination on the grounds of national origin, all 3 programs or activities administered by the Depart- 4 ment must take adequate steps to ensure that their 5 policies and procedures do not deny or have the ef- 6 fect of denying limited-English-proficient individuals 7 with equal access to benefits and services for which 8 such persons qualify. 9 (6) Linguistic diversity in the healthcare and 10 health-care-related-services workforce is important 11 for providing all patients the environment most con- 12 ducive to positive health outcomes. 13 (7) All members of the health care and health- 14 care-related-services community should continue to 15 educate their staff and constituents about limited- 16 English proficient and disability communication 17 issues and help them identify resources to improve 18 access to quality care for limited-English-proficient 19 individuals and individuals with communication dis- 20 abilities such as hearing, vision, or print impair- 21 ments. 22 (8) Access to English as a second language and 23 sign language instructions is an important mecha- 24 nism for ensuring effective communication and elimi- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 45 •S 2474 IS nating the language barriers that impede access to 1 health care. 2 (9) Competent languages services in health care 3 settings should be available as a matter of course. 4 (b) AMENDMENT.—The Public Health Service Act 5 (42 U.S.C. 201 et seq.) is amended by adding at the end 6 the following: 7 ‘‘TITLE XXXIV—CULTURALLY 8 AND LINGUISTICALLY APPRO- 9 PRIATE HEALTH CARE 10 ‘‘SEC. 3400. DEFINITIONS. 11 ‘‘In this title: 12 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re- 13 spect to an individual means a person who has suffi- 14 cient degree of proficiency in two languages. 15 ‘‘(2) COMMUNITY HEALTH WORKER.—The term 16 ‘community health worker’ means an individual who 17 promotes health or nutrition within the community 18 in which the individual resides. 19 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 20 The term ‘competent interpreter services’ means a 21 translanguage rendition of a spoken or signed mes- 22 sage in which the interpreter comprehends the 23 source language and can communicate comprehen- 24 sively in the target language to convey the meaning 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 46 •S 2474 IS intended in the source language. The interpreter 1 knows health and health-related terminology and 2 provides accurate interpretations by choosing equiva- 3 lent expressions that convey the best matching and 4 meaning to the source language and captures, to the 5 greatest possible extent, all nuances intended in the 6 source message. 7 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 8 The term ‘competent translation services’ means a 9 translanguage rendition of a written document in 10 which the translator comprehends the source lan- 11 guage and can write or sign comprehensively in the 12 target language to convey the meaning intended in 13 the source language. The translator knows health 14 and health-related terminology and provides accurate 15 translations by choosing equivalent expressions that 16 convey the best matching and meaning to the source 17 language and captures, to the greatest possible ex- 18 tent, all nuances intended in the source document. 19 ‘‘(5) CULTURAL COMPETENCE.—The term ‘cul- 20 tural competence’ means a set of congruent behav- 21 iors, attitudes, and policies that come together in a 22 system, agency, or among professionals that enables 23 effective work in cross-cultural situations. In the 24 preceding sentence— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 47 •S 2474 IS ‘‘(A) the term ‘cultural’ refers to inte- 1 grated patterns of human behavior that include 2 the language, thoughts, communications, ac- 3 tions, customs, beliefs, values, and institutions 4 of racial, ethnic, religious, or social groups, in- 5 cluding lesbian, gay, bisexual, transgender and 6 intersex individuals, and individuals with phys- 7 ical and mental disabilities; and 8 ‘‘(B) the term ‘competence’ implies having 9 the capacity to function effectively as an indi- 10 vidual and an organization within the context of 11 the cultural beliefs, behaviors, and needs pre- 12 sented by consumers and their communities. 13 ‘‘(6) EFFECTIVE COMMUNICATION.—The term 14 ‘effective communication’ means an exchange of in- 15 formation between the provider of health care or 16 health-care-related services and the recipient of such 17 services who is limited in English proficiency, or has 18 a communication impairment such as a hearing, vi- 19 sion, or learning impairment, that enables access, 20 understanding, and benefit from health care or 21 health-care-related services, and full participation in 22 the development of their treatment plan. 23 ‘‘(7) GRIEVANCE RESOLUTION PROCESS.—The 24 term ‘grievance resolution process’ means all aspects 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 48 •S 2474 IS of dispute resolution including filing complaints, 1 grievance and appeal procedures, and court action. 2 ‘‘(8) HEALTH CARE GROUP.—The term ‘health 3 care group’ means a group of physicians organized, 4 at least in part, for the purposes of providing physi- 5 cians’ services under the Medicaid, SCHIP, or Medi- 6 care programs and may include a hospital and any 7 other individual or entity furnishing services covered 8 under the Medicaid, SCHIP, or Medicare programs 9 that is affiliated with the health care group. 10 ‘‘(9) HEALTH-CARE SERVICES.—The term 11 ‘health care services’ means services that address 12 physical as well as mental health conditions in all 13 care settings. 14 ‘‘(10) HEALTH CARE-RELATED SERVICES.—The 15 term ‘health-care-related services’ means human or 16 social services programs or activities that provide ac- 17 cess, referrals or links to health care. 18 ‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 19 means any Indian tribe, band, nation, or other orga- 20 nized group or community, including any Alaska Na- 21 tive village or group or regional or village corpora- 22 tion as defined in or established pursuant to the 23 Alaska Native Claims Settlement Act (85 Stat. 688) 24 (43 U.S.C. 1601 et seq.), which is recognized as eli- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 49 •S 2474 IS gible for the special programs and services provided 1 by the United States to Indians because of their sta- 2 tus as Indians. 3 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY 4 SYSTEM.—The term ‘integrated health care delivery 5 system’ means an interdisciplinary system that 6 brings together providers from the primary health, 7 mental health, substance use and related disciplines 8 to improve the health outcomes of an individual. 9 Providers may include but are not limited to hos- 10 pitals, health, mental health or substance use clinics 11 and providers, home health agencies, ambulatory 12 surgery centers, skilled nursing facilities, rehabilita- 13 tion centers, and employed, independent or con- 14 tracted physicians. 15 ‘‘(13) INTERPRETING/INTERPRETATION.—The 16 terms ‘interpreting’ and ‘interpretation’ mean the 17 transmission of a spoken, written, or signed message 18 from one language or format into another, faithfully, 19 accurately, and objectively. 20 ‘‘(14) LANGUAGE ACCESS.—The term ‘language 21 access’ means the provision of language services to 22 an LEP individual or individual with communication 23 disabilities designed to enhance that individual’s ac- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 50 •S 2474 IS cess to, understanding of or benefit from health care 1 or health-care-related services. 2 ‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV- 3 ICES.—The term ‘language or language access serv- 4 ices’ means provision of health care services directly 5 in a non-English language, interpretation, trans- 6 lation, signage, video recording, and English or non- 7 English alternative formats. 8 ‘‘(16) LEP.—The term ‘LEP’ means limited- 9 English proficient. 10 ‘‘(17) LEP RELATED DATA COLLECTION AC- 11 TIVITIES.—The term ‘LEP related data collection 12 activities’ includes identifying, collecting, storing, 13 tracking, and analyzing primary language data, and 14 information on the methods used to meet the lan- 15 guage access needs of limited-English-proficient indi- 16 viduals. 17 ‘‘(18) MEDICARE, MEDICAID, AND SCHIP.—The 18 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ means 19 the respective programs under titles XVIII, XIX, 20 and XXI of the Social Security Act. 21 ‘‘(19) MINORITY.— 22 ‘‘(A) IN GENERAL.—The terms ‘minority’ 23 and ‘minorities’ refer to individuals from a mi- 24 nority group. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 51 •S 2474 IS ‘‘(B) POPULATIONS.—The term ‘minority’, 1 with respect to populations, refers to racial and 2 ethnic minority groups. 3 ‘‘(20) MINORITY GROUP.—The term ‘minority 4 group’ has the meaning given the term ‘racial and 5 ethnic minority group’. 6 ‘‘(21) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘racial and ethnic minority group’ means 8 American Indians and Alaska Natives, African- 9 Americans (including Caribbean Blacks, Africans 10 and other Blacks), Asian-Americans, Hispanics (in- 11 cluding Latinos), and Native Hawaiians and other 12 Pacific Islanders. 13 ‘‘(22) ON-SITE INTERPRETING/INTERPRETA- 14 TION.—The term ‘on-site interpreting/interpretation’ 15 means a method of interpreting or interpretation for 16 which the interpreter is in the physical presence of 17 the provider of health care or health-care-related 18 services and the recipient of such services who is 19 limited in English proficiency or has a communica- 20 tion impairment such as hearing, vision, or learning. 21 ‘‘(23) SECRETARY.—The term ‘Secretary’ 22 means the Secretary of Health and Human Services. 23 ‘‘(24) SIGHT TRANSLATION.—The term ‘sight 24 translation’ means the transmission of a written 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 52 •S 2474 IS message in one language into a spoken or signed 1 message in another language, or an alternative for- 2 mat in English or another language. 3 ‘‘(25) STATE.—The term ‘State’ means each of 4 the several States, the District of Columbia, the 5 Commonwealth of Puerto Rico, the Indian tribes, 6 the United States Virgin Islands, Guam, American 7 Samoa, and the Commonwealth of the Northern 8 Mariana Islands. 9 ‘‘(26) TELEPHONIC INTERPRETATION.—The 10 term ‘telephonic interpretation’ (also known as over 11 the phone interpretation or OPI) means a method of 12 interpreting/interpretation for which the interpreter 13 is not in the physical presence of the provider of 14 health care or related services and the limited- 15 English-proficient recipient of such services but is 16 connected via telephone. 17 ‘‘(27) TRANSLATION.—The term ‘translation’ 18 means the transmission of a written message in one 19 language into a written or signed message in an- 20 other language, and includes translation into an- 21 other language or alternative format, such as large 22 print font, Braille, audio recording, or CD. 23 ‘‘(28) VIDEO INTERPRETATION.—The term 24 ‘video interpretation’ means a method of inter- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 53 •S 2474 IS preting/interpretation for which the interpreter is 1 not in the physical presence of the provider of health 2 care or related services and the limited-English-pro- 3 ficient recipient of such services but is connected via 4 a video hook-up that includes both audio and video 5 transmission. 6 ‘‘(29) VITAL DOCUMENT.—The term ‘vital doc- 7 ument’ includes but is not limited to applications for 8 government programs that provide health care serv- 9 ices, medical or financial consent forms, financial as- 10 sistance documents, letters containing important in- 11 formation regarding patient instructions (such as 12 prescriptions, referrals to other providers, and dis- 13 charge plans) and participation in a program (such 14 as a Medicaid managed care program), notices per- 15 taining to the reduction, denial, or termination of 16 services or benefits, notices of the right to appeal 17 such actions, and notices advising limited-English- 18 proficient individuals and individuals with commu- 19 nication disabilities of the availability of free lan- 20 guage services, alternative formats, and other out- 21 reach materials. 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 54 •S 2474 IS ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID- 1 UALS WITH LIMITED ENGLISH PROFICIENCY. 2 ‘‘(a) PURPOSE.—As provided in Executive Order 3 13166, it is the purpose of this section— 4 ‘‘(1) to improve Federal agency performance re- 5 garding access to federally conducted and federally 6 assisted programs and activities for individuals who 7 are limited in their English proficiency; 8 ‘‘(2) to require each Federal agency to examine 9 the services it provides and develop and implement 10 a system by which limited-English-proficient individ- 11 uals can obtain cultural competence and meaningful 12 access to those services consistent with, and without 13 substantially burdening, the fundamental mission of 14 the agency; 15 ‘‘(3) to require each Federal agency to ensure 16 that recipients of Federal financial assistance pro- 17 vide cultural competence and meaningful access to 18 their limited-English-proficient applicants and bene- 19 ficiaries; 20 ‘‘(4) to ensure that recipients of Federal finan- 21 cial assistance take reasonable steps, consistent with 22 the guidelines set forth in the Limited English Pro- 23 ficient Guidance of the Department of Justice (as 24 issued on June 12, 2002), to ensure cultural com- 25 petence and meaningful access to their programs 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 55 •S 2474 IS and activities by limited-English-proficient individ- 1 uals; and 2 ‘‘(5) to ensure compliance with title VI of the 3 Civil Rights Act of 1964 and that health care pro- 4 viders and organizations do not discriminate in the 5 provision of services. 6 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC- 7 TIVITIES.— 8 ‘‘(1) IN GENERAL.—Not later than 120 days 9 after the date of enactment of this title, each Fed- 10 eral agency that carries out health-care-related ac- 11 tivities shall prepare a plan to improve access cul- 12 tural competence to the federally conducted, health- 13 are-related programs and activities of the agency by 14 limited-English-proficient individuals. Each Federal 15 agency must ensure that such plan is fully imple- 16 mented not later than one year after the date of en- 17 actment of this Act. 18 ‘‘(2) PLAN REQUIREMENT.—Each plan under 19 paragraph (1) shall include— 20 ‘‘(A) the steps the agency will take to en- 21 sure that limited-English-proficient individuals 22 have access to the agency’s federally conducted 23 health care and health-care-related programs 24 and activities; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 56 •S 2474 IS ‘‘(B) the policies and procedures for identi- 1 fying, assessing, and meeting the language 2 needs and cultural competence needs of its lim- 3 ited-English-proficient beneficiaries served by 4 federally conducted programs and activities; 5 ‘‘(C) the steps the agency will take for its 6 federally conducted programs and activities to 7 improve cultural competence to provide a range 8 of language assistance options, notice to lim- 9 ited-English-proficient individuals of the right 10 to competent language services, periodic train- 11 ing of staff, monitoring and quality assessment 12 of the language services and, in appropriate cir- 13 cumstances, the translation of written mate- 14 rials; 15 ‘‘(D) the steps the agency will take to en- 16 sure that applications, forms, and other rel- 17 evant documents for its federally conducted pro- 18 grams and activities are competently translated 19 into the primary language of a limited-English- 20 proficient client where such materials are need- 21 ed to improve access to federally conducted and 22 federally assisted programs and activities for 23 such a limited-English-proficient individual; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 57 •S 2474 IS ‘‘(E) the resources the agency will provide 1 to improve cultural competence to assist recipi- 2 ents of Federal funds to improve access to 3 health care or health-care-related programs and 4 activities for limited-English-proficient individ- 5 uals. 6 Each agency shall send a copy of such plan to the 7 Department of Justice, which shall serve as the cen- 8 tral repository of the Agency’s plans. 9 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI- 10 TIES.— 11 ‘‘(1) IN GENERAL.—Not later than 120 days 12 after the date of enactment of this title, each Fed- 13 eral agency providing health-care-related Federal fi- 14 nancial assistance shall ensure that the guidance for 15 recipients of Federal financial assistance developed 16 by the agency to ensure compliance with title VI of 17 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 18 seq.) is specifically tailored to the recipients of such 19 assistance. Each agency shall send a copy of such 20 guidance to the Department of Justice which shall 21 serve as the central repository of the Agency’s plans. 22 After approval by the Department of Justice, each 23 agency shall publish its guidance document in the 24 Federal Register for public comment. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 58 •S 2474 IS ‘‘(2) REQUIREMENTS.—The agency-specific 1 guidance developed under paragraph (1) shall take 2 into account the types of health care services pro- 3 vided by the recipients, the individuals served by the 4 recipients, and other factors set out in such stand- 5 ards. 6 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 7 that has developed a guidance for purposes of title 8 VI of the Civil Rights Act of 1964 shall examine 9 such existing guidance, as well as the programs and 10 activities to which such guidance applies, to deter- 11 mine if modification of such guidance is necessary to 12 comply with this subsection. 13 ‘‘(4) CONSULTATION.—Each Federal agency 14 shall consult with the Department of Justice in es- 15 tablishing the guidances under this subsection. 16 ‘‘(d) CONSULTATIONS.— 17 ‘‘(1) IN GENERAL.—In carrying out this sec- 18 tion, each Federal agency that carriers out health 19 care and health-care-related activities shall ensure 20 that stakeholders, such as limited-English-proficient 21 individuals and their representative organizations, 22 recipients of Federal assistance, and other appro- 23 priate individuals or entities, have an adequate op- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 59 •S 2474 IS portunity to provide input with respect to the actions 1 of the agency. 2 ‘‘(2) EVALUATION.—Each Federal agency de- 3 scribed in paragraph (1) shall evaluate the— 4 ‘‘(A) particular needs of the limited- 5 English-proficient individuals served by the 6 agency; 7 ‘‘(B) particular needs of the limited- 8 English-proficient individuals served by the 9 agency’s recipients of Federal financial assist- 10 ance; and 11 ‘‘(C) burdens of compliance with the agen- 12 cy guidance and this section for the agency and 13 its recipients. 14 ‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 15 LINGUISTICALLY APPROPRIATE SERVICES IN 16 HEALTH CARE. 17 ‘‘Recipients of Federal financial assistance from the 18 Secretary shall, to the extent reasonable and practicable 19 after applying the 4-factor analysis described in title V 20 of the Guidance to Federal Financial Assistance Recipi- 21 ents Regarding Title VI Prohibition Against National Ori- 22 gin Discrimination Affecting Limited-English Proficient 23 Persons (June 12, 2002)— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 60 •S 2474 IS ‘‘(1) implement strategies to recruit, retain, and 1 promote individuals at all levels of the organization 2 to maintain a diverse staff and leadership that can 3 provide culturally and linguistically appropriate 4 health care to patient populations of the service area 5 of the organization; 6 ‘‘(2) ensure that staff at all levels and across all 7 disciplines of the organization receive ongoing edu- 8 cation and training in culturally and linguistically 9 appropriate service delivery; 10 ‘‘(3) offer and provide language assistance serv- 11 ices, including trained bilingual staff and interpreter 12 services, at no cost to each patient with limited- 13 English proficiency at all points of contact, in a 14 timely manner during all hours of operation; 15 ‘‘(4) notify patients, in a culturally appropriate 16 manner, of their right to receive language assistance 17 services in their primary language; 18 ‘‘(5) ensure the competence of language assist- 19 ance provided to limited-English-proficient patients 20 by interpreters and bilingual staff, and ensure that 21 family, particularly minor children, and friends are 22 not used to provide interpretation services— 23 ‘‘(A) except in case of emergency; or 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 61 •S 2474 IS ‘‘(B) except on request of the patient, who 1 has been informed in his or her preferred lan- 2 guage of the availability of free interpretation 3 services; 4 ‘‘(6) make available easily understood patient- 5 related materials, if such materials exist for non-lim- 6 ited-English-proficient patients, including informa- 7 tion or notices about termination of benefits and 8 post signage in the languages of the commonly en- 9 countered groups or groups represented in the serv- 10 ice area of the organization; 11 ‘‘(7) develop and implement clear goals, poli- 12 cies, operational plans, and management account- 13 ability and oversight mechanisms to provide cul- 14 turally and linguistically appropriate services; 15 ‘‘(8) conduct initial and ongoing organizational 16 assessments of culturally and linguistically appro- 17 priate services-related activities and integrate valid 18 linguistic, competence-related measures into the in- 19 ternal audits, performance improvement programs, 20 patient satisfaction assessments, and outcomes-based 21 evaluations of the organization; 22 ‘‘(9) ensure that, consistent with the privacy 23 protections provided for under the regulations pro- 24 mulgated under section 264(c) of the Health Insur- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 62 •S 2474 IS ance Portability and Accountability Act of 1996 (42 1 U.S.C. 1320d–2 note)— 2 ‘‘(A) data on the individual patient’s race, 3 ethnicity, primary language, alternative format 4 preferences, and policy modification needs are 5 collected in health records, integrated into the 6 organization’s management information sys- 7 tems, and periodically updated; and 8 ‘‘(B) if the patient is a minor or is inca- 9 pacitated, the primary language of the parent 10 or legal guardian is collected; 11 ‘‘(10) maintain a current demographic, cultural, 12 and epidemiological profile of the community as well 13 as a needs assessment to accurately plan for and im- 14 plement services that respond to the cultural and 15 linguistic characteristics of the service area of the 16 organization; 17 ‘‘(11) develop participatory, collaborative part- 18 nerships with communities and utilize a variety of 19 formal and informal mechanisms to facilitate com- 20 munity and patient involvement in designing and im- 21 plementing culturally and linguistically appropriate 22 services-related activities; 23 ‘‘(12) ensure that conflict and grievance resolu- 24 tion processes are culturally and linguistically sen- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 63 •S 2474 IS sitive and capable of identifying, preventing, and re- 1 solving cross-cultural conflicts or complaints by pa- 2 tients; 3 ‘‘(13) regularly make available to the public in- 4 formation about their progress and successful inno- 5 vations in implementing the standards under this 6 section and provide public notice in their commu- 7 nities about the availability of this information; and 8 ‘‘(14) if requested, regularly make available to 9 the head of each Federal entity from which Federal 10 funds are received, information about their progress 11 and successful innovations in implementing the 12 standards under this section as required by the head 13 of such entity. 14 ‘‘SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL 15 AND LINGUISTIC COMPETENCE IN HEALTH 16 CARE. 17 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 18 through the Director of the Agency for Healthcare Re- 19 search and Quality, shall establish and support a center 20 to be known as the ‘Robert T. Matsui Center for Cultural 21 and Linguistic Competence in Health Care’ (referred to 22 in this section as the ‘Center’) to carry out the following 23 activities: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 64 •S 2474 IS ‘‘(1) INTERPRETATION SERVICES.—The Center 1 shall provide resources via the Internet to identify 2 and link health care providers to competent inter- 3 preter and translation services. 4 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 5 ‘‘(A) The Center shall provide, directly or 6 through contract, vital documents from com- 7 petent translation services for providers of 8 health care and health-care-related services at 9 no cost to such providers. Materials may be 10 submitted for translation into non-English lan- 11 guages. Translation services shall be provided 12 in a timely and reasonable manner and in ac- 13 cordance with the guidelines and standards set 14 forth in subsection (c) when such standards be- 15 come available. The quality of such translation 16 services shall be monitored and reported pub- 17 licly. 18 ‘‘(B) For each form developed or revised 19 by the Secretary that will be used by LEP indi- 20 viduals in health care or health-care-related set- 21 tings, the Center shall translate the form, at a 22 minimum, into the top 15 non-English lan- 23 guages in the United States according to the 24 most recent data from the American Commu- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 65 •S 2474 IS nity Survey or its replacement. The translation 1 must be completed within 45 days of the Sec- 2 retary receiving final approval of the form from 3 the Office of Management and Budget. 4 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 5 PHONE NUMBER.—The Center shall provide, 6 through a toll-free number, a customer service line 7 for LEP individuals— 8 ‘‘(A) to obtain information about federally 9 conducted or funded health programs, including 10 Medicare, Medicaid, and SCHIP; 11 ‘‘(B) to obtain assistance with applying for 12 or accessing these programs and understanding 13 Federal notices written in English; and 14 ‘‘(C) to learn how to access language serv- 15 ices. 16 ‘‘(4) HEALTH INFORMATION CLEARING- 17 HOUSE.— 18 ‘‘(A) IN GENERAL.—The Center shall de- 19 velop and maintain an information clearing- 20 house to facilitate the provision of language 21 services by providers of health care and health- 22 care-related services to reduce medical errors, 23 improve medical outcomes, to improve cultural 24 competence, reduce health care costs caused by 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 66 •S 2474 IS miscommunication with individuals with lim- 1 ited-English proficiency, and reduce or elimi- 2 nate the duplication of effort to translate mate- 3 rials. The clearinghouse shall make such infor- 4 mation available on the Internet and in print. 5 Such information shall include the information 6 described in the succeeding provisions of this 7 paragraph. 8 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 9 ter shall collect and evaluate for accuracy, de- 10 velop, and make available templates for stand- 11 ard documents that are necessary for patients 12 and consumers to access and make educated de- 13 cisions about their health care, including the 14 following: 15 ‘‘(i) Administrative and legal docu- 16 ments, including— 17 ‘‘(I) intake forms; 18 ‘‘(II) Medicare, Medicaid, and 19 SCHIP forms, including eligibility in- 20 formation; 21 ‘‘(III) forms informing patient of 22 HIPAA compliance and consent; and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 67 •S 2474 IS ‘‘(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.—The oper- 15 ating the clearinghouse, the Center shall— 16 ‘‘(i) ensure that the documents posted 17 in English and non-English languages are 18 culturally appropriate; 19 ‘‘(ii) allow public review of the docu- 20 ments before dissemination in order to en- 21 sure that the documents are understand- 22 able and culturally appropriate for the tar- 23 get populations; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 68 •S 2474 IS ‘‘(iii) allow health care providers to 1 customize the documents for their use; 2 ‘‘(iv) facilitate access to these docu- 3 ments; 4 ‘‘(v) provide technical assistance with 5 respect to the access and use of such infor- 6 mation; and 7 ‘‘(vi) carry out any other activities the 8 Secretary determines to be useful to fulfill 9 the purposes of the clearinghouse. 10 ‘‘(D) LANGUAGE ASSISTANCE PRO- 11 GRAMS.—The Center shall provide for the col- 12 lection and dissemination of information on cur- 13 rent examples of language assistance programs 14 and strategies to improve language services for 15 LEP individuals, including case studies using 16 de-identified patient information, program sum- 17 maries, and program evaluations. 18 ‘‘(E) CULTURAL AND LINGUISTIC COM- 19 PETENCE MATERIALS.—The Center shall pro- 20 vide information relating to culturally and lin- 21 guistically competent health care for minority 22 populations residing in the United States to all 23 health care providers and health-care-related 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 69 •S 2474 IS services at no cost. Such information shall in- 1 clude— 2 ‘‘(i) tenets of culturally and linguis- 3 tically competent care; 4 ‘‘(ii) cultural and linguistic com- 5 petence self-assessment tools; 6 ‘‘(iii) cultural and linguistic com- 7 petence training tools; 8 ‘‘(iv) strategic plans to increase cul- 9 tural and linguistic competence in different 10 types of providers of health care and 11 health-care-related services, including re- 12 gional collaborations among health care or- 13 ganizations; and 14 ‘‘(v) cultural and linguistic com- 15 petence information for educators, practi- 16 tioners, and researchers. 17 ‘‘(F) INFORMATION ABOUT PROGRESS.— 18 The Center shall regularly collect and make 19 publicly available information about the 20 progress of entities receiving grants under sec- 21 tion 3404 regarding successful innovations in 22 implementing the obligations under this sub- 23 section and provide public notice in the entities’ 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 70 •S 2474 IS communities about the availability of this infor- 1 mation; 2 ‘‘(b) DIRECTOR.—The Center shall be headed by a 3 Director who shall be appointed by, and who shall report 4 to, the Director of the Agency for Healthcare Research 5 and Quality. 6 ‘‘(c) INTERPRETATION AND TRANSLATION GUIDE- 7 LINES AND STANDARDS.—The Center shall convene a 8 working group to develop and adopt interpretation and 9 translation quality guidelines and standards for use by the 10 Center. The guidelines and standards must be sufficient 11 to ensure that LEP individuals have the equal opportunity 12 to benefit from health care services to the same extent 13 as non-LEP individuals. The guidelines and standards 14 shall address the training, assessment, and certification of 15 individuals to provide competent interpreter and trans- 16 lator services to work in health care and health-care-re- 17 lated settings and of bilingual staff who provide services 18 directly in non-English languages. The working group may 19 develop different guidelines and standards for bilingual 20 staff, interpreters, and translators. 21 ‘‘(d) MEMBERSHIP.— 22 ‘‘(1) QUALIFICATIONS.—The Working Group 23 shall consist of 14 members as follows: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 71 •S 2474 IS ‘‘(A) Four members from organizations 1 that advocate on behalf of LEP individuals. 2 ‘‘(B) One member who represents a profes- 3 sional interpreter association (that is not the 4 National Council on Interpreting in Health 5 Care) or translator association. 6 ‘‘(C) One member from a nonprofit com- 7 munity-based organization that provides lan- 8 guage services. 9 ‘‘(D) Three members recommended by the 10 National Council on Interpreting in Health 11 Care, including one who individual who is a 12 professional interpreter. 13 ‘‘(E) Four members who are health care or 14 mental health providers or represent health care 15 provider associations, including one individual 16 who represents a health care practice of fewer 17 than 5 clinicians. 18 ‘‘(F) One member who works in or has ex- 19 tensive knowledge of issues related to health 20 care risk management. 21 ‘‘(2) GEOGRAPHIC REPRESENTATION.—The 22 membership of the Working Group shall reflect a 23 broad geographic representation including both 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 72 •S 2474 IS urban and rural representatives, including represent- 1 atives of the United States territories. 2 ‘‘(3) PROHIBITED APPOINTMENTS.—Members 3 of the Working Group shall not include Members of 4 Congress or other elected Federal, State, or local 5 government officials. 6 ‘‘(4) VACANCIES.—Any vacancies in the Work- 7 ing Group shall not affect the power and duties of 8 the Working Group but shall be filled in the same 9 manner as the original appointment. 10 ‘‘(5) SUBCOMMITTEES.—The Working Group 11 may establish subcommittees if doing so increases 12 the efficiency of the Working Group in completing 13 its tasks, including subcommittees to develop dif- 14 ferent guidelines and standards for interpreters, 15 translators, and bilingual staff. 16 ‘‘(6) ADVISORY PANEL TO THE WORKING 17 GROUP.—The Working Group shall consult with the 18 Advisory Panel in the development of the guidelines 19 and standards. The Advisory Panel shall include— 20 ‘‘(A) representatives from the American 21 Translators Association, Association of Lan- 22 guage Companies, the National Center for 23 State Courts, and States which have developed 24 interpreter standards such as California, Mas- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 73 •S 2474 IS sachusetts, and Oregon who have experience in 1 the development or implementation of their or- 2 ganizations’ interpreter and translator certifi- 3 cation programs; 4 ‘‘(B) Federal agencies including the Office 5 for Civil Rights, the Office of Minority Health, 6 the Centers for Medicare & Medicaid Services, 7 and the National Institute on Minority Health 8 and Health Disparities; and 9 ‘‘(C) other individuals or entities deter- 10 mined appropriate by the Secretary who have 11 specific expertise that will be useful to the 12 Working Group. 13 ‘‘(7) PUBLICATION.— 14 ‘‘(A) DRAFT STANDARDS.—Not later than 15 18 months after the date of enactment of this 16 title, the Working Group shall— 17 ‘‘(i) prepare and make available to the 18 public through the Internet, the Federal 19 Register, and other appropriate public 20 channels, a proposed set of interpretation 21 and translation guidelines and standards 22 for training, assessment, and certification; 23 and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 74 •S 2474 IS ‘‘(ii) accept public comment on such 1 guidelines and standards for a period of 2 not less than 90 days. 3 ‘‘(B) FINAL STANDARDS.—Not later than 4 120 days after the expiration of the public com- 5 ment period described in subparagraph (A), the 6 Director of the Agency for Healthcare Research 7 and Quality shall publish, after consultation 8 with and the approval of the Working Group, 9 final guidelines and standards in the Federal 10 Register and on the Internet. 11 ‘‘(C) TESTING DEVELOPMENT.—Not later 12 than 120 days after the publication of the final 13 recommendations described in subparagraph 14 (B), the Director of the Agency for Healthcare 15 Research and Quality shall, if deemed necessary 16 by the Working Group, enter into a contract 17 with an entity experienced in the development 18 of designing certification tests in language re- 19 lated fields to develop such tests as may be nec- 20 essary to implement the guidelines and stand- 21 ards. 22 ‘‘(D) PILOT PROJECT.— 23 ‘‘(i) Not later than 120 days after 24 completion of the test development de- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 75 •S 2474 IS scribed in subparagraph (C) or after publi- 1 cation of the final guidelines and stand- 2 ards, whichever is later, the Secretary shall 3 design, fund, and implement a pilot project 4 in up to 50 geographically and demo- 5 graphically diverse sites, two of which must 6 be in the United States territories, to test 7 and evaluate implementation of the rec- 8 ommendations. 9 ‘‘(ii) The Secretary shall consult with 10 the Working Group and the Advisory 11 Panel in development of the pilot project 12 and report progress to the Working Group 13 on an ongoing basis. 14 ‘‘(iii) The pilot project shall include 15 interpreters and translators working with 16 various provider types, including small 17 group practices, hospitals, mental health 18 and substance use clinics, and community 19 health clinics, and shall include broad geo- 20 graphic representation including both 21 urban and rural representatives. 22 ‘‘(iv) The pilot project shall operate 23 for not less than 2 nor more than 4 years, 24 as determined by the Secretary. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 76 •S 2474 IS ‘‘(v) If the Working Group determines 1 that any revisions to guidelines and stand- 2 ards are necessary as a result of the pilot 3 project, it shall revise such guidelines and 4 standards and the Director of the Agency 5 for Healthcare Research and Quality shall 6 publish the revisions in the Federal Reg- 7 ister for notice and comment. Not later 8 than 120 days after the expiration of the 9 public comment period on such revisions, 10 the Director of the Agency for Healthcare 11 Research and Quality shall publish, after 12 consultation with and the approval of the 13 Working Group, final revisions to the 14 guidelines and standards in the Federal 15 Register and on the Internet. 16 ‘‘(8) ADMINISTRATION.— 17 ‘‘(A) CHAIRPERSON.—Not later than 15 18 days after the date on which all members of the 19 Working Group have been appointed under sub- 20 section (d), the Working Group shall designate 21 its chairperson. 22 ‘‘(B) COMPENSATION.—While serving on 23 the business of the Working Group (including 24 travel time), a member of the Working Group 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 77 •S 2474 IS or the Advisory Panel shall be entitled to com- 1 pensation at the per diem equivalent of the rate 2 provided for level IV of the Executive Schedule 3 under section 5315 of title 5, United States 4 Code, and while so serving away from home and 5 the member’s regular place of business, a mem- 6 ber may be allowed travel expenses, as author- 7 ized by the chairperson of the Working Group. 8 For purposes of pay and employment benefits, 9 rights, and privileges, all personnel of the 10 Working Group shall be treated as if they were 11 employees of the House of Representatives. 12 ‘‘(C) INFORMATION FROM FEDERAL AGEN- 13 CIES.—The Working Group may secure directly 14 from any Federal department or agency such 15 information as the Working Group considers 16 necessary to carry out this section. Upon re- 17 quest of the Working Group, the head of such 18 department or agency shall furnish such infor- 19 mation. Any information that contains individ- 20 ually identifiable information received by the 21 Working Group shall not be disseminated or 22 disclosed outside of the Working Group and 23 shall not be used except by the Working Group. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 78 •S 2474 IS ‘‘(D) DETAIL.—Not more than 10 Federal 1 Government employees employed by the Depart- 2 ment of Health and Human Services may be 3 detailed to staff the Working Group under this 4 section without further reimbursement. Any de- 5 tail of an employee shall be without interruption 6 or loss of civil service status or privilege. 7 ‘‘(E) TEMPORARY AND INTERMITTENT 8 SERVICES.—The Working Group may procure 9 temporary and intermittent services under sec- 10 tion 3109(b) of title 5, United States Code, at 11 rates for individuals which do not exceed the 12 daily equivalent of the annual rate of basic pay 13 prescribed for level V of the Executive Schedule 14 under section 5316 of such title. 15 ‘‘(9) DEEMED STATUS.— 16 ‘‘(A) CERTIFICATION BY PRIVATE ORGANI- 17 ZATION.—If a private accreditation organization 18 establishes training, assessment, or certification 19 standards for interpreters or translators in 20 health care which the Secretary determines are 21 at least equivalent to the training, assessment, 22 or certification standards promulgated by the 23 Secretary as described in subsection (c), the 24 Secretary shall find that all organizations or in- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 79 •S 2474 IS dividuals accredited by such organization com- 1 ply also with the standard described in sub- 2 section (c) if— 3 ‘‘(i) such organization or individual 4 authorizes the organization to release to 5 the Secretary upon the Secretary’s request 6 (or such State agency as the Secretary 7 may designate) a copy of the most current 8 accreditation survey of such organization 9 or individual made by the organization, to- 10 gether with any other information directly 11 related to the survey as the Secretary may 12 require (including corrective action plans); 13 and 14 ‘‘(ii) such organization releases such a 15 copy and any such information to the Sec- 16 retary. 17 ‘‘(B) CERTIFICATION BY A STATE OR LO- 18 CALITY.—If a State or locality has or estab- 19 lishes training, assessment, or certification 20 standards for interpreters or translators in 21 health care which the Secretary determines are 22 at least equivalent to the training, assessment, 23 or certification standards promulgated by the 24 Secretary as described in subsection (c), the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 80 •S 2474 IS Secretary shall find that all organizations or in- 1 dividuals accredited by such State or locality 2 comply also with the standard described in sub- 3 section (c) if— 4 ‘‘(i) such organization or individual 5 authorizes the State or locality to release 6 to the Secretary upon his request (or such 7 State agency as the Secretary may des- 8 ignate) a copy of the most current accredi- 9 tation survey of such organization or indi- 10 vidual made by such State or locality, to- 11 gether with any other information directly 12 related to the survey as the Secretary may 13 require (including corrective action plans); 14 and 15 ‘‘(ii) such State or locality releases 16 such a copy and any such information to 17 the Secretary. 18 ‘‘(C) TIMELY ACTION ON APPLICATION.— 19 The Secretary shall determine, within 210 days 20 after the date the Secretary receives an applica- 21 tion by a private accrediting organization, 22 State, or locality whether the process of the pri- 23 vate accrediting organization, State, or locality 24 meets the requirements with respect to training, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 81 •S 2474 IS assessment, or certification standards for inter- 1 preters or translators with respect to which 2 standards the application is made. The Sec- 3 retary may not deny an application on the basis 4 that it seeks to meet the requirements with re- 5 spect to only one, or more than one, training, 6 assessment, or certification standards for inter- 7 preters or translators. 8 ‘‘(D) DISCLOSURE OF ACCREDITATION 9 SURVEY.—The Secretary may not disclose any 10 accreditation survey made and released to him 11 by the National Council on Interpreting in 12 Health Care or any State or locality of an ac- 13 credited organization or individual, except that 14 the Secretary may disclose such a survey and 15 information related to such a survey to the ex- 16 tent such survey and information relate to an 17 enforcement action taken by the Secretary. 18 ‘‘(E) DEFICIENCIES.—If the Secretary 19 finds that an accredited organization or indi- 20 vidual has significant deficiencies (as defined in 21 regulations pertaining to the training, assess- 22 ment, or certification standards), the organiza- 23 tion or individual shall, after the date of notice 24 of such finding to the organization and for such 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 82 •S 2474 IS period as may be prescribed in regulations, be 1 deemed not to meet the conditions or require- 2 ments the organization or individual has been 3 treated as meeting pursuant to subparagraph 4 (A). 5 ‘‘(e) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 6 rector shall collaborate with the Administrator of the Of- 7 fice of Minority Health, the Administrator of the Centers 8 for Medicare & Medicaid Services, and the Administrator 9 of the Health Resources and Services Administration to 10 notify health care providers and health care organizations 11 about the availability of language access services by the 12 Center. 13 ‘‘(f) EDUCATION.—The Secretary, directly or through 14 contract, shall undertake a national education campaign 15 to inform providers, LEP individuals, health professionals, 16 graduate schools, and community health centers about— 17 ‘‘(1) Federal and State laws and guidelines gov- 18 erning access to language services; 19 ‘‘(2) the value of using trained interpreters and 20 the risks associated with using family members, 21 friends, minors, and untrained bilingual staff; 22 ‘‘(3) funding sources for developing and imple- 23 menting language services; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 83 •S 2474 IS ‘‘(4) promising practices to effectively provide 1 language services. 2 ‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 3 COMPETENCE GRANTS. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Director of the Agency for Healthcare Research and 6 Quality, shall award grants to eligible entities to enable 7 such entities to design, implement, and evaluate innova- 8 tive, cost-effective programs to improve cultural com- 9 petence and language access in health care for individuals 10 with limited-English proficiency. The Director of the 11 Agency for Healthcare Research and Quality shall coordi- 12 nate with, and ensure the participation of, other agencies 13 including but not limited to the Health Resources and 14 Services Administration, the Center on Minority Health 15 and Health Disparities at the National Institutes of 16 Health, and the Office of Minority Health, regarding the 17 design and evaluation of the grants program. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 19 under subsection (a) an entity shall— 20 ‘‘(1) be— 21 ‘‘(A) a city, county, Indian tribe, State, 22 territory or subdivision thereof; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 84 •S 2474 IS ‘‘(B) an organization described in section 1 501(c)(3) of the Internal Revenue Code of 2 1986; 3 ‘‘(C) a community health, mental health, 4 or substance use center or clinic; 5 ‘‘(D) a solo or group physician practice; 6 ‘‘(E) an integrated health care delivery 7 system; 8 ‘‘(F) a public hospital; 9 ‘‘(G) a health care group, university, or 10 college; or 11 ‘‘(H) other entity designated by the Sec- 12 retary; and 13 ‘‘(2) prepare and submit to the Secretary an 14 application, at such time, in such manner, and ac- 15 companied by such additional information as the 16 Secretary may require. 17 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 18 ceived under a grant under this section to— 19 ‘‘(1) develop, implement, and evaluate models of 20 providing competent interpretation services through 21 on-site interpretation, telephonic interpretation, or 22 video interpretation; 23 ‘‘(2) implement strategies to recruit, retain, and 24 promote individuals at all levels of the organization 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 85 •S 2474 IS to maintain a diverse staff and leadership that can 1 promote and provide language services to patient 2 populations of the service area of the organization; 3 ‘‘(3) develop and maintain a needs assessment 4 that identifies the current demographic, cultural, 5 and epidemiological profile of the community to ac- 6 curately plan for and implement language services 7 needed in service area of the organization; 8 ‘‘(4) develop a strategic plan to implement lan- 9 guage services; 10 ‘‘(5) develop participatory, collaborative part- 11 nerships with communities encompassing the LEP 12 patient populations being served to gain input in de- 13 signing and implementing language services; 14 ‘‘(6) develop and implement grievance resolu- 15 tion processes that are culturally and linguistically 16 sensitive and capable of identifying, preventing, and 17 resolving complaints by LEP individuals; or 18 ‘‘(7) develop short-term medical mental health 19 interpretation training courses and incentives for bi- 20 lingual health care staff who are asked to interpret 21 in the workplace; 22 ‘‘(8) develop formal training programs, includ- 23 ing continued professional development and edu- 24 cation programs as well as supervision, for individ- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 86 •S 2474 IS uals interested in becoming dedicated health care in- 1 terpreters and culturally competent providers; 2 ‘‘(9) provide staff language training instruction, 3 which shall include information on the practical limi- 4 tations of such instruction for non-native speakers; 5 ‘‘(10) develop policies that address compensa- 6 tion in salary for staff who receive training to be- 7 come either a staff interpreter or bi-lingual provider; 8 ‘‘(11) develop other language assistance services 9 as determined appropriate by the Secretary; 10 ‘‘(12) develop, implement, and evaluate models 11 of improving cultural competence; and 12 ‘‘(13) ensure that, consistent with the privacy 13 protections provided for under the regulations pro- 14 mulgated under section 264(c) of the Health Insur- 15 ance Portability and Accountability Act of 1996 (42 16 U.S.C. 1320d–2 note), and any applicable State pri- 17 vacy laws, data on the individual patient or recipi- 18 ent’s race, ethnicity, and primary language are col- 19 lected (and periodically updated) in health records 20 and integrated into the organization’s information 21 management systems or any similar system used to 22 store and retrieve data. 23 ‘‘(d) PRIORITY.—In awarding grants under this sec- 24 tion, the Secretary shall give priority to entities that pri- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 87 •S 2474 IS marily engage in providing direct care and that have devel- 1 oped partnerships with community organizations or with 2 agencies with experience language access. 3 ‘‘(e) EVALUATION.— 4 ‘‘(1) An entity that receives a grant under this 5 section shall submit to the Secretary an evaluation 6 that describes, in the manner and to the extent re- 7 quired by the Secretary, the activities carried out 8 with funds received under the grant, and how such 9 activities improved access to health and health-care- 10 related services and the quality of health care for in- 11 dividuals with limited-English proficiency. Such eval- 12 uation shall be collected and disseminated through 13 the Robert T. Matsui Center for Cultural and Lin- 14 guistic Competence in Health Care established under 15 section 3403. The Director of the Agency for 16 Healthcare Research and Quality shall notify grant- 17 ees of the availability of technical assistance for the 18 evaluation and provide such assistance upon request. 19 ‘‘(2) The Director of the Agency for Healthcare 20 Research and Quality shall evaluate or arrange with 21 other individuals or organizations to evaluate 22 projects funded under this section. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 88 •S 2474 IS ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM- 1 PETENCE. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the Agency for Healthcare Research and 4 Quality, shall expand research concerning language access 5 in the provision of health care. 6 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 7 Healthcare Research and Quality may conduct the re- 8 search described in subsection (a) or enter into contracts 9 with other individuals or organizations to do so. 10 ‘‘(c) USE OF FUNDS.—Research under this section 11 shall be designed to do one or more of the following: 12 ‘‘(1) To identify the barriers to mental and be- 13 havioral services that are faced by LEP individuals. 14 ‘‘(2) To identify health care providers’ and 15 health administrators’ attitudes, knowledge, and 16 awareness of the barriers to quality health care serv- 17 ices that are faced by LEP individuals. 18 ‘‘(3) To identify optimal approaches for deliv- 19 ering language access. 20 ‘‘(4) To identify best practices for data collec- 21 tion, including— 22 ‘‘(A) the collection by providers of health 23 care and health-care-related services of data on 24 the race, ethnicity, and primary language of re- 25 cipients of such services, taking into account ex- 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 89 •S 2474 IS isting research conducted by the Government or 1 private sector; 2 ‘‘(B) the development and implementation 3 of data collection and reporting systems; and 4 ‘‘(C) effective privacy safeguards for col- 5 lected data. 6 ‘‘(5) To develop a minimum data collection set 7 for primary language. 8 ‘‘(6) To evaluate the most effective ways in 9 which the Department can create or coordinate, and 10 then subsidize or otherwise fund telephonic interpre- 11 tation providers for health care providers, taking 12 into consideration, among other factors, the flexi- 13 bility necessary for such a system to accommodate 14 variations in— 15 ‘‘(A) provider type; 16 ‘‘(B) languages needed and their frequency 17 of use; 18 ‘‘(C) type of encounter; 19 ‘‘(D) time of encounter, including regular 20 business hours and after hours; and 21 ‘‘(E) location of encounter.’’. 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 90 •S 2474 IS SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 1 AND LINGUISTICALLY APPROPRIATE SERV- 2 ICES UNDER THE MEDICARE, MEDICAID, AND 3 STATE CHILDREN’S HEALTH INSURANCE 4 PROGRAMS. 5 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 6 PROVIDERS.— 7 (1) ESTABLISHMENT.— 8 (A) IN GENERAL.—Not later than 6 9 months after the date of the enactment of this 10 Act, the Secretary of Health and Human Serv- 11 ices (in this section referred to as the ‘‘Sec- 12 retary’’), acting through the Centers for Medi- 13 care & Medicaid Services and in consultation 14 with the Center for Medicare and Medicaid In- 15 novation, shall establish demonstration program 16 under which the Secretary shall award grants 17 to eligible Medicare service providers to improve 18 communication between such providers and lim- 19 ited-English-proficient Medicare beneficiaries, 20 including beneficiaries who live in diverse and 21 underserved communities. 22 (B) APPLICATION OF INNOVATION 23 RULES.—The demonstration project under sub- 24 paragraph (A) shall be conducted in a manner 25 that is consistent with the applicable provisions 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 91 •S 2474 IS of subsections (b), (c), and (d) of section 1115A 1 of the Social Security Act. 2 (C) NUMBER OF GRANTS.—To the extent 3 practicable, the Secretary shall award not less 4 than 24 grants under this subsection. 5 (D) GRANT PERIOD.—Except as provided 6 under paragraph (2)(D), each grant awarded 7 under this subsection shall be for a 3-year pe- 8 riod. 9 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 10 ble for a grant under this subsection, an entity must 11 meet the following requirements: 12 (A) MEDICARE PROVIDER.—The entity 13 must be— 14 (i) a provider of services under part A 15 of title XVIII of the Social Security Act; 16 (ii) a provider of services under part 17 B of such title; 18 (iii) a Medicare Advantage organiza- 19 tion offering a Medicare Advantage plan 20 under part C of such title; or 21 (iv) a PDP sponsor offering a pre- 22 scription drug plan under part D of such 23 title. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 92 •S 2474 IS (B) UNDERSERVED COMMUNITIES.—The 1 entity must serve a community that, with re- 2 spect to necessary language services for improv- 3 ing access and utilization of health care among 4 limited-English proficient individuals, is 5 disproportionally underserved. 6 (C) APPLICATION.—The entity must pre- 7 pare and submit to the Secretary an applica- 8 tion, at such time, in such manner, and accom- 9 panied by such additional information as the 10 Secretary may require. 11 (D) REPORTING.—In the case of a grantee 12 that received a grant under this subsection in 13 a previous year, such grantee is only eligible for 14 continued payments under a grant under this 15 subsection if the grantee met the reporting re- 16 quirements under paragraph (9) for such year. 17 If a grantee fails to meet the requirement of 18 such paragraph for the first year of a grant, the 19 Secretary may terminate the grant and solicit 20 applications from new grantees to participate in 21 the demonstration program. 22 (3) DISTRIBUTION.—To the extent feasible, the 23 Secretary shall award— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 93 •S 2474 IS (A) at least 6 grants to providers of serv- 1 ices described in paragraph (2)(A)(i); 2 (B) at least 6 grants to service providers 3 described in paragraph (2)(A)(ii); 4 (C) at least 6 grants to organizations de- 5 scribed in paragraph (2)(A)(iii); and 6 (D) at least 6 grants to sponsors described 7 in paragraph (2)(A)(iv). 8 (4) CONSIDERATIONS IN AWARDING GRANTS.— 9 (A) VARIATION IN GRANTEES.—In award- 10 ing grants under this subsection, the Secretary 11 shall select grantees to ensure the following: 12 (i) The grantees provide many dif- 13 ferent types of language services. 14 (ii) The grantees serve Medicare bene- 15 ficiaries who speak different languages, 16 and who, as a population, have differing 17 needs for language services. 18 (iii) The grantees serve Medicare 19 beneficiaries in both urban and rural set- 20 tings. 21 (iv) The grantees serve Medicare 22 beneficiaries in at least two geographic re- 23 gions, as defined by the Secretary. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 94 •S 2474 IS (v) The grantees serve Medicare bene- 1 ficiaries in at least two large metropolitan 2 statistical areas with racial, ethnic, and 3 economically diverse populations. 4 (B) PRIORITY FOR PARTNERSHIPS WITH 5 COMMUNITY ORGANIZATIONS AND AGENCIES.— 6 In awarding grants under this subsection, the 7 Secretary shall give priority to eligible entities 8 that have a partnership with— 9 (i) a community organization; or 10 (ii) a consortia of community organi- 11 zations, state agencies, and local agencies, 12 that has experience in providing language serv- 13 ices. 14 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 15 SERVICES.— 16 (A) IN GENERAL.—Subject to subpara- 17 graph (E), a grantee may only use grant funds 18 received under this subsection to pay for the 19 provision of competent language services to 20 Medicare beneficiaries who are limited-English 21 proficient. 22 (B) COMPETENT LANGUAGE SERVICES DE- 23 FINED.—For purposes of this subsection, the 24 term ‘‘competent language services’’ means— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 95 •S 2474 IS (i) interpreter and translation services 1 that— 2 (I) subject to the exceptions 3 under subparagraph (C)— 4 (aa) if the grantee operates 5 in a State that has statewide 6 health care interpreter standards, 7 meet the State standards cur- 8 rently in effect; or 9 (bb) if the grantee operates 10 in a State that does not have 11 statewide health care interpreter 12 standards, utilizes competent in- 13 terpreters who follow the Na- 14 tional Council on Interpreting in 15 Health Care’s Code of Ethics and 16 Standards of Practice; and 17 (II) that, in the case of inter- 18 preter services, are provided 19 through— 20 (aa) on-site interpretation; 21 (bb) telephonic interpreta- 22 tion; or 23 (cc) video interpretation; 24 and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 96 •S 2474 IS (ii) the direct provision of health care 1 or health-care-related services by a com- 2 petent bilingual health care provider. 3 (C) EXCEPTIONS.—The requirements of 4 subparagraph (B)(i)(I) do not apply— 5 (i) to a Medicare beneficiary who is 6 limited-English-proficient who has been in- 7 formed, in the beneficiary’s primary lan- 8 guage, of the availability of free interpreter 9 and translation services and who, instead, 10 requests that a family member, friend, or 11 other person provide such services, if the 12 grantee documents such request in the 13 beneficiary’s medical record; or 14 (ii) in the case of a medical emergency 15 where the delay directly associated with ob- 16 taining a competent interpreter or trans- 17 lation services would jeopardize the health 18 of the patient. 19 Subparagraph (C)(ii) shall not be construed to 20 exempt emergency rooms or similar entities 21 that regularly provide health care services in 22 medical emergencies to limited-English-pro- 23 ficient patients from any applicable legal or reg- 24 ulatory requirements related to providing com- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 97 •S 2474 IS petent interpreter and translation services with- 1 out undue delay. 2 (D) MA ORGANIZATIONS AND PDP SPON- 3 SORS.—If a grantee is a Medicare Advantage 4 organization or a PDP sponsor, such entity 5 must provide at least 50 percent of the grant 6 funds that the entity receives under this sub- 7 section directly to the entity’s network providers 8 (including physicians and pharmacies) for the 9 purpose of providing support for such providers 10 to provide competent language services to Medi- 11 care beneficiaries who are limited-English pro- 12 ficient. 13 (E) ADMINISTRATIVE AND REPORTING 14 COSTS.—A grantee may use up to 10 percent of 15 the grant funds to pay for administrative costs 16 associated with the provision of competent lan- 17 guage services and for reporting required under 18 paragraph (9). 19 (6) DETERMINATION OF AMOUNT OF GRANT 20 PAYMENTS.— 21 (A) IN GENERAL.—Payments to grantees 22 under this subsection shall be calculated based 23 on the estimated numbers of limited-English- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 98 •S 2474 IS proficient Medicare beneficiaries in a grantee’s 1 service area utilizing— 2 (i) data on the numbers of limited- 3 English-proficient individuals who speak 4 English less than ‘‘very well’’ from the 5 most recently available data from the Bu- 6 reau of the Census or other State-based 7 study the Secretary determines likely to 8 yield accurate data regarding the number 9 of such individuals in such service area; or 10 (ii) data provided by the grantee, if 11 the grantee routinely collects data on the 12 primary language of the Medicare bene- 13 ficiaries that the grantee serves and the 14 Secretary determines that the data is accu- 15 rate and shows a greater number of lim- 16 ited-English-proficient individuals than 17 would be estimated using the data under 18 clause (i). 19 (B) DISCRETION OF SECRETARY.—Subject 20 to subparagraph (C), the amount of payment 21 made to a grantee under this subsection may be 22 modified annually at the discretion of the Sec- 23 retary, based on changes in the data under sub- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 99 •S 2474 IS paragraph (A) with respect to the service area 1 of a grantee for the year. 2 (C) LIMITATION ON AMOUNT.—The 3 amount of a grant made under this subsection 4 to a grantee may not exceed $500,000 for the 5 period under paragraph (1)(D). 6 (7) ASSURANCES.—Grantees under this sub- 7 section shall— 8 (A) ensure that clinical and support staff 9 receive appropriate ongoing education and 10 training in linguistically appropriate service de- 11 livery; 12 (B) ensure the linguistic competence of bi- 13 lingual providers; 14 (C) offer and provide appropriate language 15 services at no additional charge to each patient 16 with limited-English proficiency for all points of 17 contact between the patient and the grantee, in 18 a timely manner during all hours of operation; 19 (D) notify Medicare beneficiaries of their 20 right to receive language services in their pri- 21 mary language; 22 (E) post signage in the primary languages 23 commonly used by the patient population in the 24 service area of the organization; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 100 •S 2474 IS (F) ensure that— 1 (i) primary language data is collected 2 for recipients of language services and 3 such data is consistent with standards de- 4 veloped under title XXXIV of the Public 5 Health Service Act, as added by section 6 202 of this Act, to the extent such stand- 7 ards are available upon the initiation of the 8 demonstration program; and 9 (ii) consistent with the privacy protec- 10 tions provided under the regulations pro- 11 mulgated pursuant to section 264(c) of the 12 Health Insurance Portability and Account- 13 ability Act of 1996 (42 U.S.C. 1320d–2 14 note), if the recipient of language services 15 is a minor or is incapacitated, primary lan- 16 guage data is collected on the parent or 17 legal guardian of such recipient. 18 (8) NO COST SHARING.—Limited-English-pro- 19 ficient Medicare beneficiaries shall not have to pay 20 cost-sharing or co-payments for competent language 21 services provided under this demonstration program. 22 (9) REPORTING REQUIREMENTS FOR GRANT- 23 EES.—Not later than the end of each calendar year, 24 a grantee that receives funds under this subsection 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 101 •S 2474 IS in such year shall submit to the Secretary a report 1 that includes the following information: 2 (A) The number of Medicare beneficiaries 3 to whom competent language services are pro- 4 vided. 5 (B) The primary languages of those Medi- 6 care beneficiaries. 7 (C) The types of language services pro- 8 vided to such beneficiaries. 9 (D) Whether such language services were 10 provided by employees of the grantee or 11 through a contract with external contractors or 12 agencies). 13 (E) The types of interpretation services 14 provided to such beneficiaries, and the approxi- 15 mate length of time such service is provided to 16 such beneficiaries. 17 (F) The costs of providing competent lan- 18 guage services. 19 (G) An account of the training or accredi- 20 tation of bilingual staff, interpreters, and trans- 21 lators providing services funded by the grant 22 under this subsection. 23 (10) EVALUATION AND REPORT TO CON- 24 GRESS.—Not later than 1 year after the completion 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 102 •S 2474 IS of a 3-year grant under this subsection, the Sec- 1 retary shall conduct an evaluation of the demonstra- 2 tion program under this subsection and shall submit 3 to the Congress a report that includes the following: 4 (A) An analysis of the patient outcomes 5 and the costs of furnishing care to the limited- 6 English-proficient Medicare beneficiaries par- 7 ticipating in the project as compared to such 8 outcomes and costs for limited-English-pro- 9 ficient Medicare beneficiaries not participating, 10 based on the data provided under paragraph (9) 11 and any other information available to the Sec- 12 retary. 13 (B) The effect of delivering language serv- 14 ices on— 15 (i) Medicare beneficiary access to care 16 and utilization of services; 17 (ii) the efficiency and cost effective- 18 ness of health care delivery; 19 (iii) patient satisfaction; 20 (iv) health outcomes; and 21 (v) the provision of culturally appro- 22 priate services provided to such bene- 23 ficiaries. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 103 •S 2474 IS (C) The extent to which bilingual staff, in- 1 terpreters, and translators providing services 2 under such demonstration were trained or ac- 3 credited and the nature of accreditation or 4 training needed by type of provider, service, or 5 other category as determined by the Secretary 6 to ensure the provision of high-quality interpre- 7 tation, translation, or other language services to 8 Medicare beneficiaries if such services are ex- 9 panded pursuant to subsection (c) of section 10 1907 of this Act. 11 (D) Recommendations, if any, regarding 12 the extension of such project to the entire Medi- 13 care program, subject the to provision of section 14 1115A(c) of the Social Security Act. 15 (b) LANGUAGE SERVICES UNDER THE MEDICARE 16 PROGRAM.— 17 (1) Subsection (aa)(1) of section 1861 of the 18 Social Security Act (42 U.S.C. 1395x) is amended— 19 (A) in subparagraph (B), by striking the 20 ‘‘and’’ at the end; 21 (B) in subparagraph (C), by inserting 22 ‘‘and’’ after the comma at the end; and 23 (C) by inserting after subparagraph (C) 24 the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 104 •S 2474 IS ‘‘(D) language services as defined in sub- 1 section (iii),’’. 2 (2) Section 1833(a) of the Social Security Act 3 (42 U.S.C. 1395l(a)) is amended— 4 (A) by striking ‘‘and’’ at the end of para- 5 graph (8); 6 (B) by redesignating paragraph (9) as 7 paragraph (10); and 8 (C) by inserting after paragraph (8) the 9 following new paragraph: 10 ‘‘(9) in the case of language services described 11 in section 1861(iii), 100 percent of the reasonable 12 charges for such services, as determined in consulta- 13 tion with the Medicare Payment Advisory Commis- 14 sion; and’’. 15 (3) Section 1832(a)(2) of such Act (42 U.S.C. 16 1395k(a)(2)) is amended— 17 (A) by striking ‘‘and’’ at the end of sub- 18 paragraph (I); 19 (B) by striking the period at the end of 20 subparagraph (J) and inserting ‘‘; and’’; and 21 (C) by adding at the end the following new 22 subparagraph: 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 105 •S 2474 IS ‘‘(K) language services (as defined in sec- 1 tion 1861(iii)) furnished by a interpreter or 2 translator.’’. 3 (4) Section 1861 of the Social Security Act (42 4 U.S.C. 1395x) is amended by adding at the end the 5 following new subsection: 6 ‘‘Language Services and Related Terms 7 ‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 8 ‘language services’ has the same meaning given ‘language 9 or language access services’ in section 3400 of the Public 10 Health Service Act. 11 ‘‘(2) INTERPRETER SERVICES DEFINED.—For pur- 12 poses of this subsection, the term ‘interpreter services’ has 13 the meaning given ‘competent interpreter services’ under 14 section 3400(3) of the Public Health Service Act. 15 ‘‘(3) INTERPRETER DEFINED.—The term ‘inter- 16 preter’— 17 ‘‘(A) means an individual— 18 ‘‘(i) who faithfully, accurately, and objec- 19 tively transmits a spoken message from one lan- 20 guage into another language; and 21 ‘‘(ii) who knows health and health-related 22 terminology in both languages; and 23 ‘‘(B) includes individuals who provide in-person, 24 telephonic, and video interpretation. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 106 •S 2474 IS ‘‘(4) TRANSLATION DEFINED.—The term ‘trans- 1 lation’ means the transmission of a written message in one 2 language into a written message in another language that 3 retains the intended meaning of the original message. 4 ‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE- 5 FINED.—The terms ‘Limited-English-proficient’ and 6 ‘LEP’ have the meaning given the term ‘limited english 7 proficient’ under section 9101(25) of the Elementary and 8 Secondary Education Act of 1965, except that subpara- 9 graphs (A), (B), and (D) of such section shall not apply.’’. 10 (5) WAIVER OF BUDGET NEUTRALITY.—For 11 the 3-year period beginning on the date of enact- 12 ment of this section, the budget neutrality provision 13 of section 1848(c)(2)(B)(ii) of the Social Security 14 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 15 apply to language services (as such term is defined 16 in section 1861(iii) of such Act, as added by para- 17 graph (4)). 18 (c) MEDICARE PART C AND PART D.— 19 (1) MEDICARE PART C.—Section 1852 of the 20 Social Security Act (42 U.S.C. 1395ww–22) is 21 amended by adding at the end the following new 22 subsection: 23 ‘‘(m) PROVISION OF EFFECTIVE LANGUAGE SERV- 24 ICES.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 107 •S 2474 IS ‘‘(1) IN GENERAL.—Each Medicare Advantage 1 organization that offers a Medicare Advantage plan 2 under this part shall provide effective language serv- 3 ices to enrollees in such plan. 4 ‘‘(2) REPORTING REQUIREMENTS.—A Medicare 5 Advantage organization shall annually submit to the 6 Secretary a report that contains information on the 7 internal policies and procedures of Medicare Advan- 8 tage plans offered by the organization related to re- 9 cruitment and retention efforts directed to workforce 10 diversity and linguistically and culturally appropriate 11 provision of services in each of the following con- 12 texts: 13 ‘‘(A) The collection of data in a manner 14 that meets the requirements of title I of the 15 Health Equity and Accountability Act of 2012, 16 regarding the enrollee population. 17 ‘‘(B) Education of staff and contractors 18 who have routine contact with enrollees regard- 19 ing the various needs of the diverse enrollee 20 population. 21 ‘‘(C) Evaluation of the plan’s language 22 services programs and services with respect to 23 the plan’s enrollee population, such as through 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 108 •S 2474 IS analysis of complaints or satisfaction survey re- 1 sults. 2 ‘‘(D) Methods by which the plan provides 3 to the Secretary information regarding the eth- 4 nic diversity of the plan’s enrollee population. 5 ‘‘(E) The periodic provision of educational 6 information to plan enrollees on the plan’s lan- 7 guage services and programs.’’. 8 (2) MEDICARE PART D.—Section 1860D–4 of 9 the Social Security Act (42 U.S.C. 1395w–104) is 10 amended by adding at the end the following new 11 subsection: 12 ‘‘(m) PROVISION OF EFFECTIVE LANGUAGE SERV- 13 ICES.—The provisions of section 1852(m) shall apply to 14 a PDP sponsor (and a prescription drug plan offered by 15 such sponsor) in the same manner as such provisions 16 apply to a Medicare Advantage organization (and a Medi- 17 care Advantage plan offered by such organization.’’. 18 (3) EFFECTIVE DATE.—The amendments made 19 by this subsection shall apply with respect to plan 20 years beginning on or after the date of enactment of 21 this Act. 22 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 23 AND SCHIP.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 109 •S 2474 IS (1) Section 1903(a)(2)(E) of the Social Secu- 1 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended 2 by— 3 (A) striking ‘‘75’’ and inserting ‘‘90’’; 4 (B) striking ‘‘translation or interpretation 5 services’’ and inserting ‘‘language services’’; 6 and 7 (C) striking ‘‘children of families’’ and in- 8 serting ‘‘individuals’’. 9 (2) Section 1902(a)(10)(A) of the Social Secu- 10 rity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in 11 the matter preceding clause (i), by striking ‘‘and 12 (28)’’ and inserting ‘‘(28), and (29)’’. 13 (3) Section 1905(a) of the Social Security Act 14 (42 U.S.C. 1396d(a)) is amended by— 15 (A) in paragraph (28), by striking ‘‘and’’ 16 at the end; 17 (B) by redesignating paragraph (29) as 18 paragraph (30); and 19 (C) by inserting after paragraph (28) the 20 following new paragraph: 21 ‘‘(29) language services, as such term is defined 22 in section 1861(iii), provided in a timely manner to 23 limited-English-proficient individuals who need such 24 services; and’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 110 •S 2474 IS (4) Section 1916(a)(2) of the Social Security 1 Act (42 U.S.C. 1396o(2)) is amended by— 2 (A) by striking ‘‘or’’ at the end of subpara- 3 graph (D); 4 (B) by striking ‘‘; and’’ at the end of sub- 5 paragraph (E) and inserting ‘‘, or’’; and 6 (C) by adding at the end the following new 7 subparagraph: 8 ‘‘(F) language services described in section 9 1905(a)(29); and’’. 10 (5) Section 2103 of the Social Security Act (42 11 U.S.C. 1397cc) is amended— 12 (A) in subsection (a), in the matter before 13 paragraph (1), by striking ‘‘ and (7)’’ and in- 14 serting ‘‘(7), and (9)’’; and 15 (B) in subsection (c), by adding at the end 16 the following new paragraph: 17 ‘‘(9) LANGUAGE SERVICES.—The child health 18 assistance provided to a targeted low-income child 19 shall include coverage of language services, as such 20 term is defined in section 1861(iii), provided in a 21 timely manner to limited-English-proficient individ- 22 uals who need such services.’’; and 23 (C) in subsection (e)(2)— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 111 •S 2474 IS (i) in the heading, by striking ‘‘PRE- 1 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 2 (ii) by inserting ‘‘, subsection (c)(9),’’ 3 after ‘‘subsection (c)(1)(C)’’. 4 (6) Section 2110(a)(27) of the Social Security 5 Act (42 U.S.C. 1397jj) is amended by striking 6 ‘‘translation’’ and inserting ‘‘language services as 7 described in section 2103(c)(9)’’. 8 (7) Pursuant to the reporting requirement de- 9 scribed in section 2107(b)(1) of the Social Security 10 Act (42 U.S.C. 1397gg(b)(1)), the Secretary of 11 Health and Human Services shall require that 12 States collect data on— 13 (A) the primary language of individuals re- 14 ceiving child health assistance under title XXI 15 of the Social Security Act; and 16 (B) in the case of such individuals who are 17 minors or incapacitated, the primary language 18 of the individual’s parent or guardian. 19 (8) Section 2105 of the Social Security Act (42 20 U.S.C. 1397ee(c)) is amended— 21 (A) in subsection (a)(1), in the matter pre- 22 ceding subparagraph (A), by striking ‘‘75’’ and 23 inserting ‘‘90’’; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 112 •S 2474 IS (B) in subsection (c)(2)(A), by inserting 1 before the period ‘‘, except that expenditures 2 pursuant to clause (iv) of subparagraph (D) of 3 such paragraph shall not count towards this 4 total’’. 5 (e) FUNDING LANGUAGE SERVICES FURNISHED BY 6 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE- 7 LATED SERVICES THAT SERVE HIGH RATES OF UNIN- 8 SURED LEP INDIVIDUALS.— 9 (1) PAYMENT OF COSTS.— 10 (A) IN GENERAL.—Subject to subpara- 11 graph (B), the Secretary of Health and Human 12 Services shall make payments (on a quarterly 13 basis) directly to eligible entities to support the 14 provision of language services to limited- 15 English-proficient individuals in an amount 16 equal to an entity’s eligible costs (as defined 17 under paragraph (3)) for such services for the 18 quarter. 19 (B) FUNDING.—Out of any funds in the 20 Treasury not otherwise appropriated, there are 21 appropriated to the Secretary of Health and 22 Human Services such sums as may be nec- 23 essary for each of fiscal years 2012 through 24 2016. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 113 •S 2474 IS (C) RELATION TO MEDICAID DSH.—Pay- 1 ments under this subsection shall not offset or 2 reduce payments under section 1923 of the So- 3 cial Security Act, nor shall payments under 4 such section be considered when determining 5 uncompensated costs associated with the provi- 6 sion of language services. 7 (2) ELIGIBLE ENTITY.—In order to receive 8 grants under this paragraph, an entity must— 9 (A) be a Medicaid provider that is— 10 (i) a physician; 11 (ii) a hospital with a low-income utili- 12 zation rate (as defined in section 13 1923(b)(3) of the Social Security Act (42 14 U.S.C. 1396r–4(b)(3))) of greater than 25 15 percent; or 16 (iii) a federally qualified health center 17 (as defined in section 1905(l)(2)(B) of the 18 Social Security Act (42 U.S.C. 19 1396d(l)(2)(B))); 20 (B) provide language services to at least 8 21 percent of the entity’s total number of patients, 22 not later than 6 months after the date of the 23 enactment of the Act; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 114 •S 2474 IS (C) prepare and submit an application to 1 the Secretary, at such time, in such manner, 2 and accompanied by such information as the 3 Secretary may require to ascertain the entity’s 4 eligibility for funding under this subsection. 5 (3) ELIGIBLE COSTS DEFINED.— 6 (A) IN GENERAL.—In this subsection, the 7 term ‘‘eligible costs’’ means, with respect to an 8 eligible entity that provides language services to 9 LEP individuals, the product of— 10 (i) the average per person cost of lan- 11 guage services, determined according to 12 the methodology devised under subpara- 13 graph (B); and 14 (ii) the number of limited-English-pro- 15 ficient individuals who are provided lan- 16 guage services by the entity and for whom 17 no reimbursement is available for such 18 services under the amendments made by 19 subsections (a), (b), (c), or (d) or by pri- 20 vate health insurance. 21 (B) METHODOLOGY.— 22 (i) IN GENERAL.—The Secretary shall 23 establish a methodology to determine the 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 115 •S 2474 IS average per person cost of language serv- 1 ices. 2 (ii) DIFFERENT ENTITIES.—In estab- 3 lishing such methodology, the Secretary 4 may establish different methodologies for 5 different types of eligible entities. 6 (iii) NO INDIVIDUAL CLAIMS.—The 7 Secretary may not require eligible entities 8 to submit individual claims for language 9 services for individual patients as a re- 10 quirement for payment under this sub- 11 section. 12 (4) DATA COLLECTION INSTRUMENT.—For pur- 13 poses of this subsection, the Secretary shall create a 14 standard data collection instrument that is con- 15 sistent with any existing reporting requirements by 16 the Secretary or relevant accrediting organizations 17 regarding the number of individuals to whom lan- 18 guage access are provided. 19 (5) REPORTING REQUIREMENTS.—Entities re- 20 ceiving payment under this subsection shall provide 21 the Secretary with a quarterly report on how the en- 22 tity used such funds. Such report shall contain ag- 23 gregate (and may not contain individualized) data 24 collected using the instrument under paragraph (4) 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 116 •S 2474 IS and shall otherwise be in a form and manner deter- 1 mined by the Secretary. 2 (6) LANGUAGE SERVICES.—For purposes of 3 this subsection, the term ‘‘language services’’ has 4 the meaning given such term in section 1861(iii) of 5 the Social Security Act. 6 (7) GUIDELINES AND REPORT.— 7 (A) ESTABLISHMENT.—Not later than 6 8 months after the date of enactment of this Act, 9 the Secretary of Health and Human Services 10 shall establish and distribute guidelines con- 11 cerning the implementation of this subsection. 12 (B) REPORT.—Not later than 2 years after 13 the date of enactment of this Act, and every 2 14 years thereafter, the Secretary shall submit a 15 report to Congress concerning the implementa- 16 tion of this subsection. 17 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 18 OTHER LAWS.—Nothing in this section shall be construed 19 to limit otherwise existing obligations of recipients of Fed- 20 eral financial assistance under title VI of the Civil Rights 21 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 22 that protect the civil rights of individuals. 23 (g) EFFECTIVE DATE.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 117 •S 2474 IS (1) IN GENERAL.—Except as otherwise pro- 1 vided and subject to paragraph (2), the amendments 2 made by this section shall take effect on January 1, 3 2013. 4 (2) EXCEPTION IF STATE LEGISLATION RE- 5 QUIRED.—In the case of a State plan for medical as- 6 sistance under title XIX of the Social Security Act 7 which the Secretary of Health and Human Services 8 determines requires State legislation (other than leg- 9 islation appropriating funds) in order for the plan to 10 meet the additional requirement imposed by the 11 amendments made by this section, the State plan 12 shall not be regarded as failing to comply with the 13 requirements of such title solely on the basis of its 14 failure to meet this additional requirement before 15 the first day of the first calendar quarter beginning 16 after the close of the first regular session of the 17 State legislature that begins after the date of the en- 18 actment of this Act. For purposes of the previous 19 sentence, in the case of a State that has a 2-year 20 legislative session, each year of such session shall be 21 deemed to be a separate regular session of the State 22 legislature. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 118 •S 2474 IS SEC. 204. INCREASING UNDERSTANDING OF AND IMPROV- 1 ING HEALTH LITERACY. 2 (a) IN GENERAL.—The Secretary, acting through the 3 Director of the Agency for Healthcare Research and Qual- 4 ity and the Administrator of the Health Resources and 5 Services Administration, in consultation with the Director 6 of the National Institute on Minority Health and Health 7 Disparities and the Office of Minority Health, shall award 8 grants to eligible entities to improve health care for pa- 9 tient populations that have low functional health literacy. 10 (b) ELIGIBILITY.—To be eligible to receive a grant 11 under subsection (a), an entity shall— 12 (1) be a hospital, health center or clinic, health 13 plan, or other health entity (including a nonprofit 14 minority health organization or association); and 15 (2) prepare and submit to the Secretary an ap- 16 plication at such time, in such manner, and con- 17 taining such information as the Secretary may re- 18 quire. 19 (c) USE OF FUNDS.— 20 (1) AGENCY FOR HEALTHCARE RESEARCH AND 21 QUALITY.—Grants awarded under subsection (a) 22 through the Agency for Healthcare Research and 23 Quality shall be used— 24 (A) to define and increase the under- 25 standing of health literacy; 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 119 •S 2474 IS (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 of the Agency. 6 (2) HEALTH RESOURCES AND SERVICES ADMIN- 7 ISTRATION.—Grants awarded under subsection (a) 8 through the Health Resources and Services Adminis- 9 tration shall be used to conduct demonstration 10 projects for interventions for patients with low 11 health literacy that may include— 12 (A) the development of new disease man- 13 agement programs for patients with low health 14 literacy; 15 (B) the tailoring of existing disease man- 16 agement programs addressing mental, physical, 17 oral, and behavioral health conditions for pa- 18 tients with low health literacy; 19 (C) the translation of written health mate- 20 rials for patients with low health literacy; 21 (D) the identification, implementation, and 22 testing of low health literacy screening tools; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 120 •S 2474 IS (E) the conduct of educational campaigns 1 for patients and providers about low health lit- 2 eracy; and 3 (F) other activities determined appropriate 4 by the Administrator of the Health Resources 5 and Services Administration. 6 (d) DEFINITIONS.—In this section, the term ‘‘low 7 health literacy’’ means the inability of an individual to ob- 8 tain, process, and understand basic health information 9 and services needed to make appropriate health decisions. 10 SEC. 205. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 11 (a) IN GENERAL.—Entities that receive Federal 12 funds under sections 201 or 202 (including under the 13 amendments made by such section), in order to ensure the 14 right of LEP individuals to receive access to quality health 15 care, shall— 16 (1) ensure that appropriate clinical and support 17 staff receive ongoing education and training in lin- 18 guistically appropriate service delivery; 19 (2) offer and provide appropriate language serv- 20 ices at no additional charge to each patient with lim- 21 ited-English proficiency at all points of contact, in a 22 timely manner during all hours of operation; 23 (3) notify patients of their right to receive lan- 24 guage services in their primary language; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 121 •S 2474 IS (4) utilize only competent interpreter or trans- 1 lation services which— 2 (A) until adoption of the Interpreter and 3 Translator Guidelines and Standards described 4 in section 3403(c) of the Public Health Service 5 Act, are defined in section 3400 of the Public 6 Health Service Act; and 7 (B) after adoption of the Interpreter and 8 Translator Guidelines and Standards described 9 in section 3403(c) of the Public Health Service 10 Act, meet those guidelines and standards; 11 (b) EXEMPTIONS.—The requirements of subsection 12 (a)(4) shall not apply as follows: 13 (1) When a patient (who has been informed in 14 his or her primary language of the availability of 15 free interpreter and translation services) requests 16 the use of family, friends, or other persons untrained 17 in interpretation or translation if the following con- 18 ditions are met: 19 (A) The interpreter requested by the pa- 20 tient is over the age of 18. 21 (B) The recipient informs the patient that 22 he or she has the option of having the recipient 23 provide an interpreter for him/her without 24 charge, or of using his/her own interpreter. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 122 •S 2474 IS (C) The recipient informs the patient that 1 the recipient may not require an LEP person to 2 use a family member or friend as an inter- 3 preter. 4 (D) The recipient evaluates whether the 5 person the patient wishes to use as an inter- 6 preter is competent. If the recipient has reason 7 to believe that the interpreter is not competent, 8 the recipient provides the recipient’s own inter- 9 preter to protect the recipient from liability if 10 the patient’s interpreter is later found not com- 11 petent. 12 (E) If the recipient has reason to believe 13 that there is a conflict of interest between the 14 interpreter and patient, the recipient may not 15 use the patient’s interpreter. 16 (F) The recipient has the patient sign a 17 waiver, witnessed by at least 1 individual not 18 related to the patient, that includes the infor- 19 mation stated in subparagraphs (A) through 20 (E) and is translated into the patient’s lan- 21 guage. 22 (2) When a medical emergency exists and the 23 delay directly associated with obtaining competent 24 interpreter or translation services would jeopardize 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 123 •S 2474 IS the health of the patient but only until a competent 1 interpreter or translation service is available; how- 2 ever, nothing in this subsection shall exempt emer- 3 gency rooms or similar entities that regularly pro- 4 vide health care services in medical emergencies 5 from having in place systems to provide competent 6 interpreter and translation services without undue 7 delay. 8 SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 9 TURALLY AND LINGUISTICALLY APPRO- 10 PRIATE HEALTH CARE SERVICES. 11 Not later than 1 year after the date of enactment 12 of this Act and annually thereafter, the Secretary of 13 Health and Human Services shall enter into a contract 14 with the Institute of Medicine for the preparation and 15 publication of a report that describes Federal efforts to 16 ensure that all individuals with limited-English proficiency 17 have meaningful access culturally competent to health care 18 and health-care-related services. Such report shall in- 19 clude— 20 (1) a description and evaluation of the activities 21 carried out under this Act; 22 (2) a description and analysis of best practices, 23 model programs, guidelines, and other effective 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 124 •S 2474 IS strategies for providing access to culturally and lin- 1 guistically appropriate health care services; 2 (3) recommendations on the development and 3 implementation of policies and practices by providers 4 of health care and health-care-related services for 5 limited-English-proficient individuals; 6 (4) a description of the effect of providing lan- 7 guage services on quality of health care and access 8 to care; and 9 (5) a description of the costs associated with or 10 savings related to the provision of language services. 11 SEC. 207. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 12 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 13 cation is authorized to provide grants to eligible entities 14 for the provision of English as a second language (here- 15 after referred to as ‘‘ESL’’) instruction and shall deter- 16 mine, after consultation with appropriate stakeholders, the 17 mechanism for administering and distributing such 18 grants. 19 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 20 this section, the term ‘‘eligible entity’’ means a State or 21 community-based organization that employs, and serves, 22 minority populations. 23 (c) APPLICATION.—An eligible entity may apply for 24 a grant under this section by submitting such information 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 125 •S 2474 IS as the Secretary may require and in such form and man- 1 ner as the Secretary may require. 2 (d) USE OF GRANT.—As a condition of receiving a 3 grant under this section, an eligible entity shall— 4 (1) develop and implement a plan for assuring 5 the availability of ESL instruction that effectively 6 integrates information about the nature of the 7 United States health care system, how to access 8 care, and any special language skills that may be re- 9 quired for them to access and regularly negotiate the 10 system effectively; 11 (2) develop a plan, including, where appro- 12 priate, public-private partnerships, for making ESL 13 instruction progressively available to all individuals 14 seeking instruction; and 15 (3) maintain current ESL instruction efforts by 16 using the additional funds to supplement rather 17 than supplant any funds expended for ESL instruc- 18 tion in the State as of January 1, 2006. 19 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 20 Secretary of Education shall— 21 (1) collect and publicize annual data on how 22 much Federal, State, and local governments spend 23 on ESL instruction; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 126 •S 2474 IS (2) collect data from State and local govern- 1 ments to identify the unmet needs of English lan- 2 guage learners for appropriate ESL instruction, in- 3 cluding— 4 (A) the preferred written and spoken lan- 5 guage of such English language learners; 6 (B) the extent of waiting lists including 7 how many programs maintain waiting lists and, 8 for programs that do not have waiting lists, the 9 reasons why not; 10 (C) the availability of programs to geo- 11 graphically isolated communities; 12 (D) the impact of course enrollment poli- 13 cies, including open enrollment, on the avail- 14 ability of ESL instruction; 15 (E) the number individuals in the State 16 and each participating locality; 17 (F) the effectiveness of the instruction in 18 meeting the needs of individuals receiving in- 19 struction and those needing instruction; 20 (G) as assessment of the need for pro- 21 grams that integrate job training and ESL in- 22 struction, to assist individuals to obtain better 23 jobs; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 127 •S 2474 IS (H) the availability of ESL slots by State 1 and locality; 2 (3) determine the cost and most appropriate 3 methods of making ESL instruction available to all 4 English language learners seeking instruction; and 5 (4) within 1 year of the date of enactment of 6 this Act, issue a report to Congress that assesses the 7 information collected in paragraphs (1), (2), and (3) 8 and makes recommendations on steps that should be 9 taken to progressively realize the goal of making 10 ESL instruction available to all English language 11 learners seeking instruction. 12 SEC. 208. IMPLEMENTATION. 13 (a) GENERAL PROVISIONS.— 14 (1) A State shall not be immune under the 15 Eleventh Amendment of the Constitution of the 16 United States from suit in Federal court for failing 17 to provide the language access funded pursuant to 18 this title. 19 (2) In a suit against a State for a violation of 20 this title, remedies (including remedies at both at 21 law and in equity) are available for such a violation 22 to the same extent as such remedies are available for 23 such a violation in the suit against any public or pri- 24 vate entity other than a State. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 128 •S 2474 IS (b) RULE OF CONSTRUCTION.—Nothing in this title 1 shall be construed to limit otherwise existing obligations 2 of recipients of Federal financial assistance under title VI 3 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 4 seq.) or any other statute. 5 SEC. 209. LANGUAGE ACCESS SERVICES. 6 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 7 the Patient Protection and Affordable Care Act (42 8 U.S.C. 18022(b)(1)) is amended by adding at the end the 9 following: 10 ‘‘(K) Language access services, including 11 oral interpretation and written translations.’’. 12 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 13 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev- 14 enue Code of 1986 is amended by adding at the end the 15 following: 16 ‘‘(v) COVERAGE MUST INCLUDE LAN- 17 GUAGE ACCESS AND SERVICES.—Except as 18 provided in clause (iii), an employee shall 19 not be treated as eligible for minimum es- 20 sential coverage if such coverage consists 21 of an eligible employer-sponsored plan (as 22 defined in section 5000A(f)(2)) and the 23 plan does not provide coverage for lan- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 129 •S 2474 IS guage access services, including oral inter- 1 pretation and written translations.’’. 2 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 3 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 4 amended— 5 (1) by striking ‘‘and’’ at the end of subpara- 6 graph (C); 7 (2) by striking the period at the end of sub- 8 paragraph (D) and inserting ‘‘; and’’; and 9 (3) by adding at the end the following new sub- 10 paragraph: 11 ‘‘(E) reduce health disparities through the 12 provision of language access services, including 13 oral interpretation and written translations.’’. 14 (d) REGULATIONS REGARDING INTERNAL CLAIMS 15 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 16 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 17 The Secretary of the Treasury, the Secretary of Labor, 18 and the Secretary of Health and Human Services shall 19 amend the regulations in section 54.9815–2719T(e) of 20 title 26, Code of Federal Regulations, section 2590.715– 21 2719(e) of title 29, Code of Federal Regulations, and sec- 22 tion 147.136(e) of title 45, Code of Federal Regulations, 23 respectively, to require group health plans and health in- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 130 •S 2474 IS surance issuers offering group or individual health insur- 1 ance coverage to which such sections apply— 2 (1) to provide oral interpretation services with- 3 out any threshold requirements; 4 (2) to provide in the English versions of all no- 5 tices a statement prominently displayed in not less 6 than 15 non–English languages clearly indicating 7 how to access the language services provided by the 8 plan or issuer; and 9 (3) with respect to written translations of no- 10 tices, to apply a threshold that 5 percent of the pop- 11 ulation or at least 500 individuals per service area 12 are literate only in the same non–English language 13 in lieu of 10 percent or more residing in a county. 14 SEC. 210. ASSISTANT SECRETARY OF THE INDIAN HEALTH 15 SERVICE. 16 (a) IN GENERAL.—Section 5315 of title 5, United 17 States Code, is amended in the matter relating to the As- 18 sistant Secretaries of Health and Human Services by 19 striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be the 20 Assistant Secretary of the Indian Health Service’’. 21 (b) CONFORMING AMENDMENTS.— 22 (1) POSITIONS AT LEVEL V.—Section 5316 of 23 title 5, United States Code, is amended by striking 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 131 •S 2474 IS ‘‘Director, Indian Health Service, Department of 1 Health and Human Services.’’. 2 (2) REFERENCES.—Any reference in a law, reg- 3 ulation, document, paper, or other record of the 4 United States to the Director of the Indian Health 5 Service shall be deemed to be a reference to the As- 6 sistant Secretary of the Indian Health Service. 7 SEC. 211. REAUTHORIZATION OF THE NATIVE HAWAIIAN 8 HEALTH CARE IMPROVEMENT ACT. 9 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 10 Section 6(h)(1) of the Native Hawaiian Health Care Im- 11 provement Act (42 U.S.C. 11705(h)(1)) is amended by 12 striking ‘‘may be necessary for fiscal years 1993 through 13 2019’’ and inserting ‘‘are necessary’’. 14 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 15 LOKAHI.—Section 7(b) of the Native Hawaiian Health 16 Care Improvement Act (42 U.S.C. 11706(b)) is amended 17 by striking ‘‘may be necessary for fiscal years 1993 18 through 2019’’ and inserting ‘‘are necessary’’. 19 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 20 Section 10(c) of the Native Hawaiian Health Care Im- 21 provement Act (42 U.S.C. 11709(c)) is amended by strik- 22 ing ‘‘may be necessary for fiscal years 1993 through 23 2019’’ and inserting ‘‘are necessary’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 132 •S 2474 IS TITLE III—HEALTH WORKFORCE 1 DIVERSITY 2 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 3 ACT. 4 Title XXXIV of the Public Health Service Act, as 5 added by section 202, is amended by adding at the end 6 the following: 7 ‘‘Subtitle A—Diversifying the 8 Health Care Workplace 9 ‘‘SEC. 3411. REPORT ON WORKFORCE DIVERSITY. 10 ‘‘(a) IN GENERAL.—Not later than July 1, 2012, and 11 biannually thereafter, the Secretary, acting through the 12 director of each entity within the Department of Health 13 and Human Services, shall prepare and submit to the 14 Committee on Health, Education, Labor, and Pensions of 15 the Senate and the Committee on Energy and Commerce 16 of the House of Representatives a report on health work- 17 force diversity. 18 ‘‘(b) REQUIREMENT.—The report under subsection 19 (a) shall contain the following information: 20 ‘‘(1) A description of any grant support that is 21 provided by each entity for workforce diversity ini- 22 tiatives with the following information— 23 ‘‘(A) the number of grants made; 24 ‘‘(B) the purpose of the grants; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 133 •S 2474 IS ‘‘(C) the populations served through the 1 grants; 2 ‘‘(D) the organizations and institutions re- 3 ceiving the grants; and 4 ‘‘(E) the tracking efforts that were used to 5 follow the progress of participants. 6 ‘‘(2) A description of the entity’s plan to 7 achieve workforce diversity goals that includes, to 8 the extent relevant to such entity— 9 ‘‘(A) the number of underrepresented mi- 10 nority health professionals that will be needed 11 in various disciplines over the next 10 years to 12 achieve population parity; 13 ‘‘(B) the level of funding needed to fully 14 expand and adequately support health profes- 15 sions pipeline programs; 16 ‘‘(C) the impact such programs have had 17 on the admissions practices and policies of 18 health professions schools; 19 ‘‘(D) the management strategy necessary 20 to effectively administer and institutionalize 21 health profession pipeline programs; and 22 ‘‘(E) the impact that the Government Per- 23 formance and Results Act (GPRA) has had on 24 evaluating the performance of grantees and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 134 •S 2474 IS whether the GPRA is the best assessment tool 1 for programs under titles VII and VIII. 2 ‘‘(3) A description of measurable objectives of 3 each entity relating to workforce diversity initiatives. 4 ‘‘(c) PUBLIC AVAILABILITY.—The report under sub- 5 section (a) shall be made available for public review and 6 comment. 7 ‘‘SEC. 3412. NATIONAL WORKING GROUP ON WORKFORCE 8 DIVERSITY. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Bureau of Health Professions within the Health Re- 11 sources and Services Administration, shall award a grant 12 to an entity determined appropriate by the Secretary for 13 the establishment of a national working group on work- 14 force diversity. 15 ‘‘(b) REPRESENTATION.—In establishing the national 16 working group under subsection (a): 17 ‘‘(1) The grantee shall ensure that the group 18 has representatives of the following: 19 ‘‘(A) The Health Resources and Services 20 Administration. 21 ‘‘(B) The Department of Health and 22 Human Services Data Council. 23 ‘‘(C) The Office of Minority Health. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 135 •S 2474 IS ‘‘(D) The Bureau of Labor Statistics of 1 the Department of Labor. 2 ‘‘(E) The Public Health Practice Program 3 Office—Office of Workforce Policy and Plan- 4 ning. 5 ‘‘(F) The National Institute on Minority 6 Health and Health Disparities. 7 ‘‘(G) The Agency for Healthcare Research 8 and Quality. 9 ‘‘(H) The Institute of Medicine Study 10 Committee for the 2004 workforce diversity re- 11 port. 12 ‘‘(I) The Indian Health Service. 13 ‘‘(J) Minority-serving academic institu- 14 tions. 15 ‘‘(K) Consumer organizations. 16 ‘‘(L) Health professional associations, in- 17 cluding those that represent underrepresented 18 minority populations. 19 ‘‘(M) Researchers in the area of health 20 workforce. 21 ‘‘(N) Health workforce accreditation enti- 22 ties. 23 ‘‘(O) Private foundations that have spon- 24 sored workforce diversity initiatives. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 136 •S 2474 IS ‘‘(2) The grantee shall ensure that, in addition 1 to the representatives under paragraph (1), the 2 group has not less than 5 health professions stu- 3 dents representing various health profession fields 4 and levels of training. 5 ‘‘(c) ACTIVITIES.—The working group established 6 under subsection (a) shall convene at least twice each year 7 to complete the following activities: 8 ‘‘(1) Review current public and private health 9 workforce diversity initiatives. 10 ‘‘(2) Identify successful health workforce diver- 11 sity programs and practices. 12 ‘‘(3) Examine challenges relating to the devel- 13 opment and implementation of health workforce di- 14 versity initiatives. 15 ‘‘(4) Draft a national strategic work plan for 16 health workforce diversity, including recommenda- 17 tions for public and private sector initiatives. 18 ‘‘(5) Develop a framework and methods for the 19 evaluation of current and future health workforce di- 20 versity initiatives. 21 ‘‘(6) Develop recommended standards for work- 22 force diversity that could be applicable to all health 23 professions programs and programs funded under 24 this Act. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 137 •S 2474 IS ‘‘(7) Develop curriculum guidelines for diversity 1 training. 2 ‘‘(8) Develop a strategy for the inclusion of 3 community members on admissions committees for 4 health profession schools. 5 ‘‘(9) Other activities determined appropriate by 6 the Secretary. 7 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 8 the establishment of the working group under subsection 9 (a), and annually thereafter, the working group shall pre- 10 pare and make available to the general public for com- 11 ment, an annual report on the activities of the working 12 group. Such report shall include the recommendations of 13 the working group for improving health workforce diver- 14 sity. 15 ‘‘SEC. 3413. TECHNICAL CLEARINGHOUSE FOR HEALTH 16 WORKFORCE DIVERSITY. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Office of Minority Health, and in collaboration with 19 the Agency for Healthcare Research and Quality, the Bu- 20 reau of Health Professions within the Health Resources 21 and Services Administration, and the National Institute 22 on Minority Health and Health Disparities, shall establish 23 a technical clearinghouse on health workforce diversity 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 138 •S 2474 IS within the Office of Minority Health and coordinate cur- 1 rent and future clearinghouses. 2 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 3 house established under subsection (a) shall offer the fol- 4 lowing information and services: 5 ‘‘(1) Information on the importance of health 6 workforce diversity. 7 ‘‘(2) Statistical information relating to under- 8 represented minority representation in health and al- 9 lied health professions and occupations. 10 ‘‘(3) Model health workforce diversity practices 11 and programs. 12 ‘‘(4) Admissions policies that promote health 13 workforce diversity and are in compliance with Fed- 14 eral and State laws. 15 ‘‘(5) Lists of scholarship, loan repayment, and 16 loan cancellation grants as well as fellowship infor- 17 mation for underserved populations for health pro- 18 fessions schools. 19 ‘‘(6) Foundation and other large organizational 20 initiatives relating to health workforce diversity. 21 ‘‘(c) CONSULTATION.—In carrying out this section, 22 the Secretary shall consult with non-Federal entities which 23 may include minority health professional associations to 24 ensure the adequacy and accuracy of information. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 139 •S 2474 IS ‘‘SEC. 3414. SUPPORT FOR INSTITUTIONS COMMITTED TO 1 WORKFORCE DIVERSITY. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Administrator of the Health Resources and Services 4 Administration and the Centers for Disease Control and 5 Prevention, shall award grants to eligible entities that 6 demonstrate a commitment to health workforce diversity. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 8 under subsection (a), an entity shall— 9 ‘‘(1) be an educational institution or entity that 10 historically produces or trains meaningful numbers 11 of underrepresented minority health professionals, 12 including— 13 ‘‘(A) historically Black colleges and univer- 14 sities; 15 ‘‘(B) Hispanic-serving health professions 16 schools; 17 ‘‘(C) Hispanic-serving institutions; 18 ‘‘(D) tribal colleges and universities; 19 ‘‘(E) Asian-American, Native American, 20 and Pacific Islander-serving institutions; 21 ‘‘(F) institutions that have programs to re- 22 cruit and retain underrepresented minority 23 health professionals, in which a significant 24 number of the enrolled participants are under- 25 represented minorities; 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 140 •S 2474 IS ‘‘(G) health professional associations, 1 which may include underrepresented minority 2 health professional associations; and 3 ‘‘(H) institutions— 4 ‘‘(i) located in communities with pre- 5 dominantly underrepresented minority pop- 6 ulations; 7 ‘‘(ii) with whom partnerships have 8 been formed for the purpose of increasing 9 workforce diversity; and 10 ‘‘(iii) in which at least 20 percent of 11 the enrolled participants are underrep- 12 resented minorities; and 13 ‘‘(2) submit to the Secretary an application at 14 such time, in such manner, and containing such in- 15 formation as the Secretary may require. 16 ‘‘(c) USE OF FUNDS.—Amounts received under a 17 grant under subsection (a) shall be used to expand existing 18 workforce diversity programs, implement new workforce 19 diversity programs, or evaluate existing or new workforce 20 diversity programs, including with respect to mental 21 health care professions. Such programs shall enhance di- 22 versity by considering minority status as part of an indi- 23 vidualized consideration of qualifications. Possible activi- 24 ties may include— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 141 •S 2474 IS ‘‘(1) educational outreach programs relating to 1 opportunities in the health professions; 2 ‘‘(2) scholarship, fellowship, grant, loan repay- 3 ment, and loan cancellation programs; 4 ‘‘(3) postbaccalaureate programs; 5 ‘‘(4) academic enrichment programs, particu- 6 larly targeting those who would not be competitive 7 for health professions schools; 8 ‘‘(5) kindergarten through 12th grade and 9 other health pipeline programs; 10 ‘‘(6) mentoring programs; 11 ‘‘(7) internship or rotation programs involving 12 hospitals, health systems, health plans and other 13 health entities; 14 ‘‘(8) community partnership development for 15 purposes relating to workforce diversity; or 16 ‘‘(9) leadership training. 17 ‘‘(d) REPORTS.—Not later than 1 year after receiving 18 a grant under this section, and annually for the term of 19 the grant, a grantee shall submit to the Secretary a report 20 that summarizes and evaluates all activities conducted 21 under the grant. 22 ‘‘(e) DEFINITION.—In this section, the term ‘Asian- 23 American, Native American, and Pacific Islander-serving 24 institutions’ has the same meaning as the term ‘Asian 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 142 •S 2474 IS American and Native American Pacific Islander-serving 1 institution’ as defined in section 371(c) of the Higher 2 Education Act of 1965 (20 U.S.C. 1067q(c)). 3 ‘‘SEC. 3415. CAREER DEVELOPMENT FOR SCIENTISTS AND 4 RESEARCHERS. 5 ‘‘(a) IN GENERAL.—The Secretary, acting through 6 the Director of the National Institutes of Health, the Di- 7 rector of the Centers for Disease Control and Prevention, 8 the Commissioner of Food and Drugs, and the Director 9 of the Agency for Healthcare Research and Quality, shall 10 award grants that expand existing opportunities for sci- 11 entists and researchers and promote the inclusion of 12 underrepresented minorities in the health professions. 13 ‘‘(b) RESEARCH FUNDING.—The head of each entity 14 within the Department of Health and Human Services 15 shall establish or expand existing programs to provide re- 16 search funding to scientists and researchers in training. 17 Under such programs, the head of each such entity shall 18 give priority in allocating research funding to support 19 health research in traditionally underserved communities, 20 including underrepresented minority communities, and re- 21 search classified as community or participatory. 22 ‘‘(c) DATA COLLECTION.—The head of each entity 23 within the Department of Health and Human Services 24 shall collect data on the number (expressed as an absolute 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 143 •S 2474 IS number and a percentage) of underrepresented minority 1 and nonminority applicants who receive and are denied 2 agency funding at every stage of review. Such data shall 3 be reported annually to the Secretary and the appropriate 4 committees of Congress. 5 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 6 retary shall establish a student loan reimbursement pro- 7 gram to provide student loan reimbursement assistance to 8 researchers who focus on racial and ethnic disparities in 9 health. The Secretary shall promulgate regulations to de- 10 fine the scope and procedures for the program under this 11 subsection. 12 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 13 retary shall establish a student loan cancellation program 14 to provide student loan cancellation assistance to research- 15 ers who focus on racial and ethnic disparities in health. 16 Students participating in the program shall make a min- 17 imum 5-year commitment to work at an accredited health 18 profession school. The Secretary shall promulgate addi- 19 tional regulations to define the scope and procedures for 20 the program under this subsection. 21 ‘‘SEC. 3416. CAREER SUPPORT FOR NON-RESEARCH 22 HEALTH PROFESSIONALS. 23 ‘‘(a) IN GENERAL.—The Secretary, acting through 24 the Director of the Centers for Disease Control and Pre- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 144 •S 2474 IS vention, the Administrator of the Substance Abuse and 1 Mental Health Services Administration, the Administrator 2 of the Health Resources and Services Administration, and 3 the Administrator of the Centers for Medicare and Med- 4 icaid Services shall establish a program to award grants 5 to eligible individuals for career support in non-research- 6 related health care. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 8 under subsection (a) an individual shall— 9 ‘‘(1) be a student in a health professions school, 10 a graduate of such a school who is working in a 11 health profession, or a faculty member of such a 12 school; and 13 ‘‘(2) submit to the Secretary an application at 14 such time, in such manner, and containing such in- 15 formation as the Secretary may require. 16 ‘‘(c) USE OF FUNDS.—An individual shall use 17 amounts received under a grant under this section to— 18 ‘‘(1) support the individual’s health activities or 19 projects that involve underserved communities, in- 20 cluding racial and ethnic minority communities; 21 ‘‘(2) support health-related career advancement 22 activities; 23 ‘‘(3) to pay, or as reimbursement for payments 24 of, student loans for individuals who are health pro- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 145 •S 2474 IS fessionals and are focused on health issues affecting 1 underserved communities, including racial and eth- 2 nic minority communities; and 3 ‘‘(4) to establish and promote leadership train- 4 ing programs to decrease health disparities and to 5 increase cultural competence with the goal of in- 6 creasing diversity in leadership positions. 7 ‘‘(d) DEFINITION.—In this section, the term ‘career 8 in non-research-related health care’ means employment or 9 intended employment in the field of public health, health 10 policy, health management, health administration, medi- 11 cine, nursing, pharmacy, psychology, social work, psychi- 12 atry, other mental and behavioral health, allied health, 13 community health, social work, or other fields determined 14 appropriate by the Secretary, other than in a position that 15 involves research. 16 ‘‘SEC. 3417. RESEARCH ON THE EFFECT OF WORKFORCE DI- 17 VERSITY ON QUALITY. 18 ‘‘(a) IN GENERAL.—The Director of the Agency for 19 Healthcare Research and Quality, in collaboration with 20 the Deputy Assistant Secretary for Minority Health and 21 the Director of the National Institute on Minority Health 22 and Health Disparities, shall award grants to eligible enti- 23 ties to expand research on the link between health work- 24 force diversity and quality health care. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 146 •S 2474 IS ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a) an entity shall— 2 ‘‘(1) be a clinical, public health, or health serv- 3 ices research entity or other entity determined ap- 4 propriate by the Director; and 5 ‘‘(2) submit to the Secretary an application at 6 such time, in such manner, and containing such in- 7 formation as the Secretary may require. 8 ‘‘(c) USE OF FUNDS.—Amounts received under a 9 grant awarded under subsection (a) shall be used to sup- 10 port research that investigates the effect of health work- 11 force diversity on— 12 ‘‘(1) language access; 13 ‘‘(2) cultural competence; 14 ‘‘(3) patient satisfaction; 15 ‘‘(4) timeliness of care; 16 ‘‘(5) safety of care; 17 ‘‘(6) effectiveness of care; 18 ‘‘(7) efficiency of care; 19 ‘‘(8) patient outcomes; 20 ‘‘(9) community engagement; 21 ‘‘(10) resource allocation; 22 ‘‘(11) organizational structure; 23 ‘‘(12) compliance of care; or 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 147 •S 2474 IS ‘‘(13) other topics determined appropriate by 1 the Director. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Director shall give individualized consider- 4 ation to all relevant aspects of the applicant’s background. 5 Consideration of prior research experience involving the 6 health of underserved communities shall be such a factor. 7 ‘‘SEC. 3418. HEALTH DISPARITIES EDUCATION PROGRAM. 8 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 9 through the National Institute on Minority Health and 10 Health Disparities and in collaboration with the Office of 11 Minority Health, the Office of the Surgeon General, the 12 Office for Civil Rights, the Centers for Disease Control 13 and Prevention, the Centers for Medicare & Medicaid 14 Services, the Health Resources and Services Administra- 15 tion, and other appropriate public and private entities, 16 shall establish and coordinate a health and health care dis- 17 parities education program to support, develop, and imple- 18 ment educational initiatives and outreach strategies that 19 inform health care professionals and the public about the 20 existence of and methods to reduce racial and ethnic dis- 21 parities in health and health care. 22 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 23 cation program established under subsection (a) shall, 24 through the use of public awareness and outreach cam- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 148 •S 2474 IS paigns targeting the general public and the medical com- 1 munity at large— 2 ‘‘(1) disseminate scientific evidence for the ex- 3 istence and extent of racial and ethnic disparities in 4 health care, including disparities that are not other- 5 wise attributable to known factors such as access to 6 care, patient preferences, or appropriateness of 7 intervention, as described in the 2002 Institute of 8 Medicine Report entitled ‘Unequal Treatment: Con- 9 fronting Racial and Ethnic Disparities in Health 10 Care’, as well as the impact of disparities related to 11 age, disability status, socioeconomic status, sex, gen- 12 der identity, and sexual orientation on racial and 13 ethnic minorities; 14 ‘‘(2) disseminate new research findings to 15 health care providers and patients to assist them in 16 understanding, reducing, and eliminating health and 17 health care disparities; 18 ‘‘(3) disseminate information about the impact 19 of linguistic and cultural barriers on health care 20 quality and the obligation of health providers who 21 receive Federal financial assistance to ensure that 22 people with limited-English proficiency have access 23 to language access services; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 149 •S 2474 IS ‘‘(4) disseminate information about the impor- 1 tance and legality of racial, ethnic, disability status, 2 socioeconomic status, sex, gender identity, and sex- 3 ual orientation, and primary language data collec- 4 tion, analysis, and reporting; 5 ‘‘(5) design and implement specific educational 6 initiatives to health care providers relating to health 7 and health care disparities; and 8 ‘‘(6) assess the impact of the programs estab- 9 lished under this section in raising awareness of 10 health and health care disparities and providing in- 11 formation on available resources.’’. 12 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 13 SCHOOLS. 14 Part B of title VII of the Public Health Service Act 15 (42 U.S.C. 293 et seq.) is amended by adding at the end 16 the following: 17 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 18 SCHOOLS. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration, shall award grants to Hispanic-serving 22 health professions schools for the purpose of carrying out 23 programs to recruit Hispanic individuals to enroll in and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 150 •S 2474 IS graduate from such schools, which may include providing 1 scholarships and other financial assistance as appropriate. 2 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His- 3 panic-serving health professions school’ means an entity 4 that— 5 ‘‘(1) is a school or program under section 6 799B; 7 ‘‘(2) has an enrollment of full-time equivalent 8 students that is made up of at least 9 percent His- 9 panic students; 10 ‘‘(3) has been effective in carrying out pro- 11 grams to recruit Hispanic individuals to enroll in 12 and graduate from the school; 13 ‘‘(4) has been effective in recruiting and retain- 14 ing Hispanic faculty members; 15 ‘‘(5) has a significant number of graduates who 16 are providing health services to medically under- 17 served populations or to individuals in health profes- 18 sional shortage areas; and 19 ‘‘(6) Regional Hispanic Centers of Excellence.’’. 20 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 21 DISEASE CONTROL AND PREVENTION. 22 Section 317F(c) of the Public Health Service Act (42 23 U.S.C. 247b–7(c)) is amended— 24 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 151 •S 2474 IS (2) by inserting before the period the following: 1 ‘‘$750,000 for fiscal year 2012, and such sums as 2 may be necessary for each of the fiscal years 2013 3 through 2017.’’. 4 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 5 GREE PROGRAMS AT SCHOOLS OF PUBLIC 6 HEALTH AND SCHOOLS OF ALLIED HEALTH. 7 Part B of title VII of the Public Health Service Act 8 (42 U.S.C. 293 et seq.), as amended by section 302, is 9 further amended by adding at the end the following: 10 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 11 GREE PROGRAMS. 12 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 13 acting through the Administrator of the Health Resources 14 and Services Administration, in consultation with the Di- 15 rector of the Centers for Disease Control and Prevention, 16 the Director of the Agency for Healthcare Research and 17 Quality, and the Deputy Assistant Secretary for Minority 18 Health, shall award cooperative agreements to schools of 19 public health and schools of allied health to design and 20 implement online degree programs. 21 ‘‘(b) PRIORITY.—In awarding cooperative agreements 22 under this section, the Secretary shall give priority to any 23 school of public health or school of allied health that has 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 152 •S 2474 IS an established track record of serving medically under- 1 served communities. 2 ‘‘(c) REQUIREMENTS.—Awardees must design and 3 implement an online degree program, that meet the fol- 4 lowing restrictions: 5 ‘‘(1) Enrolling individuals who have obtained a 6 secondary school diploma or its recognized equiva- 7 lent. 8 ‘‘(2) Maintaining a significant enrollment of 9 underrepresented minority or disadvantaged stu- 10 dents.’’. 11 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 12 NATIONAL HEALTH CARE WORKFORCE COM- 13 MISSION. 14 It is the sense of Congress that the National Health 15 Care Workforce Commission established by section 5101 16 of the Patient Protection and Affordable Care Act should, 17 in carrying out its assigned duties under that section, give 18 attention to the needs of racial and ethnic minorities, indi- 19 viduals with lower socioeconomic status, individuals with 20 mental, developmental, and physical disabilities, lesbian, 21 gay, bisexual and transgender populations, and individuals 22 who are members of multiple minority or special popu- 23 lation groups. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 153 •S 2474 IS SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 1 Subtitle A of title XXXIV of the Public Health Serv- 2 ice Act, as amended by section 301, is further amended 3 by inserting after section 3418 the following: 4 ‘‘SEC. 3419. DAVID SATCHER PUBLIC HEALTH AND HEALTH 5 SERVICES CORPS. 6 ‘‘(a) IN GENERAL.—The Administrator of the Health 7 Resources and Services Administration and the Director 8 of the Centers for Disease Control and Prevention, in col- 9 laboration with the Deputy Assistant Secretary for Minor- 10 ity Health, shall award grants to eligible entities to in- 11 crease awareness among postprimary and postsecondary 12 students of career opportunities in the health professions. 13 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 14 under subsection (a) an entity shall— 15 ‘‘(1) be a clinical, public health or health serv- 16 ices organization, community-based or nonprofit en- 17 tity, or other entity determined appropriate by the 18 Director of the Centers for Disease Control and Pre- 19 vention; 20 ‘‘(2) serve a health professional shortage area, 21 as determined by the Secretary; 22 ‘‘(3) work with students, including those from 23 racial and ethnic minority backgrounds, that have 24 expressed an interest in the health professions; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 154 •S 2474 IS ‘‘(4) 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.—Grant awards under sub- 4 section (a) shall be used to support internships that will 5 increase awareness among students of non-research-based 6 and career opportunities in the following health profes- 7 sions: 8 ‘‘(1) Medicine. 9 ‘‘(2) Nursing. 10 ‘‘(3) Public Health. 11 ‘‘(4) Pharmacy. 12 ‘‘(5) Health administration and management. 13 ‘‘(6) Health policy. 14 ‘‘(7) Psychology. 15 ‘‘(8) Dentistry. 16 ‘‘(9) International health. 17 ‘‘(10) Social work. 18 ‘‘(11) Allied health. 19 ‘‘(12) Psychiatry. 20 ‘‘(13) Hospice care. 21 ‘‘(14) Other professions deemed appropriate by 22 the Director of the Centers for Disease Control and 23 Prevention. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 155 •S 2474 IS ‘‘(d) PRIORITY.—In awarding grants under sub- 1 section (a), the Director of the Centers for Disease Con- 2 trol and Prevention shall give priority to those entities 3 that— 4 ‘‘(1) serve a high proportion of individuals from 5 disadvantaged backgrounds; 6 ‘‘(2) have experience in health disparity elimi- 7 nation programs; 8 ‘‘(3) facilitate the entry of disadvantaged indi- 9 viduals into institutions of higher education; and 10 ‘‘(4) provide counseling or other services de- 11 signed to assist disadvantaged individuals in success- 12 fully completing their education at the postsecondary 13 level. 14 ‘‘(e) STIPENDS.—The Secretary may approve sti- 15 pends under this section for individuals for any period of 16 education in student-enhancement programs (other than 17 regular courses) at health professions schools, programs, 18 or entities, except that such a stipend may not be provided 19 to an individual for more than 6 months, and such a sti- 20 pend may not exceed $20 per day (notwithstanding any 21 other provision of law regarding the amount of stipends). 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 156 •S 2474 IS ‘‘SEC. 3420. 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 postsecondary students who seek a 6 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 experience in public health research 10 or public health practice, or other health professions 11 as determined appropriate by the Director of the 12 Centers for Disease Control and Prevention; 13 ‘‘(2) reside in a health professional shortage 14 area as determined by the Secretary; 15 ‘‘(3) have expressed an interest in public health; 16 ‘‘(4) demonstrate promise for becoming a leader 17 in public health; 18 ‘‘(5) secure admission to a 4-year institution of 19 higher education; 20 ‘‘(6) comply with subsection (f); and 21 ‘‘(7) submit to the Secretary an application at 22 such time, in such manner, and containing such in- 23 formation as the Secretary may require. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 157 •S 2474 IS ‘‘(c) USE OF FUNDS.—Amounts received under an 1 award under subsection (a) shall be used to support oppor- 2 tunities for students to become public health professionals. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director shall give priority to those stu- 5 dents that— 6 ‘‘(1) are from disadvantaged backgrounds; 7 ‘‘(2) have secured admissions to a minority- 8 serving institution; and 9 ‘‘(3) have identified a health professional as a 10 mentor at their school or institution and an aca- 11 demic advisor to assist in the completion of their 12 baccalaureate degree. 13 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 14 payment of scholarships under this section for such indi- 15 viduals for any period of education in student under- 16 graduate tenure, except that such a scholarship may not 17 be provided to an individual for more than 4 years, and 18 such scholarships may not exceed $10,000 per academic 19 year (notwithstanding any other provision of law regard- 20 ing the amount of scholarship). 21 ‘‘SEC. 3420A. PATSY MINK HEALTH AND GENDER RESEARCH 22 FELLOWSHIP PROGRAM. 23 ‘‘(a) IN GENERAL.—The Director of the Centers for 24 Disease Control and Prevention, in collaboration with the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 158 •S 2474 IS Deputy Assistant Secretary for Minority Health, the Ad- 1 ministrator of the Substance Abuse and Mental Health 2 Services Administration, the Director of the Indian Health 3 Service, the Director of the National Institutes of Health, 4 and the Director of the Agency for Healthcare Research 5 and Quality, shall award research fellowships to post-bac- 6 calaureate students to conduct research that will examine 7 gender and health disparities and to pursue a career in 8 the health professions. 9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 10 ship under subsection (a) an individual shall— 11 ‘‘(1) have experience in health research or pub- 12 lic health practice; 13 ‘‘(2) reside in a health professional shortage 14 area as determined by the Secretary; 15 ‘‘(3) have expressed an interest in the health 16 professions; 17 ‘‘(4) demonstrate promise for becoming a leader 18 in the field of women’s health; 19 ‘‘(5) secure admission to a health professions 20 school or graduate program with an emphasis in 21 gender studies; 22 ‘‘(6) comply with subsection (f); and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 159 •S 2474 IS ‘‘(7) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—Amounts received under an 4 award under subsection (a) shall be used to support oppor- 5 tunities for students to become researchers and advance 6 the research base on the intersection between gender and 7 health. 8 ‘‘(d) PRIORITY.—In awarding grants 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 (notwith- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 160 •S 2474 IS standing any other provision of law regarding the amount 1 of fellowship). 2 ‘‘SEC. 3420B. PAUL DAVID WELLSTONE INTERNATIONAL 3 HEALTH FELLOWSHIP PROGRAM. 4 ‘‘(a) IN GENERAL.—The Director of the Agency for 5 Healthcare Research and Quality, in collaboration with 6 the Deputy Assistant Secretary for Minority Health, shall 7 award research fellowships to college students or recent 8 graduates to advance their understanding of international 9 health. 10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 11 ship under subsection (a) an individual shall— 12 ‘‘(1) have educational experience in the field of 13 international health; 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 the field of international health; 18 ‘‘(4) be a college senior or recent graduate of 19 a four-year higher education institution; 20 ‘‘(5) comply with subsection (f); and 21 ‘‘(6) submit to the Secretary an application at 22 such time, in such manner, and containing such in- 23 formation as the Secretary may require. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 161 •S 2474 IS ‘‘(c) USE OF FUNDS.—Amounts received under an 1 award under subsection (a) shall be used to support oppor- 2 tunities for students to become health professionals and 3 to advance their knowledge about international issues re- 4 lating to health care access and quality. 5 ‘‘(d) PRIORITY.—In awarding grants under sub- 6 section (a), the Director shall give priority to those appli- 7 cants that— 8 ‘‘(1) are from a disadvantaged background; and 9 ‘‘(2) have identified a mentor at a health pro- 10 fessions school or institution, an academic advisor to 11 assist in the completion of their graduate or profes- 12 sional degree, and an advisor from an international 13 health non-governmental organization, private volun- 14 teer organization, or other international institution 15 or program that focuses on increasing health care 16 access and quality for residents in developing coun- 17 tries. 18 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 19 fellowships for college seniors or recent graduates, except 20 that such a fellowship may not be provided to an indi- 21 vidual for more than 6 months, may not be awarded to 22 a graduate that has not been enrolled in school for more 23 than 1 year, and may not exceed $4,000 per academic year 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 162 •S 2474 IS (notwithstanding any other provision of law regarding the 1 amount of fellowship). 2 ‘‘SEC. 3420C. EDWARD R. ROYBAL HEALTH CARE SCHOLAR 3 PROGRAM. 4 ‘‘(a) IN GENERAL.—The Director of the Agency for 5 Healthcare Research and Quality, the Director of the Cen- 6 ters for Medicaid & Medicare, and the Administrator for 7 Health Resources and Services Administration, in collabo- 8 ration with the Deputy Assistant Secretary for Minority 9 Health, shall award grants to eligible entities to expose 10 entering graduate students to the health professions. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 12 under subsection (a) an entity shall— 13 ‘‘(1) be a clinical, public health or health serv- 14 ices organization, community-based or nonprofit en- 15 tity, or other entity determined appropriate by the 16 Director of the Agency for Healthcare Research and 17 Quality; 18 ‘‘(2) serve in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) work with students obtaining a degree in 21 the health professions; and 22 ‘‘(4) submit to the Secretary an application at 23 such time, in such manner, and containing such in- 24 formation as the Secretary may require. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 163 •S 2474 IS ‘‘(c) USE OF FUNDS.—Amounts received under a 1 grant awarded under subsection (a) shall be used to sup- 2 port opportunities that expose students to non-research- 3 based health professions, including— 4 ‘‘(1) public health policy; 5 ‘‘(2) health care and pharmaceutical policy; 6 ‘‘(3) health care administration and manage- 7 ment; 8 ‘‘(4) health economics; and 9 ‘‘(5) other professions determined appropriate 10 by the Director of the Agency for Healthcare Re- 11 search and Quality. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director of the Agency for Healthcare Re- 14 search and Quality shall give priority to those entities 15 that— 16 ‘‘(1) have experience with health disparity elimi- 17 nation programs; 18 ‘‘(2) facilitate training in the fields described in 19 subsection (c); and 20 ‘‘(3) provide counseling or other services de- 21 signed to assist such individuals in successfully com- 22 pleting their education at the postsecondary level. 23 ‘‘(e) STIPENDS.—The Secretary may approve the 24 payment of stipends for individuals under this section for 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 164 •S 2474 IS any period of education in student-enhancement programs 1 (other than regular courses) at health professions schools 2 or entities, except that such a stipend may not be provided 3 to an individual for more than 2 months, and such a sti- 4 pend may not exceed $100 per day (notwithstanding any 5 other provision of law regarding the amount of sti- 6 pends).’’. 7 SEC. 307. ADVISORY COMMITTEE ON HEALTH PROFES- 8 SIONS TRAINING FOR DIVERSITY. 9 (a) ESTABLISHMENT.—The Secretary of Health and 10 Human Services (referred to in this section as the ‘‘Sec- 11 retary’’) shall establish an advisory committee to be known 12 as the Advisory Committee on Health Professions Train- 13 ing for Diversity (in this section referred to as the ‘‘Advi- 14 sory Committee’’). 15 (b) COMPOSITION.— 16 (1) IN GENERAL.—The Secretary shall deter- 17 mine the appropriate number of individuals to serve 18 on the Advisory Committee. Such individuals shall 19 not be officers or employees of the Federal Govern- 20 ment. 21 (2) APPOINTMENT.—Not later than 60 days 22 after the date of enactment of this section, the Sec- 23 retary shall appoint the members of the Advisory 24 Committee from among individuals who are health 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 165 •S 2474 IS professionals. In making such appointments, the 1 Secretary shall ensure a fair balance between the 2 health professions, that at least 75 percent of the 3 members of the Advisory Committee are health pro- 4 fessionals, a broad geographic representation of 5 members and a balance between urban and rural 6 members. Members shall be appointed based on their 7 competence, interest, and knowledge of the mission 8 of the profession involved. 9 (3) MINORITY REPRESENTATION.—In appoint- 10 ing the members of the Advisory Committee under 11 paragraph (2), the Secretary shall ensure the ade- 12 quate representation of women and minorities. 13 (c) TERMS.— 14 (1) IN GENERAL.—A member of the Advisory 15 Committee shall be appointed for a term of 3 years, 16 except that of the members first appointed— 17 (A) 1⁄3 of such members shall serve for a 18 term of 1 year; 19 (B) 1⁄3 of such members shall serve for a 20 term of 2 years; and 21 (C) 1⁄3 of such members shall serve for a 22 term of 3 years. 23 (2) VACANCIES.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 166 •S 2474 IS (A) IN GENERAL.—A vacancy on the Advi- 1 sory Committee shall be filled in the manner in 2 which the original appointment was made and 3 shall be subject to any conditions which applied 4 with respect to the original appointment. 5 (B) FILLING UNEXPIRED TERM.—An indi- 6 vidual chosen to fill a vacancy shall be ap- 7 pointed for the unexpired term of the member 8 replaced. 9 (d) DUTIES.— 10 (1) IN GENERAL.—The Advisory Committee 11 shall— 12 (A) provide advice and recommendations to 13 the Secretary concerning policy and program 14 development and other matters of significance 15 concerning activities under this part; and 16 (B) not later than 2 years after the date 17 of enactment of this section, and annually 18 thereafter, prepare and submit to the Secretary, 19 and the Committee on Health, Education, 20 Labor, and Pensions of the Senate, and the 21 Committee on Energy and Commerce of the 22 House of Representatives, a report describing 23 the activities of the Committee. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 167 •S 2474 IS (2) CONSULTATION WITH STUDENTS.—In car- 1 rying out duties under paragraph (1), the Advisory 2 Committee shall consult with individuals who are at- 3 tending health professions schools with which this 4 part is concerned. 5 (e) MEETINGS AND DOCUMENTS.— 6 (1) MEETINGS.—The Advisory Committee shall 7 meet not less than 2 times each year. Such meetings 8 shall be held jointly with other related entities estab- 9 lished under this title where appropriate. 10 (2) DOCUMENTS.—Not later than 14 days prior 11 to the convening of a meeting under paragraph (1), 12 the Advisory Committee shall prepare and make 13 available an agenda of the matters to be considered 14 by the Advisory Committee at such meeting. At any 15 such meeting, the Advisory Committee shall dis- 16 tribute materials with respect to the issues to be ad- 17 dressed at the meeting. Not later than 30 days after 18 the adjourning of such a meeting, the Advisory Com- 19 mittee shall prepare and make available a summary 20 of the meeting and any actions taken by the Com- 21 mittee based upon the meeting. 22 (f) COMPENSATION AND EXPENSES.— 23 (1) COMPENSATION.—Each member of the Ad- 24 visory Committee shall be compensated at a rate 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 168 •S 2474 IS equal to the daily equivalent of the annual rate of 1 basic pay prescribed for level IV of the Executive 2 Schedule under section 5315 of title 5, United 3 States Code, for each day (including travel time) 4 during which such member is engaged in the per- 5 formance of the duties of the Committee. 6 (2) EXPENSES.—The members of the Advisory 7 Committee shall be allowed travel expenses, includ- 8 ing per diem in lieu of subsistence, at rates author- 9 ized for employees of agencies under subchapter I of 10 chapter 57 of title 5, United States Code, while 11 away from their homes or regular places of business 12 in the performance of services for the Committee. 13 (g) FACA.—The Federal Advisory Committee Act 14 shall apply to the Advisory Committee under this section 15 only to the extent that the provisions of such Act do not 16 conflict with the requirements of this section. 17 SEC. 308. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 18 PROGRAM. 19 Section 402E of the Higher Education Act of 1965 20 (20 U.S.C. 1070a–15) is amended by striking subsection 21 (g) and inserting the following: 22 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 23 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 24 ordinate with the Secretary of Health and Human Serv- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 169 •S 2474 IS ices to ensure that there is collaboration between the goals 1 of the program under this section and programs of the 2 Health Resources and Services Administration that pro- 3 mote health workforce diversity. The Secretary of Edu- 4 cation shall take such measures as may be necessary to 5 encourage participants in programs under this section to 6 consider health profession careers.’’. 7 SEC. 309. RULES FOR DETERMINATION OF FULL-TIME 8 EQUIVALENT RESIDENTS FOR COST REPORT- 9 ING PERIODS. 10 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 11 of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) 12 is amended— 13 (1) in subparagraph (E), by striking ‘‘Subject 14 to subparagraphs (J) and (K), such rules’’ and in- 15 serting ‘‘Subject to subparagraphs (J), (K), and (L), 16 such rules’’; 17 (2) in subparagraph (J), by striking ‘‘Such 18 rules’’ and inserting ‘‘Subject to subparagraph (L), 19 such rules’’; 20 (3) in subparagraph (K), by striking ‘‘In deter- 21 mining’’ and inserting ‘‘Subject to subparagraph 22 (L), in determining’’; and 23 (4) by adding at the end the following new sub- 24 paragraph: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 170 •S 2474 IS ‘‘(L) For purposes of cost-reporting peri- 1 ods beginning on or after the date of enactment 2 of the Health Equity and Accountability Act of 3 2012, in determining the hospital’s number of 4 full-time equivalent residents for purposes of 5 this subparagraph, all the time spent by an in- 6 tern or resident in an approved medical resi- 7 dency training program shall be counted toward 8 the determination of full-time equivalency if the 9 hospital— 10 ‘‘(i) is recognized as a subsection (d) 11 hospital; 12 ‘‘(ii) is recognized as a subsection (d) 13 Puerto Rico hospital; 14 ‘‘(iii) is reimbursed under a reim- 15 bursement system authorized under section 16 1814(b)(3); or 17 ‘‘(iv) is a provider-based hospital out- 18 patient department.’’. 19 (b) IME DETERMINATIONS.—Section 1886(d)(5)(B) 20 of such Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 21 (1) by redesignating clause (x), as added by 22 section 5505(b) of Public Law 111–148, as clause 23 (xi); and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 171 •S 2474 IS (2) in clause (xi), as redesignated by paragraph 1 (1)— 2 (A) in subclause (II), by striking ‘‘In de- 3 termining’’ and inserting ‘‘Subject to subclause 4 (IV), in determining’’; 5 (B) in subclause (III), by striking ‘‘In de- 6 termining’’ and inserting ‘‘Subject to subclause 7 (IV), in determining’’; and 8 (C) by adding at the end the following new 9 subclause: 10 ‘‘(IV) The provisions of subpara- 11 graph (L) of subsection (h)(4) shall 12 apply under this subparagraph in the 13 same manner as they apply under 14 such subsection.’’. 15 SEC. 310. DEVELOPING AND IMPLEMENTING STRATEGIES 16 FOR LOCAL HEALTH EQUITY. 17 (a) GRANTS.—The Secretaries of Health and Human 18 Services, Education, and Labor, acting jointly, shall make 19 grants to academic institutions 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 Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 172 •S 2474 IS (B) to serve as national models of driving 1 local health equity; 2 (2) in accordance with subsection (c), devel- 3 oping a strategic partnership with the community in 4 which the academic institution is located; and 5 (3) collecting data on, and periodically evalu- 6 ating, the effectiveness of the institution’s programs 7 funded through this section to enable the institution 8 to adapt accordingly for maximum efficiency and 9 success. 10 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 11 HEALTH EQUITY.—As a condition on receipt of a grant 12 under subsection (a), an academic institution shall agree 13 to use the grant to build an evidence base for successful 14 strategies for increasing local health equity, and to serve 15 as a national model of driving local health equity, by sup- 16 porting— 17 (1) resources to strengthen institutional metrics 18 and capacity to execute institutionwide health work- 19 force goals that can serve as models for increasing 20 health equity in communities across the country ; 21 (2) collaborations among a cohort of institu- 22 tions in implementing systemic change, partnership 23 development, and programmatic efforts supportive of 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 173 •S 2474 IS health equity goals across disciplines and popu- 1 lations; and 2 (3) enhanced or newly developed data systems 3 and research infrastructure capable of informing 4 current and future workforce efforts and building a 5 foundation for a broader research agenda targeting 6 urban health disparities. 7 (c) STRATEGIC PARTNERSHIPS.—As a condition on 8 receipt of a grant under subsection (a), an academic insti- 9 tution shall agree to use the grant to develop a strategic 10 partnership with the community in which the institution 11 is located for the purposes of— 12 (1) strengthening connections between the insti- 13 tution and the community— 14 (A) to improve evaluation of and address 15 the community’s health and health workforce 16 needs; and 17 (B) to engage the community in health 18 workforce development; 19 (2) developing, enhancing, or accelerating inno- 20 vative undergraduate and graduate programs in the 21 biomedical sciences and health professions; and 22 (3) strengthening the ‘‘birth to career’’ pipeline 23 in the biomedical sciences and health professions, in- 24 cluding by developing partnerships between institu- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 174 •S 2474 IS tions of higher education and elementary and sec- 1 ondary schools to recruit the next generation of 2 health professionals earlier in the pipeline to a 3 health care career. 4 SEC. 311. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 5 IORAL HEALTH SOCIAL WORKERS. 6 Section 455 of the Higher Education Act of 1965 (20 7 U.S.C. 1087e) is amended by adding at the end the fol- 8 lowing new subsection: 9 ‘‘(q) REPAYMENT PLAN FOR MENTAL AND BEHAV- 10 IORAL HEALTH SOCIAL WORKERS.— 11 ‘‘(1) IN GENERAL.—The Secretary shall cancel 12 the balance of interest and principal due on any eli- 13 gible Federal Direct Loan not in default for a bor- 14 rower who— 15 ‘‘(A) has made 120 monthly payments on 16 the eligible Federal Direct Loan after October 17 1, 2012, pursuant to any one or a combination 18 of the following— 19 ‘‘(i) payments under an income-based 20 repayment plan under section 493C; 21 ‘‘(ii) payments under a standard re- 22 payment plan under subsection (d)(1)(A), 23 based on a 10-year repayment period; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 175 •S 2474 IS ‘‘(iii) monthly payments under a re- 1 payment plan under subsection (d)(1) or 2 (g) of not less than the monthly amount 3 calculated under subsection (d)(1)(A), 4 based on a 10-year repayment period; or 5 ‘‘(iv) payments under an income con- 6 tingent repayment plan under subsection 7 (d)(1)(D); and 8 ‘‘(B)(i) is employed as a mental health or 9 behavioral health social worker, as defined by 10 the Secretary by regulation, at the time of such 11 forgiveness; and 12 ‘‘(ii) has been employed as such a mental 13 health or behavioral health social worker during 14 the period in which the borrower makes each of 15 the 120 payments as described in subparagraph 16 (A). 17 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 18 conclusion of the employment period described in 19 paragraph (1), the Secretary shall cancel the obliga- 20 tion to repay the balance of principal and interest 21 due as of the time of such cancellation, on the eligi- 22 ble Federal Direct Loans made to the borrower 23 under this part. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 176 •S 2474 IS ‘‘(3) DEFINITION OF ELIGIBLE FEDERAL DI- 1 RECT LOAN.—In this subsection, the term ‘eligible 2 Federal Direct Loan’ means a Federal Direct Staf- 3 ford Loan, Federal Direct PLUS Loan, Federal Di- 4 rect Unsubsidized Stafford Loan, or a Federal Di- 5 rect Consolidation Loan.’’. 6 TITLE IV—IMPROVEMENT OF 7 HEALTH CARE SERVICES 8 Subtitle A—Health Empowerment 9 Zones 10 SEC. 401. SHORT TITLE. 11 This subtitle may be cited as the ‘‘Health Empower- 12 ment Zone Act of 2012’’. 13 SEC. 402. FINDINGS. 14 The Congress finds the following: 15 (1) Numerous studies and reports, including 16 the National Healthcare Disparities Report and Un- 17 equal Treatment, the 2002 Institute of Medicine Re- 18 port, document the extensiveness to which health 19 disparities exist across the country. 20 (2) These studies have found that, on average, 21 racial and ethnic minorities are disproportionately 22 afflicted with chronic and acute conditions—such as 23 cancer, diabetes, and hypertension—and suffer 24 worse health outcomes, worse health status, and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 177 •S 2474 IS higher mortality rates than their White counter- 1 parts. 2 (3) Several recent studies also show that health 3 disparities are a function of not only access to health 4 care, but also the social determinants of health—in- 5 cluding the environment, the physical structure of 6 communities, nutrition and food options, educational 7 attainment, employment, race, ethnicity, geography, 8 and language preference—that directly and indi- 9 rectly affect the health, health care, and wellness of 10 individuals and communities. 11 (4) Integrally involving and fully supporting the 12 communities most affected by health inequities in 13 the assessment, planning, launch, and evaluation of 14 health disparity elimination efforts is among the 15 leading recommendations made to adequately ad- 16 dress and ultimately reduce health disparities. 17 (5) Recommendations also include supporting 18 the efforts of community stakeholders from a broad 19 cross section—including, but not limited to local 20 businesses, local departments of commerce, edu- 21 cation, labor, urban planning, and transportation, 22 and community-based and other nonprofit organiza- 23 tions—to find areas of common ground around 24 health disparity elimination and collaborate to im- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 178 •S 2474 IS prove the overall health and wellness of a community 1 and its residents. 2 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 3 ZONES. 4 (a) IN GENERAL.—At the request of an eligible com- 5 munity partnership, the Secretary may designate an eligi- 6 ble area as a health empowerment zone. 7 (b) ELIGIBILITY CRITERIA.— 8 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 9 community partnership is eligible to submit a re- 10 quest under this section if the partnership— 11 (A) demonstrates widespread public sup- 12 port from key individuals and entities in the eli- 13 gible area, including State and local govern- 14 ments, nonprofit organizations, and community 15 and industry leaders, for designation of the eli- 16 gible area as a health empowerment zone; and 17 (B) includes representatives of— 18 (i) a broad cross section of stake- 19 holders and residents from communities in 20 the eligible area experiencing dispropor- 21 tionate disparities in health status and 22 health care; and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 179 •S 2474 IS (ii) organizations, facilities, and insti- 1 tutions that have a history of working 2 within and serving such communities. 3 (2) ELIGIBLE AREA.—An area is eligible to be 4 designated as a health empowerment zone under this 5 section if one or more communities in the area expe- 6 rience disproportionate disparities in health status 7 and health care. In determining whether a commu- 8 nity experiences such disparities, the Secretary shall 9 consider the data collected by the Department of 10 Health and Human Services focusing on the fol- 11 lowing areas: 12 (A) Access to affordable high-quality 13 health services. 14 (B) Arthritis, osteoporosis, and chronic 15 back conditions. 16 (C) Cancer. 17 (D) Chronic kidney disease. 18 (E) Diabetes. 19 (F) Injury and violence prevention. 20 (G) Maternal, infant, and child health. 21 (H) Medical product safety. 22 (I) Mental health and mental disorders. 23 (J) Nutrition and overweight. 24 (K) Disability and secondary conditions. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 180 •S 2474 IS (L) Educational and community-based 1 health programs. 2 (M) Environmental health. 3 (N) Family planning. 4 (O) Food safety. 5 (P) Health communication. 6 (Q) Health disease and stroke. 7 (R) HIV/AIDS. 8 (S) Immunization and infectious diseases. 9 (T) Occupational safety and health. 10 (U) Oral health. 11 (V) Physical activity and fitness. 12 (W) Public health infrastructure. 13 (X) Respiratory diseases. 14 (Y) Sexually transmitted diseases. 15 (Z) Substance abuse. 16 (AA) Tobacco use. 17 (BB) Vision and hearing. 18 (CC) The degree to which those who have 19 disabilities have access to health services, in- 20 cluding physical activity and fitness, including 21 the ability to physically access the locations 22 where such services are provided. 23 (c) PROCEDURE.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 181 •S 2474 IS (1) REQUEST.—A request under subsection (a) 1 shall— 2 (A) describe the bounds of the area to be 3 designated as a health empowerment zone and 4 the process used to select those bounds; 5 (B) demonstrate that the partnership sub- 6 mitting the request is an eligible community 7 partnership described in subsection (b)(1); 8 (C) demonstrate that the area is an eligible 9 area described in subsection (b)(2); 10 (D) include a comprehensive assessment of 11 disparities in health status and health care ex- 12 perience by one or more communities in the 13 area; 14 (E) set forth— 15 (i) a vision and a set of values for the 16 area; and 17 (ii) a comprehensive and holistic set of 18 goals to be achieved in the area through 19 designation as a health empowerment zone; 20 and 21 (F) include a strategic plan for achieving 22 the goals described in subparagraph (E)(ii). 23 (2) APPROVAL.—Not later than 60 days after 24 the receipt of a request for designation of an area 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 182 •S 2474 IS as a health empowerment zone under this section, 1 the Secretary shall approve or disapprove the re- 2 quest. 3 (d) MINIMUM NUMBER.—The Secretary— 4 (1) shall designate not more than 110 health 5 empowerment zones under this section; and 6 (2) shall designate at least one health empower- 7 ment zone in each of the several States, the District 8 of Columbia, and each territory or possession of the 9 United States. 10 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 11 At the request of any organization or entity seeking 12 to submit a request under section 403(a), the Secretary 13 shall provide technical assistance, and may award a grant, 14 to assist such organization or entity— 15 (1) to form an eligible community partnership 16 described in section 403(b)(1); 17 (2) to complete a health assessment, including 18 an assessment of health disparities under section 19 403(c)(1)(D); or 20 (3) to prepare and submit a request, including 21 a strategic plan, in accordance with section 403. 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 183 •S 2474 IS SEC. 405. BENEFITS OF DESIGNATION. 1 (a) PRIORITY.—In awarding any competitive grant, 2 a Federal official shall give priority to any applicant 3 that— 4 (1) meets the eligibility criteria for the grant; 5 (2) proposes to use the grant for activities in a 6 health empowerment zone; and 7 (3) demonstrates that such activities will di- 8 rectly and significantly further the goals of the stra- 9 tegic plan approved for such zone under section 403. 10 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 11 STRATEGIC PLAN.— 12 (1) IN GENERAL.—Upon designating an eligible 13 area as a health empowerment zone at the request 14 of an eligible community partnership, the Secretary 15 shall, subject to the availability of appropriations, 16 make a grant to the community partnership for im- 17 plementation of the strategic plan for such zone. 18 (2) GRANT PERIOD.—A grant under paragraph 19 (1) for a health empowerment zone shall be for a pe- 20 riod of 2 years and may be renewed, except that the 21 total period of grants under paragraph (1) for such 22 zone may not exceed 10 years. 23 (3) LIMITATION.—In awarding grants under 24 this subsection, the Secretary shall not give less pri- 25 ority to an applicant or reduce the amount of a 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 184 •S 2474 IS grant because the Secretary rendered technical as- 1 sistance or made a grant to the same applicant 2 under section 404. 3 (4) REPORTING.—The Secretary shall require 4 each recipient of a grant under this subsection to re- 5 port to the Secretary not less than every 6 months 6 on the progress in implementing the strategic plan 7 for the health empowerment zone. 8 SEC. 406. DEFINITION. 9 In this subtitle, the term ‘‘Secretary’’ means the Sec- 10 retary of Health and Human Services, acting through the 11 Administrator of the Health Resources and Services Ad- 12 ministration and the Deputy Assistant Secretary for Mi- 13 nority Health, and in cooperation with the Director of the 14 Office of Community Services and the Director of the Na- 15 tional Institute for Minority Health and Health Dispari- 16 ties. 17 Subtitle B—Other Improvements of 18 Health Care Services 19 CHAPTER 1—EXPANSION OF COVERAGE 20 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 21 ACT. 22 Title XXXIV of the Public Health Service Act, as 23 amended by titles I, II, III, and IX of this Act, is further 24 amended by inserting after subtitle C the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 185 •S 2474 IS ‘‘Subtitle D—Reconstruction and 1 Improvement Grants for Public 2 Health Care Facilities Serving 3 Pacific Islanders and the Insu- 4 lar Areas 5 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 6 INITIATIVES. 7 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 8 with the Administrator of the Health Resources and Serv- 9 ices Administration, the Director of the Agency for 10 Healthcare Research and Quality, and the Administrator 11 of the Centers for Medicare & Medicaid Services, shall 12 award grants to eligible entities for the conduct of dem- 13 onstration projects to improve the quality of and access 14 to health care. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be a health center, hospital, health plan, 18 health system, community clinic. or other health en- 19 tity determined appropriate by the Secretary— 20 ‘‘(A) that, by legal mandate or explicitly 21 adopted mission, provides patients with access 22 to services regardless of their ability to pay; 23 ‘‘(B) that provides care or treatment for a 24 substantial number of patients who are unin- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 186 •S 2474 IS sured, are receiving assistance under a State 1 program under title XIX of the Social Security 2 Act, or are members of vulnerable populations, 3 as determined by the Secretary; and 4 ‘‘(C)(i) with respect to which, not less than 5 50 percent of the entity’s patient population is 6 made up of racial and ethnic minorities; or 7 ‘‘(ii) that— 8 ‘‘(I) serves a disproportionate percent- 9 age of local, minority racial and ethnic pa- 10 tients, or that has a patient population, at 11 least 50 percent of which is limited-English 12 proficient; and 13 ‘‘(II) provides an assurance that 14 amounts received under the grant will be 15 used only to support quality improvement 16 activities in the racial and ethnic popu- 17 lation served; and 18 ‘‘(2) prepare and submit to the Secretary an 19 application at such time, in such manner, and con- 20 taining such information as the Secretary may re- 21 quire. 22 ‘‘(c) PRIORITY.—In awarding grants under sub- 23 section (a), the Secretary shall give priority to applicants 24 under subsection (b)(2) that— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 187 •S 2474 IS ‘‘(1) demonstrate an intent to operate as part 1 of a health care partnership, network, collaborative, 2 coalition, or alliance where each member entity con- 3 tributes to the design, implementation, and evalua- 4 tion of the proposed intervention; or 5 ‘‘(2) intend to use funds to carry out system- 6 wide changes with respect to health care quality im- 7 provement, including— 8 ‘‘(A) improved systems for data collection 9 and reporting; 10 ‘‘(B) innovative collaborative or similar 11 processes; 12 ‘‘(C) group programs with behavioral or 13 self-management interventions; 14 ‘‘(D) case management services; 15 ‘‘(E) physician or patient reminder sys- 16 tems; 17 ‘‘(F) educational interventions; or 18 ‘‘(G) other activities determined appro- 19 priate by the Secretary. 20 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 21 received under a grant under subsection (a) to support 22 the implementation and evaluation of health care quality 23 improvement activities or minority health and health care 24 disparity reduction activities that include— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 188 •S 2474 IS ‘‘(1) with respect to health care systems, activi- 1 ties relating to improving— 2 ‘‘(A) patient safety; 3 ‘‘(B) timeliness of care; 4 ‘‘(C) effectiveness of care; 5 ‘‘(D) efficiency of care; 6 ‘‘(E) patient centeredness; and 7 ‘‘(F) health information technology; and 8 ‘‘(2) with respect to patients, activities relating 9 to— 10 ‘‘(A) staying healthy; 11 ‘‘(B) getting well; 12 ‘‘(C) living with illness or disability; and 13 ‘‘(D) coping with end-of-life issues. 14 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 15 provide financial and other technical assistance to grant- 16 ees under this section for the development of common data 17 systems. 18 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration, shall designate centers of excellence at 22 public hospitals, and other health systems serving large 23 numbers of minority patients, that— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 189 •S 2474 IS ‘‘(1) meet the requirements of section 1 3451(b)(1); 2 ‘‘(2) demonstrate excellence in providing care to 3 minority populations; and 4 ‘‘(3) demonstrate excellence in reducing dispari- 5 ties in health and health care. 6 ‘‘(b) REQUIREMENTS.—A hospital or health system 7 that serves as a Center of Excellence under subsection (a) 8 shall— 9 ‘‘(1) design, implement, and evaluate programs 10 and policies relating to the delivery of care in ra- 11 cially, ethnically, and linguistically diverse popu- 12 lations; 13 ‘‘(2) provide training and technical assistance 14 to other hospitals and health systems relating to the 15 provision of quality health care to minority popu- 16 lations; and 17 ‘‘(3) develop activities for graduate or con- 18 tinuing medical education that institutionalize a 19 focus on cultural competence training for health care 20 providers. 21 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 190 •S 2474 IS ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 1 FOR PUBLIC HEALTH CARE FACILITIES SERV- 2 ING PACIFIC ISLANDERS AND THE INSULAR 3 AREAS. 4 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 5 rect financial assistance to designated health care pro- 6 viders and community health centers in American Samoa, 7 Guam, the Commonwealth of the Northern Mariana Is- 8 lands, the United States Virgin Islands, Puerto Rico, and 9 Hawaii for the purposes of reconstructing and improving 10 health care facilities and services. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 12 nancial assistance under subsection (a), an entity shall be 13 a public health facility or community health center located 14 in American Samoa, Guam, the Commonwealth of the 15 Northern Mariana Islands, the United States Virgin Is- 16 lands, Puerto Rico, or Hawaii that— 17 ‘‘(1) is owned or operated by— 18 ‘‘(A) the Government of American Samoa, 19 Guam, the Commonwealth of the Northern 20 Mariana Islands, the United States Virgin Is- 21 lands, Puerto Rico, or Hawaii or a unit of local 22 government; or 23 ‘‘(B) a nonprofit organization; and 24 ‘‘(2)(A) provides care or treatment for a sub- 25 stantial number of patients who are uninsured, re- 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 191 •S 2474 IS ceiving assistance under a State program under a 1 title XVIII of the Social Security Act, or a State 2 program under title XIX of such Act, or who are 3 members of a vulnerable population, as determined 4 by the Secretary; or 5 ‘‘(B) serves a disproportionate percentage of 6 local, minority racial and ethnic patients. 7 ‘‘(c) REPORT.—Not later than 180 days after the 8 date of enactment of this title and annually thereafter, the 9 Secretary shall submit to the Congress and the President 10 a report that includes an assessment of health resources 11 and facilities serving populations in American Samoa, 12 Guam, the Commonwealth of the Northern Mariana Is- 13 lands, the United States Virgin Islands, Puerto Rico, and 14 Hawaii. In preparing such report, the Secretary shall— 15 ‘‘(1) consult with and obtain information on all 16 health care facilities needs from the entities de- 17 scribed in subsection (b); 18 ‘‘(2) include all amounts of Federal assistance 19 received by each entity in the preceding fiscal year; 20 ‘‘(3) review the total unmet needs of each juris- 21 diction for health care facilities, including needs for 22 renovation and expansion of existing facilities; and 23 ‘‘(4) include a strategic plan for addressing the 24 needs of each jurisdiction identified in the report.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 192 •S 2474 IS SEC. 412. REMOVING BARRIERS TO UNSUBSIDIZED PUR- 1 CHASE OF PRIVATE INSURANCE IN AMER- 2 ICAN HEALTH BENEFIT EXCHANGES. 3 (a) IN GENERAL.—Section 1312(f) of the Patient 4 Protection and Affordable Care Act (42 U.S.C.18032(f)) 5 is amended— 6 (1) in the subsection heading, by striking the 7 semicolon and all that follows through ‘‘RESI- 8 DENTS’’; and 9 (2) by striking paragraph (3). 10 (b) CONFORMING AMENDMENT.—Section 1411(a)(1) 11 of such Act (42 U.S.C. 18081(a)(1)) is amended by strik- 12 ing ‘‘1312(f)(3),’’. 13 SEC. 413. STUDY ON THE UNINSURED. 14 (a) IN GENERAL.—The Secretary of Health and 15 Human Services shall— 16 (1) conduct a study on the demographic charac- 17 teristics of the population of individuals who do not 18 have health insurance coverage; and 19 (2) predict, based on such study, the demo- 20 graphic characteristics of the population of individ- 21 uals who will not have health insurance coverage 22 after January 1, 2014. 23 (b) REPORTING REQUIREMENTS.— 24 (1) IN GENERAL.—Not later than 12 months 25 after the date of the enactment of this Act, the Sec- 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 193 •S 2474 IS retary shall submit to the Congress the results of 1 the study under subsection (a)(1) and the prediction 2 made under subsection (a)(2). 3 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 4 ISTICS.—The Secretary shall report the demographic 5 characteristics under paragraphs (1) and (2) of sub- 6 section (a) on the basis of racial and ethnic group, 7 and shall stratify the reporting on each racial and 8 ethnic group by other demographic characteristics 9 that can impact access to health insurance coverage, 10 such as sexual orientation, gender identity, primary 11 language, disability status, sex, socioeconomic sta- 12 tus, and citizenship and immigration status, in a 13 manner consistent with title I of this Act. 14 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI- 15 TORIES. 16 (a) ELIMINATION OF FUNDING LIMITATIONS FOR 17 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 18 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR- 19 IANA ISLANDS, AND AMERICAN SAMOA.— 20 (1) IN GENERAL.—Section 1108 of the Social 21 Security Act (42 U.S.C. 1308) is amended— 22 (A) in subsection (f), in the matter before 23 paragraph (1), by striking ‘‘subsection (g)’’ and 24 inserting ‘‘subsections (g) and (h)’’; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 194 •S 2474 IS (B) in subsection (g)(2), in the matter be- 1 fore subparagraph (A), by inserting ‘‘and sub- 2 section (h) of this Act’’ after ‘‘paragraphs (3) 3 and (5)’’; and 4 (C) by adding at the end the following new 5 subsection: 6 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER- 7 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 8 THE COMMONWEALTH OF THE NORTHERN MARIANA IS- 9 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 10 shall not apply to Puerto Rico, the United States Virgin 11 Islands, Guam, the Commonwealth of the Northern Mar- 12 iana Islands, and American Samoa for any fiscal year 13 after fiscal year 2011.’’. 14 (2) CONFORMING AMENDMENT.—Section 15 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend- 16 ed by striking paragraph (4). 17 (3) EFFECTIVE DATE.—The amendments made 18 by this subsection shall apply beginning with fiscal 19 year 2012. 20 (b) PARITY IN FMAP.— 21 (1) IN GENERAL.—The first sentence of section 22 1905(b) of such Act (42 U.S.C. 1396d(b)) is amend- 23 ed by inserting after ‘‘shall be 50 per centum’’ the 24 following: ‘‘(except that, beginning with fiscal year 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 195 •S 2474 IS 2014, the Federal medical assistance percentage for 1 Puerto Rico, the United States Virgin Islands, 2 Guam, the Commonwealth of the Northern Mariana 3 Islands, and American Samoa shall be the Federal 4 medical assistance percentage determined by the 5 Secretary in consultation (for the United States Vir- 6 gin Islands, Guam, the Commonwealth of the North- 7 ern Mariana Islands, and American Samoa) with the 8 Secretary of the Interior)’’. 9 (2) 2-FISCAL-YEAR TRANSITION.—Notwith- 10 standing any other provision of law, during fiscal 11 years 2012 and 2013, the Federal medical assist- 12 ance percentage established under section 1905(b) of 13 the Social Security Act (42 U.S.C. 1396d(b)) for 14 Puerto Rico, the United States Virgin Islands, 15 Guam, the Commonwealth of the Northern Mariana 16 Islands, and American Samoa shall be the highest 17 such Federal medical assistance percentage applica- 18 ble to any of the 50 States or the District of Colum- 19 bia for the fiscal year involved, taking into account 20 the application of subsections (a) and (b)(1) of 5001 21 of division B of the American Recovery and Rein- 22 vestment Act of 2009 (Public Law 111–5) to such 23 States and District of Columbia for calendar quar- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 196 •S 2474 IS ters during such fiscal years for which such sub- 1 sections apply respectively. 2 (3) PER CAPITA INCOME DATA.— 3 (A) REPORT TO CONGRESS.—Not later 4 than October 1, 2012, the Secretary of Health 5 and Human Services shall submit to Congress 6 a report that describes the per capita income 7 data used to promulgate the Federal medical 8 assistance percentage in the territories and how 9 such data differ from the per capita income 10 data used to promulgate Federal medical assist- 11 ance percentages for the 50 States and the Dis- 12 trict of Columbia. The report should include 13 recommendations on how the Federal medical 14 assistance percentages can be calculated for the 15 territories to ensure parity with the 50 States 16 and the District of Columbia. 17 (B) APPLICATION.—Section 1101(a)(8)(B) 18 of the Social Security Act (42 U.S.C. 19 1308(a)(8)(B)) is amended— 20 (i) by striking ‘‘(other than Puerto 21 Rico, the United States Virgin Islands, and 22 Guam)’’ and inserting ‘‘(including Puerto 23 Rico, the United States Virgin Islands, 24 Guam, the Commonwealth of the Northern 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 197 •S 2474 IS Mariana Islands, and American Samoa)’’; 1 and 2 (ii) by inserting ‘‘(or, if such satisfac- 3 tory data are not available in the case of 4 the Virgin Islands, Guam, the Northern 5 Mariana Islands, or American Samoa, sat- 6 isfactory data available from the Depart- 7 ment of the Interior for the same period, 8 or if such satisfactory data are not avail- 9 able in the case of Puerto Rico, satisfac- 10 tory data available from the government of 11 the Commonwealth of Puerto Rico for the 12 same period)’’ after ‘‘Department of Com- 13 merce’’. 14 (4) RELATION TO AMERICAN RECOVERY AND 15 REINVESTMENT ACT OF 2009.—For any period and 16 territory in which the provisions of this subsection 17 apply to a territory, the provisions of section 18 5001(b)(2) of division B of the American Recovery 19 and Reinvestment Act of 2009 (Public Law 111–5) 20 shall not apply (except as otherwise specifically pro- 21 vided in paragraph (2)). 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 198 •S 2474 IS SEC. 415. MEDICAID ELIGIBILITY FOR CITIZENS OF FREELY 1 ASSOCIATED STATES. 2 (a) IN GENERAL.—Section 402(b)(2) of the Personal 3 Responsibility and Work Opportunity Reconciliation Act 4 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 5 the end the following: 6 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 7 OF FREELY ASSOCIATED STATES.—With respect 8 to eligibility for benefits for the program de- 9 fined in paragraph (3)(C) (relating to Med- 10 icaid), paragraph (1) shall not apply to any in- 11 dividual who lawfully resides in the United 12 States (including territories and possessions of 13 the United States) in accordance with— 14 ‘‘(i) section 141 of the Compact of 15 Free Association between the Government 16 of the United States and the Government 17 of the Federated States of Micronesia, ap- 18 proved by Congress in the Compact of 19 Free Association Amendments Act of 20 2003; 21 ‘‘(ii) section 141 of the Compact of 22 Free Association between the Government 23 of the United States and the Government 24 of the Republic of the Marshall Islands, 25 approved by Congress in the Compact of 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 199 •S 2474 IS Free Association Amendments Act of 1 2003; or 2 ‘‘(iii) section 141 of the Compact of 3 Free Association between the Government 4 of the United States and the Government 5 of Palau, approved by Congress in Public 6 Law 99–658 (100 Stat. 3672).’’. 7 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 8 Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend- 9 ed— 10 (1) in paragraph (1), by striking ‘‘or’’ at the 11 end; 12 (2) in paragraph (2), by striking the period at 13 the end and inserting ‘‘; or’’; and 14 (3) by adding at the end the following new 15 paragraph: 16 ‘‘(3) an individual described in section 17 402(b)(2)(G), but only with respect to the des- 18 ignated Federal program defined in section 19 402(b)(3)(C).’’. 20 (c) DEFINITION OF QUALIFIED ALIEN.—Section 21 431(b) of the Personal Responsibility and Work Oppor- 22 tunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is 23 amended— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 200 •S 2474 IS (1) in paragraph (6), by striking ‘‘or’’ at the 1 end; 2 (2) in paragraph (7), by striking the period at 3 the end and inserting ‘‘; or’’; and 4 (3) by adding at the end the following: 5 ‘‘(8) an individual who lawfully resides in the 6 United States (including territories and possessions 7 of the United States) in accordance with a Compact 8 of Free Association referred to in section 9 402(b)(2)(G).’’. 10 (d) CONFORMING AMENDMENTS.—Section 1108 of 11 the Social Security Act (42 U.S.C. 1308) is amended— 12 (1) in subsection (f), in the matter preceding 13 paragraph (1), by striking ‘‘subsection (g)’’ and in- 14 serting ‘‘subsections (g) and (h)’’; and 15 (2) by adding at the end the following: 16 ‘‘(h) The limitations of subsections (f) and (g) shall 17 not apply with respect to medical assistance provided to 18 an individual described in section 431(b)(8) of the Per- 19 sonal Responsibility and Work Opportunity Reconciliation 20 Act of 1996.’’. 21 (e) EFFECTIVE DATE.—The amendments made by 22 this section take effect on the date of enactment of this 23 Act and apply to benefits for items and services furnished 24 on or after that date. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 201 •S 2474 IS SEC. 416. EXTENSION OF MEDICARE SECONDARY PAYER. 1 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 2 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 3 ed— 4 (1) in the last sentence, by inserting ‘‘, and be- 5 fore January 1, 2013’’ after ‘‘prior to such date)’’; 6 and 7 (2) by adding at the end the following new sen- 8 tence: ‘‘Effective for items and services furnished on 9 or after January 1, 2013 (with respect to periods 10 beginning on or after the date that is 42 months 11 prior to such date), clauses (i) and (ii) shall be ap- 12 plied by substituting ‘42-month’ for ‘12-month’ each 13 place it appears in the first sentence.’’. 14 (b) EFFECTIVE DATE.—The amendments made by 15 this subsection shall take effect on the date of enactment 16 of this Act. For purposes of determining an individual’s 17 status under section 1862(b)(1)(C) of the Social Security 18 Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para- 19 graph (1), an individual who is within the coordinating 20 period as of the date of enactment of this Act shall have 21 that period extended to the full 42 months described in 22 the last sentence of such section, as added by the amend- 23 ment made by paragraph (1)(B). 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 202 •S 2474 IS SEC. 417. BORDER HEALTH GRANTS. 1 (a) ELIGIBLE ENTITY DEFINED.—In this section, 2 the term ‘‘eligible entity’’ means a State, public institution 3 of higher education, local government, tribal government, 4 nonprofit health organization, community health center, or 5 community clinic receiving assistance under section 330 6 of the Public Health Service Act (42 U.S.C. 254b), that 7 is located in the border area. 8 (b) AUTHORIZATION.—The Secretary of Health and 9 Human Services (in this section referred to as the ‘‘Sec- 10 retary’’), acting through the United States members of the 11 United States-Mexico Border Health Commission, shall 12 award grants to eligible entities to address priorities and 13 recommendations to improve the health of border area 14 residents that are established by— 15 (1) the United States members of the United 16 States-Mexico Border Health Commission; 17 (2) the State border health offices; and 18 (3) the Secretary. 19 (c) APPLICATION.—An eligible entity that desires a 20 grant under subsection (b) shall submit an application to 21 the Secretary at such time, in such manner, and con- 22 taining such information as the Secretary may require. 23 (d) USE OF FUNDS.—An eligible entity that receives 24 a grant under subsection (b) shall use the grant funds 25 for— 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 203 •S 2474 IS (1) programs relating to— 1 (A) maternal and child health; 2 (B) primary care and preventative health; 3 (C) public health and public health infra- 4 structure; 5 (D) health education and promotion; 6 (E) oral health; 7 (F) mental and behavioral health; 8 (G) substance abuse; 9 (H) health conditions that have a high 10 prevalence in the border area; 11 (I) medical and health services research; 12 (J) workforce training and development; 13 (K) community health workers or 14 promotoras; 15 (L) health care infrastructure problems in 16 the border area (including planning and con- 17 struction grants); 18 (M) health disparities in the border area; 19 (N) environmental health; and 20 (O) outreach and enrollment services with 21 respect to Federal programs (including pro- 22 grams authorized under titles XIX and XXI of 23 the Social Security Act (42 U.S.C. 1396 and 24 1397aa)); and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 204 •S 2474 IS (2) other programs determined appropriate by 1 the Secretary. 2 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 3 vided to an eligible entity awarded a grant under sub- 4 section (b) shall be used to supplement and not supplant 5 other funds available to the eligible entity to carry out the 6 activities described in subsection (d). 7 (f) PRIMARY CARE DEFINITION.—In this Act, the 8 term ‘‘primary care’’ includes obstetrical and gynecological 9 care and psychiatric and mental health care. 10 SEC. 418. REMOVING MEDICARE BARRIERS TO HEALTH 11 CARE. 12 (a) PART A.—Section 1818(a)(3) of the Social Secu- 13 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 14 ‘‘(B) an alien’’ and all that follows through the comma 15 and inserting ‘‘(B) an individual who is lawfully present 16 in the United States,’’. 17 (b) PART B.—Section 1836(2) of the Social Security 18 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘(B) an 19 alien’’ and all that follows through the comma and insert- 20 ing ‘‘(B) an individual who is lawfully present in the 21 United States,’’. 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 205 •S 2474 IS SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 1 PROVIDED BY URBAN INDIAN HEALTH CEN- 2 TERS. 3 (a) IN GENERAL.—Section 1905(b) of the Social Se- 4 curity Act (42 U.S.C. 1396(b)), as amended by section 5 414(b)(1), is amended by striking ‘‘or by an Indian tribe 6 or tribal organization (as defined in section 4 of the Indian 7 Health Care Improvement Act)’’ and inserting ‘‘, by an 8 Indian tribe or tribal organization (as defined in section 9 4 of the Indian Health Care Improvement Act), or are 10 received through a program operated by an urban Indian 11 organization through a grant or contract under section 12 502 of the Indian Health Care Improvement Act’’. 13 (b) EFFECTIVE DATE.—The amendment made by 14 this section shall apply to medical assistance provided on 15 or after the date of enactment of this Act. 16 SEC. 420. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 17 PROVIDED TO A NATIVE HAWAIIAN THROUGH 18 A FEDERALLY QUALIFIED HEALTH CENTER 19 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 20 TEM UNDER THE MEDICAID PROGRAM. 21 (a) IN GENERAL.—The third sentence of section 22 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 23 as amended by section 419, is amended by inserting ‘‘; 24 and, with respect to medical assistance provided to a Na- 25 tive Hawaiian (as defined in section 12(2) of the Native 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 206 •S 2474 IS Hawaiian Health Care Improvement Act) through a feder- 1 ally qualified health center or a Native Hawaiian health 2 care system (as defined in section 12(6) of such Act), 3 whether directly, by referral, or under contract or other 4 arrangement between such federally qualified health cen- 5 ter or Native Hawaiian health care system and another 6 health care provider’’ before the period. 7 (b) EFFECTIVE DATE.—The amendment made by 8 this section shall apply to medical assistance provided on 9 or after the date of enactment of this Act. 10 CHAPTER 2—EXPANSION OF ACCESS 11 SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 12 TO COMMUNITY HEALTH. 13 (a) PURPOSE.—It is the purpose of this section to 14 provide for the awarding of grants to assist communities 15 in mobilizing and organizing resources in support of effec- 16 tive and sustainable programs that will reduce or eliminate 17 disparities in health and health care experienced by racial 18 and ethnic minority individuals. 19 (b) AUTHORITY TO AWARD GRANTS.—The Sec- 20 retary, acting through the Centers for Disease Control and 21 Prevention, shall award grants to eligible entities to assist 22 in designing, implementing, and evaluating culturally and 23 linguistically appropriate, science-based, and community- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 207 •S 2474 IS driven sustainable strategies to eliminate racial and ethnic 1 health and health care disparities. 2 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 3 grant under this section, an entity shall— 4 (1) represent a coalition— 5 (A) whose principal purpose is to develop 6 and implement interventions to reduce or elimi- 7 nate a health or health care disparity in a tar- 8 geted racial or ethnic minority group in the 9 community served by the coalition; and 10 (B) that includes— 11 (i) members selected from among— 12 (I) public health departments; 13 (II) community-based organiza- 14 tions; 15 (III) university and research or- 16 ganizations; 17 (IV) American Indian tribal or- 18 ganizations, national American Indian 19 organizations, Indian Health Service, 20 or organizations serving Alaska Na- 21 tives; and 22 (V) interested public or private 23 health care providers or organizations 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 208 •S 2474 IS as deemed appropriate by the Sec- 1 retary; and 2 (ii) at least 1 member from a commu- 3 nity-based organization that represents the 4 targeted racial or ethnic minority group; 5 and 6 (2) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require, which shall 9 include— 10 (A) a description of the targeted racial or 11 ethnic populations in the community to be 12 served under the grant; 13 (B) a description of at least 1 health dis- 14 parity that exists in the racial or ethnic tar- 15 geted populations, including health issues such 16 as infant mortality, breast and cervical cancer 17 screening and management, cardiovascular dis- 18 ease, diabetes, child and adult immunization 19 levels, or other health priority areas as des- 20 ignated by the Secretary; and 21 (C) a demonstration of a proven record of 22 accomplishment of the coalition members in 23 serving and working with the targeted commu- 24 nity. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 209 •S 2474 IS (d) SUSTAINABILITY.—The Secretary shall give pri- 1 ority to an eligible entity under this section if the entity 2 agrees that, with respect to the costs to be incurred by 3 the entity in carrying out the activities for which the grant 4 was awarded, the entity (and each of the participating 5 partners in the coalition represented by the entity) will 6 maintain its expenditures of non-Federal funds for such 7 activities at a level that is not less than the level of such 8 expenditures during the fiscal year immediately preceding 9 the first fiscal year for which the grant is awarded. 10 (e) NONDUPLICATION.—Funds provided through this 11 grant program should supplement, not supplant, existing 12 Federal funding, and the funds should not be used to du- 13 plicate the activities of the other health disparity grant 14 programs in this Act. 15 (f) TECHNICAL ASSISTANCE.—The Secretary may, 16 either directly or by grant or contract, provide any entity 17 that receives a grant under this section with technical and 18 other nonfinancial assistance necessary to meet the re- 19 quirements of this section. 20 (g) DISSEMINATION.—The Secretary shall encourage 21 and enable grantees to share best practices, evaluation re- 22 sults, and reports with communities not affiliated with 23 grantees using the Internet, conferences, and other perti- 24 nent information regarding the projects funded by this 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 210 •S 2474 IS section, including the outreach efforts of the Office of Mi- 1 nority Health and Health Disparity Elimination and the 2 Centers for Disease Control and Prevention. 3 (h) ADMINISTRATIVE BURDENS.—The Secretary 4 shall make every effort to minimize duplicative or unneces- 5 sary administrative burdens on grantees. 6 SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 7 (a) ELIMINATION OF ISOLATION TEST FOR COST- 8 BASED AMBULANCE REIMBURSEMENT.— 9 (1) IN GENERAL.—Section 1834(l)(8) of the 10 Social Security Act (42 U.S.C. 1395m(l)(8)) is 11 amended— 12 (A) in subparagraph (B)— 13 (i) by striking ‘‘owned and’’; and 14 (ii) by inserting ‘‘(including when 15 such services are provided by the entity 16 under an arrangement with the hospital)’’ 17 after ‘‘hospital’’; and 18 (B) by striking the comma at the end of 19 subparagraph (B) and all that follows and in- 20 serting a period. 21 (2) EFFECTIVE DATE.—The amendments made 22 by this subsection shall apply to services furnished 23 on or after January 1, 2013. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 211 •S 2474 IS (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 1 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 2 REQUIREMENT.— 3 (1) IN GENERAL.—Section 1820(c)(2) of the 4 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 5 amended— 6 (A) in subparagraph (B)(iii), by striking 7 ‘‘provides not more than’’ and inserting ‘‘sub- 8 ject to subparagraph (F), provides not more 9 than’’; and 10 (B) by adding at the end the following new 11 subparagraph: 12 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 13 LIMIT REQUIREMENT.— 14 ‘‘(i) IN GENERAL.—A State may elect 15 to treat a facility, with respect to the des- 16 ignation of the facility for a cost reporting 17 period, as satisfying the requirement of 18 subparagraph (B)(iii) relating to a max- 19 imum number of acute care inpatient beds 20 if the facility elects, in accordance with a 21 method specified by the Secretary and be- 22 fore the beginning of the cost reporting pe- 23 riod, to meet the requirement under clause 24 (ii). 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 212 •S 2474 IS ‘‘(ii) ALTERNATE REQUIREMENT.— 1 The requirement under this clause, with 2 respect to a facility and a cost reporting 3 period, is that the total number of inpa- 4 tient bed days described in subparagraph 5 (B)(iii) during such period will not exceed 6 7,300. For purposes of this subparagraph, 7 an individual who is an inpatient in a bed 8 in the facility for a single day shall be 9 counted as one inpatient bed day. 10 ‘‘(iii) WITHDRAWAL OF ELECTION.— 11 The option described in clause (i) shall not 12 apply to a facility for a cost reporting pe- 13 riod if the facility (for any two consecutive 14 cost-reporting periods during the previous 15 5 cost-reporting periods) was treated under 16 such option and had a total number of in- 17 patient bed days for each of such two cost- 18 reporting periods that exceeded the num- 19 ber specified in such clause.’’. 20 (2) EFFECTIVE DATE.—The amendments made 21 by paragraph (1) shall apply to cost-reporting peri- 22 ods beginning on or after the date of the enactment 23 of this Act. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 213 •S 2474 IS SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS- 1 PITAL (RCH) PROGRAM. 2 (a) IN GENERAL.—Section 1861 of the Social Secu- 3 rity Act (42 U.S.C. 1395x), as amended by section 4 203(b)(1)(A), is amended by adding at the end of the fol- 5 lowing new subsection: 6 ‘‘Rural Community Hospital; Rural Community Hospital 7 Services 8 ‘‘(jjj)(1) The term ‘rural community hospital’ means 9 a hospital (as defined in subsection (e)) that— 10 ‘‘(A) is located in a rural area (as defined in 11 section 1886(d)(2)(D)) or treated as being so lo- 12 cated pursuant to section 1886(d)(8)(E); 13 ‘‘(B) subject to paragraph (2), has less than 51 14 acute care inpatient beds, as reported in its most re- 15 cent cost report; 16 ‘‘(C) makes available 24-hour emergency care 17 services; 18 ‘‘(D) subject to paragraph (3), has a provider 19 agreement in effect with the Secretary and is open 20 to the public as of January 1, 2010; and 21 ‘‘(E) applies to the Secretary for such designa- 22 tion. 23 ‘‘(2) For purposes of paragraph (1)(B), beds in a 24 psychiatric or rehabilitation unit of the hospital which is 25 a distinct part of the hospital shall not be counted. 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 214 •S 2474 IS ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 1 hibit any of the following from qualifying as a rural com- 2 munity hospital: 3 ‘‘(A) A replacement facility (as defined by the 4 Secretary in regulations in effect on January 1, 5 2012) with the same service area (as defined by the 6 Secretary in regulations in effect on such date). 7 ‘‘(B) A facility obtaining a new provider num- 8 ber pursuant to a change of ownership. 9 ‘‘(C) A facility which has a binding written 10 agreement with an outside, unrelated party for the 11 construction, reconstruction, lease, rental, or financ- 12 ing of a building as of January 1, 2012. 13 ‘‘(4) Nothing in this subsection shall be construed as 14 prohibiting a critical access hospital from qualifying as a 15 rural community hospital if the critical access hospital 16 meets the conditions otherwise applicable to hospitals 17 under subsection (e) and section 1866. 18 ‘‘(5) Nothing in this subsection shall be construed as 19 prohibiting a rural community hospital participating in 20 the demonstration program under section 410A of the 21 Medicare Prescription Drug, Improvement, and Mod- 22 ernization Act of 2003 (Public Law 108–173; 117 Stat. 23 2313) from qualifying as a rural community hospital if 24 the rural community hospital meets the conditions other- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 215 •S 2474 IS wise applicable to hospitals under subsection (e) and sec- 1 tion 1866.’’. 2 (b) PAYMENT.— 3 (1) INPATIENT HOSPITAL SERVICES.—Section 4 1814 of the Social Security Act (42 U.S.C. 1395f) 5 is amended by adding at the end the following new 6 subsection: 7 ‘‘Payment for Inpatient Services Furnished in Rural 8 Community Hospitals 9 ‘‘(m) The amount of payment under this part for in- 10 patient hospital services furnished in a rural community 11 hospital, other than such services furnished in a psy- 12 chiatric or rehabilitation unit of the hospital which is a 13 distinct part, is, at the election of the hospital in the appli- 14 cation referred to in section 1861(jjj)(1)(E)— 15 ‘‘(1) 101 percent of the reasonable costs of pro- 16 viding such services, without regard to the amount 17 of the customary or other charge, or 18 ‘‘(2) the amount of payment provided for under 19 the prospective payment system for inpatient hos- 20 pital services under section 1886(d).’’. 21 (2) OUTPATIENT SERVICES.—Section 1834 of 22 such Act (42 U.S.C. 1395m) is amended by adding 23 at the end the following new subsection: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 216 •S 2474 IS ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR- 1 NISHED IN RURAL COMMUNITY HOSPITALS.—The 2 amount of payment under this part for outpatient services 3 furnished in a rural community hospital is, at the election 4 of the hospital in the application referred to in section 5 1861(jjj)(1)(E)— 6 ‘‘(1) 101 percent of the reasonable costs of pro- 7 viding such services, without regard to the amount 8 of the customary or other charge and any limitation 9 under section 1861(v)(1)(U), or 10 ‘‘(2) the amount of payment provided for under 11 the prospective payment system for covered OPD 12 services under section 1833(t).’’. 13 (3) EXEMPTION FROM REDUCTION IN REIM- 14 BURSEMENT FOR BAD DEBT.—Section 1861(v)(1) of 15 such Act (42 U.S.C. 1395x(v)(1)) is amended— 16 (A) in subparagraph (T), in the matter 17 preceding clause (i), by inserting ‘‘(other than 18 for a rural community hospital)’’ after ‘‘In de- 19 termining such reasonable costs for hospitals’’; 20 and 21 (B) in subparagraph (W)(ii), as added by 22 section 3201(c) of the Middle Class Tax Relief 23 and Job Creation Act of 2012 (Public Law 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 217 •S 2474 IS 112–96), by inserting ‘‘(other than a rural com- 1 munity hospital)’’ after ‘‘(V)’’. 2 (c) BENEFICIARY COPAYMENT FOR OUTPATIENT 3 SERVICES.—Section 1834(p) of such Act (as added by 4 subsection (b)(2)) is amended— 5 (1) by redesignating paragraphs (1) and (2) as 6 subparagraphs (A) and (B), respectively; 7 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 8 (3) by adding at the end the following: 9 ‘‘(2) The amounts of beneficiary cost sharing for out- 10 patient services furnished in a rural community hospital 11 under this part shall be as follows: 12 ‘‘(A) For items and services that would have 13 been paid under section 1833(t) if provided by a 14 hospital, the amount of copayment determined under 15 paragraph (8) of such section. 16 ‘‘(B) For items and services that would have 17 been paid under section 1833(h) if furnished by a 18 provider or supplier, no copayment shall apply. 19 ‘‘(C) For all other items and services, the 20 amount of copayment that would apply to the item 21 or service under the methodology that would be used 22 to determine payment for such item or service if pro- 23 vided by a physician, provider, or supplier, as the 24 case may be.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 218 •S 2474 IS (d) CONFORMING AMENDMENTS.— 1 (1) PART A PAYMENT.—Section 1814(b) of 2 such Act (42 U.S.C. 1395f(b)) is amended in the 3 matter preceding paragraph (1) by inserting ‘‘other 4 than inpatient hospital services furnished by a rural 5 community hospital,’’ after ‘‘critical access hospital 6 services,’’. 7 (2) PART B PAYMENT.—Section 1833(a) of 8 such Act (42 U.S.C. 1395l(a)), as amended by sec- 9 tion 203(b)(2), is amended— 10 (A) in paragraph (2), in the matter before 11 subparagraph (A), by striking ‘‘and (I)’’ and in- 12 serting ‘‘(I), and (K)’’; 13 (B) by striking ‘‘and’’ at the end of para- 14 graph (9); 15 (C) by striking the period at the end of 16 paragraph (10) and inserting ‘‘; and’’; and 17 (D) by adding at the end the following: 18 ‘‘(11) in the case of outpatient services fur- 19 nished by a rural community hospital, the amounts 20 described in section 1834(p).’’. 21 (3) TECHNICAL AMENDMENTS.— 22 (A) CONSULTATION WITH STATE AGEN- 23 CIES.—Section 1863 of such Act (42 U.S.C. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 219 •S 2474 IS 1395z) is amended by striking ‘‘and (dd)(2)’’ 1 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 2 (B) PROVIDER AGREEMENTS.—Section 3 1866(a)(2)(A) of such Act (42 U.S.C. 4 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 5 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 6 (e) EFFECTIVE DATE.—The amendments made by 7 this section shall apply to items and services furnished on 8 or after October 1, 2012. 9 SEC. 424. MEDICARE REMOTE MONITORING PILOT 10 PROJECTS. 11 (a) PILOT PROJECTS.— 12 (1) IN GENERAL.—Not later than 9 months 13 after the date of enactment of this Act, the Sec- 14 retary of Health and Human Services (in this sec- 15 tion referred to as the ‘‘Secretary’’) shall conduct 16 pilot projects under title XVIII of the Social Secu- 17 rity Act for the purpose of providing incentives to 18 home health agencies to utilize home monitoring and 19 communications technologies that— 20 (A) enhance health outcomes for Medicare 21 beneficiaries; and 22 (B) reduce expenditures under such title. 23 (2) SITE REQUIREMENTS.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 220 •S 2474 IS (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 after 21 the date of the implementation of the projects. 22 (c) INCENTIVES.— 23 (1) PERFORMANCE TARGETS.—The Secretary 24 shall establish for each home health agency partici- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 221 •S 2474 IS pating in a pilot project under this section a per- 1 formance target using one of the following meth- 2 odologies, as determined appropriate by the Sec- 3 retary: 4 (A) ADJUSTED HISTORICAL PERFORMANCE 5 TARGET.—The Secretary shall establish for the 6 agency— 7 (i) a base expenditure amount equal 8 to the average total payments made to the 9 agency under parts A and B of title XVIII 10 of the Social Security Act for Medicare 11 beneficiaries determined to be within the 12 scope of the pilot project in a base period 13 determined by the Secretary; and 14 (ii) an annual per capita expenditure 15 target for such beneficiaries, reflecting the 16 base expenditure amount adjusted for risk 17 and adjusted growth rates. 18 (B) COMPARATIVE PERFORMANCE TAR- 19 GET.—The Secretary shall establish for the 20 agency a comparative performance target equal 21 to the average total payments under such parts 22 A and B during the pilot project for comparable 23 individuals in the same geographic area that 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 222 •S 2474 IS are not determined to be within the scope of the 1 pilot project. 2 (2) INCENTIVE.—Subject to paragraph (3), the 3 Secretary shall pay to each participating home care 4 agency an incentive payment for each year under the 5 pilot project equal to a portion of the Medicare sav- 6 ings realized for such year relative to the perform- 7 ance target under paragraph (1). 8 (3) LIMITATION ON EXPENDITURES.—The Sec- 9 retary shall limit incentive payments under this sec- 10 tion in order to ensure that the aggregate expendi- 11 tures under title XVIII of the Social Security Act 12 (including incentive payments under this subsection) 13 do not exceed the amount that the Secretary esti- 14 mates would have been expended if the pilot projects 15 under this section had not been implemented. 16 (d) WAIVER AUTHORITY.—The Secretary may waive 17 such provisions of titles XI and XVIII of the Social Secu- 18 rity Act as the Secretary determines to be appropriate for 19 the conduct of the pilot projects under this section. 20 (e) REPORT TO CONGRESS.—Not later than 5 years 21 after the date that the first pilot project under this section 22 is implemented, the Secretary shall submit to Congress a 23 report on the pilot projects. Such report shall contain a 24 detailed description of issues related to the expansion of 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 223 •S 2474 IS the projects under subsection (f) and recommendations for 1 such legislation and administrative actions as the Sec- 2 retary considers appropriate. 3 (f) EXPANSION.—If the Secretary determines that 4 any of the pilot projects under this section enhance health 5 outcomes for Medicare beneficiaries and reduce expendi- 6 tures under title XVIII of the Social Security Act, the Sec- 7 retary may initiate comparable projects in additional 8 areas. 9 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 10 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 11 tive payment under this section— 12 (1) shall be in addition to the payments that a 13 home health agency would otherwise receive under 14 title XVIII of the Social Security Act for the provi- 15 sion of home health services; and 16 (2) shall have no effect on the amount of such 17 payments. 18 SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION 19 AND DEMONSTRATION PROJECTS. 20 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 21 SION.— 22 (1) ESTABLISHMENT.—Not later than 6 23 months after the date of the enactment of this sec- 24 tion, the Secretary of Health and Human Services 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 224 •S 2474 IS (in this section referred to as the ‘‘Secretary’’) shall 1 establish a commission to be known as the Rural 2 Health Quality Advisory Commission (in this section 3 referred to as the ‘‘Commission’’). 4 (2) DUTIES OF COMMISSION.— 5 (A) NATIONAL PLAN.—The Commission 6 shall develop, coordinate, and facilitate imple- 7 mentation of a national plan for rural health 8 quality improvement. The national plan shall— 9 (i) identify objectives for rural health 10 quality improvement; 11 (ii) identify strategies to eliminate 12 known gaps in rural health system capacity 13 and improve rural health quality; and 14 (iii) provide for Federal programs to 15 identify opportunities for strengthening 16 and aligning policies and programs to im- 17 prove rural health quality. 18 (B) DEMONSTRATION PROJECTS.—The 19 Commission shall design demonstration projects 20 to test alternative models for rural health qual- 21 ity improvement, including with respect to both 22 personal and population health. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 225 •S 2474 IS (C) MONITORING.—The Commission shall 1 monitor progress toward the objectives identi- 2 fied pursuant to paragraph (1)(A). 3 (3) MEMBERSHIP.— 4 (A) NUMBER.—The Commission shall be 5 composed of 11 members appointed by the Sec- 6 retary. 7 (B) SELECTION.—The Secretary shall se- 8 lect the members of the Commission from 9 among individuals with significant rural health 10 care and health care quality expertise, including 11 expertise in clinical health care, health care 12 quality research, population or public health, or 13 purchaser organizations. 14 (4) CONTRACTING AUTHORITY.—Subject to the 15 availability of funds, the Commission may enter into 16 contracts and make other arrangements, as may be 17 necessary to carry out the duties described in para- 18 graph (2). 19 (5) STAFF.—Upon the request of the Commis- 20 sion, the Secretary may detail, on a reimbursable 21 basis, any of the personnel of the Office of Rural 22 Health Policy of the Health Resources and Services 23 Administration, the Agency for Health care Quality 24 and Research, or the Centers for Medicare & Med- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 226 •S 2474 IS icaid Services to the Commission to assist in car- 1 rying out this subsection. 2 (6) REPORTS TO CONGRESS.—Not later than 1 3 year after the establishment of the Commission, and 4 annually thereafter, the Commission shall submit a 5 report to the Congress on rural health quality. Each 6 such report shall include the following: 7 (A) An inventory of relevant programs and 8 recommendations for improved coordination and 9 integration of policy and programs. 10 (B) An assessment of achievement of the 11 objectives identified in the national plan devel- 12 oped under paragraph (2) and recommenda- 13 tions for realizing such objectives. 14 (C) Recommendations on Federal legisla- 15 tion, regulations, or administrative policies to 16 enhance rural health quality and outcomes. 17 (b) RURAL HEALTH QUALITY DEMONSTRATION 18 PROJECTS.— 19 (1) IN GENERAL.—Not later than 270 days 20 after the date of the enactment of this section, the 21 Secretary, in consultation with the Rural Health 22 Quality Advisory Commission, the Office of Rural 23 Health Policy of the Health Resources and Services 24 Administration, the Agency for Healthcare Research 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 227 •S 2474 IS and Quality, and the Centers for Medicare & Med- 1 icaid Services, shall make grants to eligible entities 2 for 5 demonstration projects to implement and 3 evaluate methods for improving the quality of health 4 care in rural communities. Each such demonstration 5 project shall include— 6 (A) alternative community models that— 7 (i) will achieve greater integration of 8 personal and population health services; 9 and 10 (ii) address safety, effectiveness, 11 patient- or community-centeredness, timeli- 12 ness, efficiency, and equity (the 6 aims 13 identified by the Institute of Medicine of 14 the National Academies in its report enti- 15 tled ‘‘Crossing the Quality Chasm: A New 16 Health System for the 21st Century’’ re- 17 leased on March 1, 2001); 18 (B) innovative approaches to the financing 19 and delivery of health services to achieve rural 20 health quality goals; and 21 (C) development of quality improvement 22 support structures to assist rural health sys- 23 tems and professionals (such as workforce sup- 24 port structures, quality monitoring and report- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 228 •S 2474 IS ing, clinical care protocols, and information 1 technology applications). 2 (2) ELIGIBLE ENTITIES.—In this subsection, 3 the term ‘‘eligible entity’’ means a consortium 4 that— 5 (A) shall include— 6 (i) at least one health care provider or 7 health care delivery system located in a 8 rural area; and 9 (ii) at least one organization rep- 10 resenting multiple community stakeholders; 11 and 12 (B) may include other partners such as 13 rural research centers. 14 (3) CONSULTATION.—In developing the pro- 15 gram for awarding grants under this subsection, the 16 Secretary shall consult with the Administrator of the 17 Agency for Healthcare Research and Quality, rural 18 health care providers, rural health care researchers, 19 and private and nonprofit groups (including national 20 associations) which are undertaking similar efforts. 21 (4) EXPEDITED WAIVERS.—The Secretary shall 22 expedite the processing of any waiver that— 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 229 •S 2474 IS (A) is authorized under title XVIII or XIX 1 of the Social Security Act (42 U.S.C. 1395 et 2 seq.); and 3 (B) is necessary to carry out a demonstra- 4 tion project under this subsection. 5 (5) DEMONSTRATION PROJECT SITES.—The 6 Secretary shall ensure that the 5 demonstration 7 projects funded under this subsection are conducted 8 at a variety of sites representing the diversity of 9 rural communities in the Nation. 10 (6) DURATION.—Each demonstration project 11 under this subsection shall be for a period of 4 12 years. 13 (7) INDEPENDENT EVALUATION.—The Sec- 14 retary shall enter into an arrangement with an enti- 15 ty that has experience working directly with rural 16 health systems for the conduct of an independent 17 evaluation of the program carried out under this 18 subsection. 19 (8) REPORT.—Not later than 1 year after the 20 conclusion of all of the demonstration projects fund- 21 ed under this subsection, the Secretary shall submit 22 a report to the Congress on the results of such 23 projects. The report shall include— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 230 •S 2474 IS (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 SEC. 426. RURAL HEALTH CARE SERVICES. 7 Section 330A of the Public Health Service Act (42 8 U.S.C. 254c) is amended to read as follows: 9 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 10 RURAL HEALTH NETWORK DEVELOPMENT, 11 DELTA RURAL DISPARITIES AND HEALTH 12 SYSTEMS DEVELOPMENT, AND SMALL RURAL 13 HEALTH CARE PROVIDER QUALITY IMPROVE- 14 MENT GRANT PROGRAMS. 15 ‘‘(a) PURPOSE.—The purpose of this section is to 16 provide for grants— 17 ‘‘(1) under subsection (b), to promote rural 18 health care services outreach; 19 ‘‘(2) under subsection (c), to provide for the 20 planning and implementation of integrated health 21 care networks in rural areas; 22 ‘‘(3) under subsection (d), to assist rural com- 23 munities in the Delta Region to reduce health dis- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 231 •S 2474 IS parities and to promote and enhance health system 1 development; and 2 ‘‘(4) under subsection (e), to provide for the 3 planning and implementation of small rural health 4 care provider quality improvement activities. 5 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 6 GRANTS.— 7 ‘‘(1) GRANTS.—The Director of the Office of 8 Rural Health Policy of the Health Resources and 9 Services Administration may award grants to eligible 10 entities to promote rural health care services out- 11 reach by expanding the delivery of health care serv- 12 ices to include new and enhanced services in rural 13 areas. The Director may award the grants for peri- 14 ods of not more than 3 years. 15 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 16 grant under this subsection for a project, an enti- 17 ty— 18 ‘‘(A) shall be a rural public or rural non- 19 profit private entity, a facility that qualifies as 20 a rural health clinic under title XVIII of the 21 Social Security Act, a public or nonprofit entity 22 existing exclusively to provide services to mi- 23 grant and seasonal farm workers in rural areas, 24 or a tribal government whose grant-funded ac- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 232 •S 2474 IS tivities will be conducted within federally recog- 1 nized tribal areas; 2 ‘‘(B) shall represent a consortium com- 3 posed of members— 4 ‘‘(i) that include 3 or more independ- 5 ently owned health care entities; and 6 ‘‘(ii) that may be nonprofit or for- 7 profit entities; and 8 ‘‘(C) shall not previously have received a 9 grant under this subsection for the same or a 10 similar project, unless the entity is proposing to 11 expand the scope of the project or the area that 12 will be served through the project. 13 ‘‘(3) APPLICATIONS.—To be eligible to receive a 14 grant under this subsection, an eligible entity shall 15 prepare and submit to the Director an application at 16 such time, in such manner, and containing such in- 17 formation as the Director may require, including— 18 ‘‘(A) a description of the project that the 19 eligible entity will carry out using the funds 20 provided under the grant; 21 ‘‘(B) a description of the manner in which 22 the project funded under the grant will meet 23 the health care needs of rural populations in 24 the local community or region to be served; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 233 •S 2474 IS ‘‘(C) a plan for quantifying how health 1 care needs will be met through identification of 2 the target population and benchmarks of service 3 delivery or health status, such as— 4 ‘‘(i) quantifiable measurements of 5 health status improvement for projects fo- 6 cusing on health promotion; or 7 ‘‘(ii) benchmarks of increased access 8 to primary care (which includes obstetrical 9 and gynecological care and psychiatric and 10 mental health care), including tracking fac- 11 tors such as the number and type of pri- 12 mary care visits, identification of a medical 13 home, or other general measures of such 14 access; 15 ‘‘(D) a description of how the local com- 16 munity or region to be served will be involved 17 in the development and ongoing operations of 18 the project; 19 ‘‘(E) a plan for sustaining the project after 20 Federal support for the project has ended; 21 ‘‘(F) a description of how the project will 22 be evaluated; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 234 •S 2474 IS ‘‘(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 Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 235 •S 2474 IS ‘‘(iv) coordinate care and manage 1 chronic illness; and 2 ‘‘(v) strengthen the rural health care 3 system as a whole in such a manner as to 4 show a quantifiable return on investment 5 to the participants in the network. 6 ‘‘(B) GRANT PERIODS.—The Director may 7 award such a rural health network development 8 grant— 9 ‘‘(i) for a period of 3 years for imple- 10 mentation activities; or 11 ‘‘(ii) for a period of 1 year for plan- 12 ning activities to assist in the initial devel- 13 opment of an integrated health care net- 14 work, if the proposed participants in the 15 network do not have a history of collabo- 16 rative efforts and a 3-year grant would be 17 inappropriate. 18 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 19 grant under this subsection, an entity— 20 ‘‘(A) shall be a rural public or rural non- 21 profit private entity, a facility that qualifies as 22 a rural health clinic under title XVIII of the 23 Social Security Act, a public or nonprofit entity 24 existing exclusively to provide services to mi- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 236 •S 2474 IS grant and seasonal farm workers in rural areas, 1 or a tribal government whose grant-funded ac- 2 tivities will be conducted within federally recog- 3 nized tribal areas; 4 ‘‘(B) shall represent a network composed 5 of participants— 6 ‘‘(i) that include 3 or more independ- 7 ently owned health care entities; and 8 ‘‘(ii) that may be nonprofit or for- 9 profit entities; and 10 ‘‘(C) shall not previously have received a 11 grant under this subsection (other than a 1- 12 year grant for planning activities) for the same 13 or a similar project. 14 ‘‘(3) APPLICATIONS.—To be eligible to receive a 15 grant under this subsection, an eligible entity, in 16 consultation with the appropriate State office of 17 rural health or another appropriate State entity, 18 shall prepare and submit to the Director an applica- 19 tion at such time, in such manner, and containing 20 such information as the Director may require, in- 21 cluding— 22 ‘‘(A) a description of the project that the 23 eligible entity will carry out using the funds 24 provided under the grant; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 237 •S 2474 IS ‘‘(B) an explanation of the reasons why 1 Federal assistance is required to carry out the 2 project; 3 ‘‘(C) a description of— 4 ‘‘(i) the history of collaborative activi- 5 ties carried out by the participants in the 6 network; 7 ‘‘(ii) the degree to which the partici- 8 pants are ready to integrate their func- 9 tions; and 10 ‘‘(iii) how the local community or re- 11 gion to be served will benefit from and be 12 involved in the activities carried out by the 13 network; 14 ‘‘(D) a description of how the local com- 15 munity or region to be served will experience in- 16 creased access to quality health care services 17 across the continuum of care as a result of the 18 integration activities carried out by the net- 19 work, including a description of— 20 ‘‘(i) return on investment for the com- 21 munity and the network members; and 22 ‘‘(ii) other quantifiable performance 23 measures that show the benefit of the net- 24 work activities; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 238 •S 2474 IS ‘‘(E) a plan for sustaining the project after 1 Federal support for the project has ended; 2 ‘‘(F) a description of how the project will 3 be evaluated; 4 ‘‘(G) the administrative capacity to submit 5 annual performance data electronically as speci- 6 fied by the Director; and 7 ‘‘(H) other such information as the Direc- 8 tor determines to be appropriate. 9 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 10 TEMS DEVELOPMENT GRANTS.— 11 ‘‘(1) GRANTS.—The Director may award grants 12 to eligible entities to support reduction of health dis- 13 parities, improve access to health care, and enhance 14 rural health system development in the Delta Re- 15 gion. 16 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 17 grant under this subsection, an entity shall be a 18 rural public or rural nonprofit private entity, a facil- 19 ity that qualifies as a rural health clinic under title 20 XVIII of the Social Security Act, a public or non- 21 profit entity existing exclusively to provide services 22 to migrant and seasonal farm workers in rural 23 areas, or a tribal government whose grant-funded 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 239 •S 2474 IS activities will be conducted within federally recog- 1 nized tribal areas. 2 ‘‘(3) APPLICATIONS.—To be eligible to receive a 3 grant under this subsection, an eligible entity shall 4 prepare and submit to the Director an application at 5 such time, in such manner, and containing such in- 6 formation as the Director may require, including— 7 ‘‘(A) a description of the project that the 8 eligible entity will carry out using the funds 9 provided under the grant; 10 ‘‘(B) an explanation of the reasons why 11 Federal assistance is required to carry out the 12 project; 13 ‘‘(C) a description of the manner in which 14 the project funded under the grant will meet 15 the health care needs of the Delta Region; 16 ‘‘(D) a description of how the local com- 17 munity or region to be served will experience in- 18 creased access to quality health care services as 19 a result of the activities carried out by the enti- 20 ty; 21 ‘‘(E) a description of how health dispari- 22 ties will be reduced or the health system will be 23 improved; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 240 •S 2474 IS ‘‘(F) a plan for sustaining the project after 1 Federal support for the project has ended; 2 ‘‘(G) a description of how the project will 3 be evaluated including process and outcome 4 measures related to the quality of care provided 5 or how the health care system improves its per- 6 formance; 7 ‘‘(H) a description of how the grantee will 8 develop an advisory group made up of rep- 9 resentatives of the communities to be served to 10 provide guidance to the grantee to best meet 11 community need; and 12 ‘‘(I) other such information as the Director 13 determines to be appropriate. 14 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 15 ITY IMPROVEMENT GRANTS.— 16 ‘‘(1) GRANTS.—The Director may award grants 17 to provide for the planning and implementation of 18 small rural health care provider quality improvement 19 activities. The Director may award the grants for 20 periods of 1 to 3 years. 21 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 22 under this subsection, an entity— 23 ‘‘(A) shall be— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 241 •S 2474 IS ‘‘(i) a rural public or rural nonprofit 1 private health care provider or provider of 2 health care services, such as a rural health 3 clinic; or 4 ‘‘(ii) another rural provider or net- 5 work of small rural providers identified by 6 the Director as a key source of local care; 7 and 8 ‘‘(B) shall not previously have received a 9 grant under this subsection for the same or a 10 similar project. 11 ‘‘(3) PREFERENCE.—In awarding grants under 12 this subsection, the Director shall give preference to 13 facilities that qualify as rural health clinics under 14 title XVIII of the Social Security Act. 15 ‘‘(4) APPLICATIONS.—To be eligible to receive a 16 grant under this subsection, an eligible entity shall 17 prepare and submit to the Director an application at 18 such time, in such manner, and containing such in- 19 formation as the Director may require, including— 20 ‘‘(A) a description of the project that the 21 eligible entity will carry out using the funds 22 provided under the grant; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 242 •S 2474 IS ‘‘(B) an explanation of the reasons why 1 Federal assistance is required to carry out the 2 project; 3 ‘‘(C) a description of the manner in which 4 the project funded under the grant will assure 5 continuous quality improvement in the provision 6 of services by the entity; 7 ‘‘(D) a description of how the local com- 8 munity or region to be served will experience in- 9 creased access to quality health care services as 10 a result of the activities carried out by the enti- 11 ty; 12 ‘‘(E) a plan for sustaining the project after 13 Federal support for the project has ended; 14 ‘‘(F) a description of how the project will 15 be evaluated including process and outcome 16 measures related to the quality of care pro- 17 vided; and 18 ‘‘(G) other such information as the Direc- 19 tor determines to be appropriate. 20 ‘‘(f) GENERAL REQUIREMENTS.— 21 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 22 that receives a grant under this section may not use 23 funds provided through the grant— 24 ‘‘(A) to build or acquire real property; or 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 243 •S 2474 IS ‘‘(B) for construction. 1 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 2 The Director shall coordinate activities carried out 3 under grant programs described in this section, to 4 the extent practicable, with Federal and State agen- 5 cies and nonprofit organizations that are operating 6 similar grant programs, to maximize the effect of 7 public dollars in funding meritorious proposals. 8 ‘‘(g) REPORT.—Not later than September 30, 2014, 9 the Secretary shall prepare and submit to the appropriate 10 committees of Congress a report on the progress and ac- 11 complishments of the grant programs described in sub- 12 sections (b), (c), (d), and (e). 13 ‘‘(h) DEFINITIONS.—In this section: 14 ‘‘(1) The term ‘Delta Region’ has the meaning 15 given to the term ‘region’ in section 382A of the 16 Consolidated Farm and Rural Development Act (7 17 U.S.C. 2009aa). 18 ‘‘(2) The term ‘Director’ means the Director of 19 the Office of Rural Health Policy of the Health Re- 20 sources and Services Administration.’’. 21 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 244 •S 2474 IS SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 1 ACCESS EXPANSION. 2 Section 330 of the Public Health Service Act (42 3 U.S.C. 254b) is amended by adding at the end the fol- 4 lowing: 5 ‘‘(t) MISCELLANEOUS PROVISIONS.— 6 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 7 TO RURAL HEALTH CLINICS.— 8 ‘‘(A) IN GENERAL.—Nothing in this sec- 9 tion shall be construed to prevent a community 10 health center from contracting with a federally 11 certified rural health clinic (as defined by sec- 12 tion 1861(aa)(2) of the Social Security Act) for 13 the delivery of primary health care services that 14 are available at the rural health clinic to indi- 15 viduals who would otherwise be eligible for free 16 or reduced cost care if that individual were able 17 to obtain that care at the community health 18 center. Such services may be limited in scope to 19 those primary health care services available in 20 that rural health clinic. 21 ‘‘(B) ASSURANCES.—In order for a rural 22 health clinic to receive funds under this section 23 through a contract with a community health 24 center under paragraph (1), such rural health 25 clinic shall establish policies to ensure— 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 245 •S 2474 IS ‘‘(i) nondiscrimination based upon the 1 ability of a patient to pay; and 2 ‘‘(ii) the establishment of a sliding fee 3 scale for low-income patients.’’. 4 SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 5 SERVICES ACROSS STATE LINES. 6 (a) IN GENERAL.—For purposes of expediting the 7 provision of telehealth services, for which payment is made 8 under the Medicare program, across State lines, the Sec- 9 retary of Health and Human Services shall, in consulta- 10 tion with representatives of States, physicians, health care 11 practitioners, and patient advocates, encourage and facili- 12 tate the adoption of provisions allowing for multistate 13 practitioner practice across State lines. 14 (b) DEFINITIONS.—In subsection (a): 15 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 16 health service’’ has the meaning given that term in 17 subparagraph (F) of section 1834(m)(4) of the So- 18 cial Security Act (42 U.S.C. 1395m(m)(4)). 19 (2) PHYSICIAN, PRACTITIONER.—The terms 20 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 21 given those terms in subparagraphs (D) and (E), re- 22 spectively, of such section. 23 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 24 program’’ means the program of health insurance 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 246 •S 2474 IS administered by the Secretary of Health and Human 1 Services under title XVIII of the Social Security Act 2 (42 U.S.C. 1395 et seq.). 3 SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 4 Section 202 of the Congressional Budget and Im- 5 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 6 ed by adding at the end the following new subsection: 7 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 8 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 9 Upon a request by the chairman or ranking minority 10 member of the Committee on the Budget of the Sen- 11 ate, or by the chairman or ranking minority member 12 of the Committee on the Budget of the House of 13 Representatives, the Director shall determine if a 14 proposed measure would result in reductions in 15 budget outlays in budgetary outyears through the 16 use of preventive health and preventive health serv- 17 ices. 18 ‘‘(2) PROJECTIONS.—If the Director determines 19 that a measure would result in substantial reduc- 20 tions in budget outlays as described in paragraph 21 (1), the Director— 22 ‘‘(A) shall include, in any projection pre- 23 pared by the Director, a description and esti- 24 mate of the reductions in budget outlays in the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 247 •S 2474 IS budgetary outyears and a description of the 1 basis for such conclusions; and 2 ‘‘(B) may prepare a budget projection that 3 includes some or all of the budgetary outyears, 4 notwithstanding the time periods for projections 5 described in subsection (e) and sections 308, 6 402, and 424. 7 ‘‘(3) DEFINITIONS.—As used in this sub- 8 section— 9 ‘‘(A) the term ‘preventive health’ means an 10 action that focuses on the health of the public, 11 individuals, and defined populations in order to 12 protect, promote, and maintain health, wellness, 13 and functional ability, and prevent disease, dis- 14 ability, and premature death that is dem- 15 onstrated by credible and publicly available epi- 16 demiological projection models, incorporating 17 clinical trials or observational studies in hu- 18 mans, to avoid future health care costs; and 19 ‘‘(B) the term ‘budgetary outyears’ means 20 the 2 consecutive 10-year periods beginning 21 with the first fiscal year that is 10 years after 22 the budget year provided for in the most re- 23 cently agreed to concurrent resolution on the 24 budget.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 248 •S 2474 IS SEC. 430. SENSE OF CONGRESS. 1 It is the sense of the Congress that— 2 (1) the maintenance of effort (MOE) provisions 3 added to sections 1902 and 2105(d) of the Social 4 Security Act by sections 2001(b) and 2101(b) of the 5 Patient Protection and Affordable Care Act were 6 written to maintain the eligibility standards for the 7 Medicaid program and Children’s Health Insurance 8 Program until the American Health Benefit Ex- 9 changes in the States are fully operational; 10 (2) it is imperative that the MOE provisions are 11 enforced to the strict standard intended by the Con- 12 gress; 13 (3) waiving the MOE provisions should not be 14 permitted, except in the case of a request for a waiv- 15 er that meets the explicit nonapplication require- 16 ments; 17 (4) the MOE provisions ensure the continued 18 success of the Medicaid program and CHIP and 19 were written deliberately to specifically protect vul- 20 nerable and disabled individuals, children, and senior 21 citizens, many of whom are also members of commu- 22 nities of color; and 23 (5) the MOE provisions must be strictly en- 24 forced and proposals to weaken the MOE provisions 25 must not be considered in this time of recession. 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 249 •S 2474 IS SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA- 1 TION EVIDENCING CITIZENSHIP OR NATION- 2 ALITY UNDER THE MEDICAID PROGRAM. 3 (a) REPEAL.—Subsections (i)(22) and (x) of section 4 1903 of the Social Security Act (42 U.S.C. 1396b), as 5 added by section 6036 of the Deficit Reduction Act of 6 2005, are each repealed. 7 (b) CONFORMING AMENDMENTS.— 8 (1) Section 1902(a)(46)(B) of the Social Secu- 9 rity Act (42 U.S.C. 1396a(a)(46)(B)) is amended by 10 striking ‘‘requirements of’’ and all that follows 11 through ‘‘subsection (ee);’’ and inserting ‘‘require- 12 ments of subsection (ee);’’. 13 (2) Subsection (c) of section 6036 of the Deficit 14 Reduction Act of 2005 is repealed. 15 (c) EFFECTIVE DATE.—The repeals and amend- 16 ments made by this section shall take effect as if included 17 in the enactment of the Deficit Reduction Act of 2005. 18 SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 19 HEALTH ADMINISTRATION OF DEPARTMENT 20 OF VETERANS AFFAIRS. 21 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 22 I of chapter 73 of title 38, United States Code, is amended 23 by adding at the end the following new section: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 250 •S 2474 IS ‘‘§ 7309. Office of Minority Health 1 ‘‘(a) ESTABLISHMENT.—There is established in the 2 Department within the Office of the Under Secretary for 3 Health an office to be known as the ‘Office of Minority 4 Health’ (in this section referred to as the ‘Office’). 5 ‘‘(b) HEAD.—The Director of the Office of Minority 6 Health shall be the head of the Office. The Director of 7 the Office of Minority Health shall be appointed by the 8 Under Secretary of Health from among individuals quali- 9 fied to perform the duties of the position. 10 ‘‘(c) FUNCTIONS.—The functions of the Office are as 11 follows: 12 ‘‘(1) To establish short-range and long-range 13 goals and objectives and coordinate all other activi- 14 ties within the Veterans Health Administration that 15 relate to disease prevention, health promotion, health 16 care services delivery, and health care research con- 17 cerning veterans who are members of a racial or eth- 18 nic minority group. 19 ‘‘(2) To support research, demonstrations, and 20 evaluations to test new and innovative models for 21 the discharge of activities described in paragraph 22 (1). 23 ‘‘(3) To increase knowledge and understanding 24 of health risk factors for veterans who are members 25 of a racial or ethnic minority group. 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 251 •S 2474 IS ‘‘(4) To develop mechanisms that support bet- 1 ter health care information dissemination, education, 2 prevention, and services delivery to veterans from 3 disadvantaged backgrounds, including veterans who 4 are members of a racial or ethnic minority group. 5 ‘‘(5) To enter into contracts or agreements with 6 appropriate public and nonprofit private entities to 7 develop and carry out programs to provide bilingual 8 or interpretive services to assist veterans who are 9 members of a racial or ethnic minority group and 10 who lack proficiency in speaking the English lan- 11 guage in accessing and receiving health care services 12 through the Veterans Health Administration. 13 ‘‘(6) To carry out programs to improve access 14 to health care services through the Veterans Health 15 Administration for veterans with limited proficiency 16 in speaking the English language, including the de- 17 velopment and evaluation of demonstration and pilot 18 projects for that purpose. 19 ‘‘(7) To advise the Under Secretary of Health 20 on matters relating to the development, implementa- 21 tion, and evaluation of health professions education 22 in decreasing disparities in health care outcomes be- 23 tween veterans who are members of a racial or eth- 24 nic minority group and other veterans, including cul- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 252 •S 2474 IS tural competency as a method of eliminating such 1 health disparities. 2 ‘‘(8) To perform such other functions and du- 3 ties as the Secretary or the Under Secretary for 4 Health considers appropriate. 5 ‘‘(d) DEFINITIONS.—In this section: 6 ‘‘(1) The term ‘racial or ethnic minority group’ 7 means the following: 8 ‘‘(A) American Indians (including Alaska 9 Natives, Eskimos, and Aleuts). 10 ‘‘(B) Asian Americans. 11 ‘‘(C) Native Hawaiians and other Pacific 12 Islanders. 13 ‘‘(D) Blacks. 14 ‘‘(E) Hispanics. 15 ‘‘(2) The term ‘Hispanic’ means individuals 16 whose origin is Mexican, Puerto Rican, Cuban, Cen- 17 tral or South American, or any other Spanish-speak- 18 ing country.’’. 19 SEC. 433. ACCESS FOR NATIVE AMERICANS UNDER PPACA. 20 (a) IN GENERAL.—Title I of the Patient Protection 21 and Affordable Care Act is amended— 22 (1) in section 1311(c)(6)(D), by striking ‘‘(as 23 defined in section 4 of the Indian Health Care Im- 24 provement Act)’’ and inserting ‘‘(as defined in sec- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 253 •S 2474 IS tion 447.50(b)(1) of title 42 of the Code of Federal 1 Regulations, as in effect on July 1, 2010)’’; and 2 (2) in section 1402(d)(1), by striking ‘‘(as de- 3 fined in section 4(d) of the Indian Self-Determina- 4 tion and Education Assistance Act (25 U.S.C. 5 450b(d)))’’ and inserting (f) ‘‘(as defined in section 6 447.50(b)(1) of title 42 of the Code of Federal Reg- 7 ulations, as in effect on July 1, 2010)’’. 8 (b) INDIVIDUAL MANDATE.—In section 5000A(e)(3) 9 of the Internal Revenue Code of 1986, by striking ‘‘(as 10 defined in section 45A(c)(6))’’ and inserting ‘‘(as defined 11 in section 447.50(b)(1) of title 42 of the Code of Federal 12 Regulations, as in effect on July 1, 2010)’’. 13 SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 14 ACCESS FOR LOW-INCOME PATIENTS. 15 (a) IN GENERAL.—Not later than January 1, 2016, 16 the Comptroller General of the United States shall— 17 (1) evaluate and examine the continued need 18 for payments to disproportionate share hospitals 19 under section 1886(d)(5)(F) of the Social Security 20 Act (42 U.S.C. 1395ww(d)(5)(F)) and section 1923 21 of such Act (42 U.S.C. 1396r-4) to ensure timely ac- 22 cess to health care services for low-income patients 23 after the expansion of coverage under the Medicaid 24 program pursuant to the Patient Protection and Af- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 254 •S 2474 IS fordable Care Act (Public Law 111-148) in 2014, as 1 well as how such funding should be allocated among 2 such hospitals; and 3 (2) provide recommendations— 4 (A) to the Secretary of Health and Human 5 Services for purposes of assisting in develop- 6 ment of the methodology for reduction of pay- 7 ments to disproportionate share hospitals, as 8 required pursuant to sections 2551 and 3133 of 9 the Patient Protection and Affordable Care Act; 10 and 11 (B) to Congress for any legislative changes 12 to the payment levels provided for dispropor- 13 tionate share hospitals that are needed to en- 14 sure access to health services for low-income pa- 15 tients, as based on the number of individuals 16 without health insurance, the amount of uncom- 17 pensated care provided by such hospitals, and 18 the impact of reduced payments levels on low- 19 income communities. 20 (b) ADDITIONAL CONSIDERATIONS.—For purposes of 21 the study and recommendations described in subsection 22 (a), the Comptroller General shall take into account— 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 255 •S 2474 IS (1) the impact of the expansion of coverage 1 under the Medicaid program pursuant to the Patient 2 Protection and Affordable Care Act on— 3 (A) the number of individuals in the 4 United States who are without health insur- 5 ance, as well as the distribution of such individ- 6 uals in relation to areas primarily served by dis- 7 proportionate share hospitals; and 8 (B) the low-income utilization rate of such 9 hospitals and their resulting fiscal sustain- 10 ability; 11 (2) the role played by disproportionate share 12 hospitals in providing critical access to emergency, 13 inpatient, and outpatient health services, as well as 14 their location in relation to medically underserved 15 areas; 16 (3) the appropriate level and distribution of 17 payments to disproportionate share hospitals in 18 order to— 19 (A) sufficiently account for the level of un- 20 compensated care provided by such hospitals to 21 low-income patients; and 22 (B) provide timely access to health services 23 for individuals in medically underserved areas; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 256 •S 2474 IS (4) the extent to which disproportionate share 1 hospitals satisfy the requirements established for 2 charitable hospital organizations under section 3 501(r) of the Internal Revenue Code of 1986 in re- 4 gard to community health needs assessments, finan- 5 cial assistance policy requirements, limitations on 6 charges, and billing and collection requirements; and 7 (5) any reports submitted by the Secretary of 8 the Treasury, in consultation with the Secretary of 9 Health and Human Services, to Congressional com- 10 mittees in regard to the costs incurred by charitable 11 hospital organizations for charity care, bad debt, 12 and non-reimbursed expenses for services provided 13 to individuals under the Medicare and Medicaid pro- 14 grams, as well as any community benefit activities 15 provided by such organizations. 16 TITLE V—IMPROVING HEALTH 17 OUTCOMES FOR WOMEN, 18 CHILDREN, AND FAMILIES 19 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV- 20 IORS IN WOMEN AND CHILDREN. 21 Part P of title III of the Public Health Service Act 22 (42 U.S.C. 280g et seq.) is amended by adding at the end 23 the following: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 257 •S 2474 IS ‘‘SEC. 399V–6. GRANTS TO PROMOTE POSITIVE HEALTH BE- 1 HAVIORS IN WOMEN AND CHILDREN. 2 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 3 laboration with the Administrator of the Health Resources 4 and Services Administration and other Federal officials 5 determined appropriate by the Secretary, is authorized to 6 award grants to eligible entities to promote positive health 7 behaviors for women and children in target populations, 8 especially racial and ethnic minority women and children 9 in medically underserved communities and in underserved 10 rural communities. 11 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 12 subsection (a) may be used to support the activities of 13 community health workers, including those activities— 14 ‘‘(1) to educate and provide outreach regarding 15 enrollment in health insurance including the State 16 Children’s Health Insurance Program under title 17 XXI of the Social Security Act, Medicare under title 18 XVIII of such Act, and Medicaid under title XIX of 19 such Act; 20 ‘‘(2) to educate, guide, and provide outreach in 21 a community setting regarding health problems prev- 22 alent among women and children and especially 23 among racial and ethnic minority women and chil- 24 dren; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 258 •S 2474 IS ‘‘(3) to educate, guide, and provide experiential 1 learning opportunities that target behavioral risk 2 factors including— 3 ‘‘(A) poor nutrition; 4 ‘‘(B) physical inactivity; 5 ‘‘(C) being overweight or obese; 6 ‘‘(D) tobacco use; 7 ‘‘(E) alcohol and substance use; 8 ‘‘(F) injury and violence; 9 ‘‘(G) risky sexual behavior; 10 ‘‘(H) mental health problems; 11 ‘‘(I) musculoskeletal health; 12 ‘‘(J) dental and oral health problems; and 13 ‘‘(K) understanding informed consent; 14 ‘‘(4) to educate and guide regarding effective 15 strategies to promote positive health behaviors with- 16 in the family; 17 ‘‘(5) to promote community wellness and aware- 18 ness; and 19 ‘‘(6) to educate and refer target populations to 20 appropriate health care agencies and community- 21 based programs and organizations in order to in- 22 crease access to quality health care services, includ- 23 ing preventive health services. 24 ‘‘(c) APPLICATION.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 259 •S 2474 IS ‘‘(1) IN GENERAL.—Each eligible entity that 1 desires to receive a grant under subsection (a) shall 2 submit an application to the Secretary, at such time, 3 in such manner, and accompanied by such additional 4 information as the Secretary may require. 5 ‘‘(2) CONTENTS.—Each application submitted 6 pursuant to paragraph (1) shall— 7 ‘‘(A) describe the activities for which as- 8 sistance under this section is sought; 9 ‘‘(B) contain an assurance that with re- 10 spect to each community health worker pro- 11 gram receiving funds under the grant awarded, 12 such program provides training and supervision 13 to community health workers to enable such 14 workers to provide authorized program services; 15 ‘‘(C) contain an assurance that the appli- 16 cant will evaluate the effectiveness of commu- 17 nity health worker programs receiving funds 18 under the grant; 19 ‘‘(D) contain an assurance that each com- 20 munity health worker program receiving funds 21 under the grant will provide services in the cul- 22 tural context most appropriate for the individ- 23 uals served by the program; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 260 •S 2474 IS ‘‘(E) contain a plan to document and dis- 1 seminate project description and results to 2 other States and organizations as identified by 3 the Secretary; and 4 ‘‘(F) describe plans to enhance the capac- 5 ity of individuals to utilize health services and 6 health-related social services under Federal, 7 State, and local programs by— 8 ‘‘(i) assisting individuals in estab- 9 lishing eligibility under the programs and 10 in receiving the services or other benefits 11 of the programs; and 12 ‘‘(ii) providing other services as the 13 Secretary determines to be appropriate, 14 that may include transportation and trans- 15 lation services. 16 ‘‘(d) PRIORITY.—In awarding grants under sub- 17 section (a), the Secretary shall give priority to those appli- 18 cants— 19 ‘‘(1) who propose to target geographic areas— 20 ‘‘(A) with a high percentage of residents 21 who are eligible for health insurance but are 22 uninsured or underinsured; and 23 ‘‘(B) with a high percentage of families for 24 whom English is not their primary language; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 261 •S 2474 IS ‘‘(2) with experience in providing health or 1 health-related social services to individuals who are 2 underserved with respect to such services; and 3 ‘‘(3) with documented community activity and 4 experience with community health workers. 5 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 6 TIONS.—The Secretary shall encourage community health 7 worker programs receiving funds under this section to col- 8 laborate with academic institutions, including minority- 9 serving institutions. Nothing in this section shall be con- 10 strued to require such collaboration. 11 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 12 NESS.—The Secretary shall establish guidelines for assur- 13 ing the quality of the training and supervision of commu- 14 nity health workers under the programs funded under this 15 section and for assuring the cost effectiveness of such pro- 16 grams. 17 ‘‘(g) MONITORING.—The Secretary shall monitor 18 community health worker programs identified in approved 19 applications and shall determine whether such programs 20 are in compliance with the guidelines established under 21 subsection (f). 22 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 23 provide technical assistance to community health worker 24 programs identified in approved applications with respect 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 262 •S 2474 IS to planning, developing, and operating programs under the 1 grant. 2 ‘‘(i) REPORT TO CONGRESS.— 3 ‘‘(1) IN GENERAL.—Not later than 4 years 4 after the date on which the Secretary first awards 5 grants under subsection (a), the Secretary shall sub- 6 mit to Congress a report regarding the grant 7 project. 8 ‘‘(2) CONTENTS.—The report required under 9 paragraph (1) shall include the following: 10 ‘‘(A) A description of the programs for 11 which grant funds were used. 12 ‘‘(B) The number of individuals served. 13 ‘‘(C) An evaluation of— 14 ‘‘(i) the effectiveness of these pro- 15 grams; 16 ‘‘(ii) the cost of these programs; and 17 ‘‘(iii) the impact of the project on the 18 health outcomes of the community resi- 19 dents. 20 ‘‘(D) Recommendations for sustaining the 21 community health worker programs developed 22 or assisted under this section. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 263 •S 2474 IS ‘‘(E) Recommendations regarding training 1 to enhance career opportunities for community 2 health workers. 3 ‘‘(j) DEFINITIONS.—In this section: 4 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 5 ‘community health worker’ means an individual who 6 promotes health or nutrition within the community 7 in which the individual resides, including by— 8 ‘‘(A) serving as a liaison between commu- 9 nities and health care agencies; 10 ‘‘(B) providing guidance and social assist- 11 ance to community residents; 12 ‘‘(C) enhancing community residents’ abil- 13 ity to effectively communicate with health care 14 providers; 15 ‘‘(D) providing culturally and linguistically 16 appropriate health or nutrition education; 17 ‘‘(E) advocating for individual and commu- 18 nity health, including dental, oral, mental, and 19 environmental health, or nutrition needs; and 20 ‘‘(F) providing referral and followup serv- 21 ices. 22 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 23 nity setting’ means a home or a community organi- 24 zation that serves a population. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 264 •S 2474 IS ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 1 tity’ means— 2 ‘‘(A) a unit of State, territorial, local, or 3 tribal government (including a federally recog- 4 nized tribe or Alaska Native village); or 5 ‘‘(B) a community-based organization. 6 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 7 The term ‘medically underserved community’ means 8 a community— 9 ‘‘(A) that has a substantial number of in- 10 dividuals who are members of a medically un- 11 derserved population, as defined by section 12 330(b)(3); and 13 ‘‘(B) a significant portion of which is a 14 health professional shortage area as designated 15 under section 332. 16 ‘‘(5) SUPPORT.—The term ‘support’ means the 17 provision of training, supervision, and materials 18 needed to effectively deliver the services described in 19 subsection (b), reimbursement for services, and 20 other benefits. 21 ‘‘(6) TARGET POPULATION.—The term ‘target 22 population’ means women of reproductive age, re- 23 gardless of their current childbearing status and 24 children under 21 years of age.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 265 •S 2474 IS SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 1 TRITION ASSISTANCE FOR CHILDREN, PREG- 2 NANT WOMEN, AND LAWFULLY PRESENT IN- 3 DIVIDUALS. 4 (a) MEDICAID.—Paragraph (4) of section 1903(v) of 5 the Social Security Act (42 U.S.C. 1396b(v)) is amended 6 to read as follows: 7 ‘‘(4)(A) Notwithstanding sections 401(a), 8 402(b), 403, and 421 of the Personal Responsibility 9 and Work Opportunity Reconciliation Act of 1996, 10 payment shall be made under this section for care 11 and services that are furnished to aliens, including 12 those described in paragraph (1), if they otherwise 13 meet the eligibility requirements for medical assist- 14 ance under the State plan approved under this sub- 15 chapter (other than the requirement of the receipt of 16 aid or assistance under title IV, supplemental secu- 17 rity income benefits under title XVI, or a State sup- 18 plementary payment), and are— 19 ‘‘(i) lawfully present in the United 20 States; 21 ‘‘(ii) children under 21 years of age, 22 including any optional targeted low-income 23 child (as such term is defined in section 24 1905(u)(2)(B)); or 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 266 •S 2474 IS ‘‘(iii) pregnant women during preg- 1 nancy and during the 60-day period begin- 2 ning on the last day of the pregnancy. 3 ‘‘(B) No debt shall accrue under an affidavit of 4 support against any sponsor of such an alien on the 5 basis of provision of assistance to such alien under 6 this paragraph and the cost of such assistance shall 7 not be considered as an unreimbursed cost.’’. 8 (b) SCHIP.—Section 2107(e)(1) of the Social Secu- 9 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by amend- 10 ing subparagraph (J) to read as follows: 11 ‘‘(J) Paragraph (4) of section 1903(v) (re- 12 lating to individuals who, but for sections 13 401(a), 403, and 421 of the Personal Responsi- 14 bility and Work Opportunity Reconciliation Act 15 of 1996, would be eligible for medical assistance 16 under title XXI).’’. 17 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 18 withstanding sections 401(a), 402(a), and 403(a) of the 19 Personal Responsibility and Work Opportunity Reconcili- 20 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 21 and section 6(f) of the Food and Nutrition Act of 2008 22 (7 U.S.C. 2015(f)), persons who are lawfully present in 23 the United States shall be not be ineligible for benefits 24 under the supplemental nutrition assistance program on 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 267 •S 2474 IS the basis of their immigration status or date of entry into 1 the United States. 2 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 3 Section of the 421(d)(3) of the Personal Responsibility 4 and Work Opportunity Reconciliation Act of 1996 (8 5 U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 6 that a qualified alien is eligible under section 7 402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 8 is a member of a household under the supplemental nutri- 9 tion assistance program’’. 10 (e) ENSURING PROPER SCREENING.—Section 11 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 12 U.S.C. 2020(e)(2)(B)) is amended— 13 (1) by redesignating clauses (vi) and (vii) as 14 clauses (vii) and (viii); and 15 (2) by inserting after clause (v) the following: 16 ‘‘(vi) shall provide a method for imple- 17 menting section 421 of the Personal Re- 18 sponsibility and Work Opportunity Rec- 19 onciliation Act of 1996 (8 U.S.C. 1631) 20 that does not require any unnecessary in- 21 formation from persons who may be ex- 22 empt from that provision;’’. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 268 •S 2474 IS SEC. 503. REPEAL OF DENIAL OF BENEFITS. 1 Section 115 of the Personal Responsibility and Work 2 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 3 is amended— 4 (1) in subsection (a) by striking paragraph (2); 5 (2) in subsection (b) by striking paragraph (2); 6 and 7 (3) in subsection (e) by striking paragraph (2). 8 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 9 AND AWARENESS. 10 (a) IN GENERAL.—The Secretary shall establish and 11 implement a birth defects prevention and public awareness 12 program, consisting of the activities described in sub- 13 sections (c) and (d). 14 (b) DEFINITIONS.—In this section: 15 (1) The term ‘‘pregnancy and breastfeeding in- 16 formation services’’ includes only— 17 (A) information services to provide accu- 18 rate, evidence-based, clinical information re- 19 garding maternal exposures during pregnancy 20 that may be associated with birth defects or 21 other health risks, such as exposures to medica- 22 tions, chemicals, infections, foodborne patho- 23 gens, illnesses, nutrition, or lifestyle factors; 24 (B) information services to provide accu- 25 rate, evidence-based, clinical information re- 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 269 •S 2474 IS garding maternal exposures during breast- 1 feeding that may be associated with health risks 2 to a breast-fed infant, such as exposures to 3 medications, chemicals, infections, foodborne 4 pathogens, illnesses, nutrition, or lifestyle fac- 5 tors; 6 (C) the provision of accurate, evidence- 7 based information weighing risks of exposures 8 during breastfeeding against the benefits of 9 breastfeeding; and 10 (D) the provision of information described 11 in subparagraph (A), (B), or (C) through coun- 12 selors, Web sites, fact sheets, telephonic or elec- 13 tronic communication, community outreach ef- 14 forts, or other appropriate means. 15 (2) The term ‘‘Secretary’’ means the Secretary 16 of Health and Human Services, acting through the 17 Director of the Centers for Disease Control and Pre- 18 vention. 19 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 20 subsection (a), the Secretary shall conduct or support a 21 nationwide media campaign to increase awareness among 22 health care providers and at-risk populations about preg- 23 nancy and breastfeeding information services. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 270 •S 2474 IS (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 1 INFORMATION SERVICES.— 2 (1) IN GENERAL.—In carrying out subsection 3 (a), the Secretary shall award grants to State or re- 4 gional agencies or organizations for any of the fol- 5 lowing: 6 (A) INFORMATION SERVICES.—The provi- 7 sion of, or campaigns to increase awareness 8 about, pregnancy and breastfeeding information 9 services. 10 (B) SURVEILLANCE AND RESEARCH.—The 11 conduct or support of— 12 (i) surveillance of or research on— 13 (I) maternal exposures and ma- 14 ternal health conditions that may in- 15 fluence the risk of birth defects, pre- 16 maturity, or other adverse pregnancy 17 outcomes; and 18 (II) maternal exposures that may 19 influence health risks to a breastfed 20 infant; or 21 (ii) networking to facilitate surveil- 22 lance or research described in this sub- 23 paragraph. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 271 •S 2474 IS (2) PREFERENCE FOR CERTAIN STATES.—The 1 Secretary, in making any grant under this sub- 2 section, shall give preference to States, otherwise 3 equally qualified, that have or had a pregnancy and 4 breastfeeding information service in place on or after 5 January 1, 2006. 6 (3) MATCHING FUNDS.—The Secretary may 7 only award a grant under this subsection to a State 8 or regional agency or organization that agrees, with 9 respect to the costs to be incurred in carrying out 10 the grant activities, to make available (directly or 11 through donations from public or private entities) 12 non-Federal funds toward such costs in an amount 13 equal to not less than 25 percent of the amount of 14 the grant. 15 (4) COORDINATION.—The Secretary shall en- 16 sure that activities funded through a grant under 17 this subsection are coordinated, to the maximum ex- 18 tent practicable, with other birth defects prevention 19 and environmental health activities of the Federal 20 Government, including with respect to pediatric envi- 21 ronmental health specialty units and children’s envi- 22 ronmental health centers. 23 (e) EVALUATION.—In furtherance of the program 24 under subsection (a), the Secretary shall provide for an 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 272 •S 2474 IS evaluation of pregnancy and breastfeeding information 1 services to identify efficient and effective models of— 2 (1) providing information; 3 (2) raising awareness and increasing knowledge 4 about birth defects prevention measures; 5 (3) modifying risk behaviors; or 6 (4) other outcome measures as determined ap- 7 propriate by the Secretary. 8 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 9 COMMITTEES ON PREGNANCY-RELATED 10 DEATHS. 11 (a) CONDITION OF RECEIPT OF PAYMENTS FROM 12 ALLOTMENT UNDER MATERNAL AND CHILD HEALTH 13 SERVICE BLOCK GRANT.—Title V of the Social Security 14 Act (42 U.S.C. 701 et seq.) is amended by adding at the 15 end the following new section: 16 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE- 17 VIEW COMMITTEES ON PREGNANCY-RE- 18 LATED DEATHS. 19 ‘‘(a) GRANTS.— 20 ‘‘(1) IN GENERAL.—Notwithstanding any other 21 provision of this title, for each of fiscal years 2012 22 through 2018, in addition to payments from allot- 23 ments for States under section 502 for such year, 24 the Secretary shall, subject to paragraph (3) and in 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 273 •S 2474 IS accordance with the criteria established under para- 1 graph (2), award grants to States to— 2 ‘‘(A) carry out the activities described in 3 subsection (b)(1); 4 ‘‘(B) establish a State maternal mortality 5 review committee, in accordance with subsection 6 (b)(2), to carry out the activities described in 7 subsection (b)(2)(A), and to establish the proc- 8 esses described in subsection (b)(1); 9 ‘‘(C) ensure the State department of 10 health carries out the applicable activities de- 11 scribed in subsection (b)(3), with respect to 12 pregnancy-related deaths occurring within the 13 State during such fiscal year; 14 ‘‘(D) implement and use the comprehensive 15 case abstraction form developed under sub- 16 section (c), in accordance with such subsection; 17 and 18 ‘‘(E) provide for public disclosure of infor- 19 mation, in accordance with subsection (e). 20 ‘‘(2) CRITERIA.—The Secretary shall establish 21 criteria for determining eligibility for and the 22 amount of a grant awarded to a State under para- 23 graph (1). Such criteria shall provide that in the 24 case of a State that receives such a grant for a fiscal 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 274 •S 2474 IS year and is determined by the Secretary to have not 1 used such grant in accordance with this section, 2 such State shall not be eligible for such a grant for 3 any subsequent fiscal year. 4 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 5 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 6 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 7 purposes of subsection (a), with respect to a State 8 that receives a grant under subsection (a), the fol- 9 lowing shall apply: 10 ‘‘(A) MANDATORY REPORTING OF PREG- 11 NANCY-RELATED DEATHS.— 12 ‘‘(i) IN GENERAL.—The State shall, 13 through the State maternal mortality re- 14 view committee, develop a process, sepa- 15 rate from any reporting process established 16 by the State department of health prior to 17 the date of the enactment of this section, 18 that provides for mandatory and confiden- 19 tial case reporting by individuals and enti- 20 ties described in clause (ii) of pregnancy- 21 related deaths to the State department of 22 health. 23 ‘‘(ii) INDIVIDUALS AND ENTITIES DE- 24 SCRIBED.—Individuals and entities de- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 275 •S 2474 IS scribed in this clause include each of the 1 following: 2 ‘‘(I) Health care providers. 3 ‘‘(II) Medical examiners. 4 ‘‘(III) Medical coroners. 5 ‘‘(IV) Hospitals. 6 ‘‘(V) Free-standing birth centers. 7 ‘‘(VI) Other health care facilities. 8 ‘‘(VII) Any other individuals re- 9 sponsible for completing death certifi- 10 cates. 11 ‘‘(VIII) Any other appropriate in- 12 dividuals or entities specified by the 13 Secretary. 14 ‘‘(B) VOLUNTARY REPORTING OF PREG- 15 NANCY-RELATED AND PREGNANCY-ASSOCIATED 16 DEATHS.— 17 ‘‘(i) The State shall, through the 18 State maternal mortality review committee, 19 develop a process for and encourage, sepa- 20 rate from any reporting process established 21 by the State department of health prior to 22 the date of the enactment of this section, 23 voluntary and confidential case reporting 24 by individuals described in clause (ii) of 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 276 •S 2474 IS pregnancy-associated deaths to the State 1 department of health. 2 ‘‘(ii) The State shall, through the 3 State maternal mortality review committee, 4 develop a process for voluntary and con- 5 fidential reporting by family members of 6 the deceased and by other individuals on 7 possible pregnancy-related and pregnancy- 8 associated deaths to the State department 9 of health. Such process shall include— 10 ‘‘(I) making publicly available on 11 the Internet Web site of the State de- 12 partment of health a telephone num- 13 ber, Internet Web link, and email ad- 14 dress for such reporting; and 15 ‘‘(II) publicizing to local profes- 16 sional organizations, community orga- 17 nizations, and social services agencies 18 the availability of the telephone num- 19 ber, Internet Web link, and email ad- 20 dress made available under subclause 21 (I). 22 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 23 The State, through the vital statistics unit of 24 the State, shall annually identify pregnancy-re- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 277 •S 2474 IS lated and pregnancy-associated deaths occur- 1 ring in such State during the year involved 2 by— 3 ‘‘(i) matching all death records, with 4 respect to such year, for women of child- 5 bearing age to live birth certificates and in- 6 fant death certificates to identify deaths of 7 women that occurred during pregnancy 8 and within one year after the end of a 9 pregnancy; 10 ‘‘(ii) identifying deaths reported dur- 11 ing such year as having an underlying or 12 contributing cause of death related to 13 pregnancy, regardless of the time that has 14 passed between the end of the pregnancy 15 and the death; 16 ‘‘(iii) collecting data from medical ex- 17 aminer and coroner reports; and 18 ‘‘(iv) any other methods the States 19 may devise to identify maternal deaths, 20 such as through review of a random sam- 21 ple of reported deaths of women of child- 22 bearing age to ascertain cases of preg- 23 nancy-related and pregnancy-associated 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 278 •S 2474 IS deaths that are not discernable from a re- 1 view of death certificates alone. 2 When feasible and for purposes of effectively 3 collecting and obtaining data on pregnancy-re- 4 lated and pregnancy-associated deaths, the 5 State shall adopt the most recent standardized 6 birth and death certificates, as issued by the 7 National Center for Vital Health Statistics, in- 8 cluding the recommended checkbox section for 9 pregnancy on the death certificates. 10 ‘‘(D) CASE INVESTIGATION AND DEVELOP- 11 MENT OF CASE SUMMARIES.—Following receipt 12 of reports by the State department of health 13 pursuant to subparagraph (A) or (B) and col- 14 lection by the vital statistics unit of the State 15 of possible cases of pregnancy-related and preg- 16 nancy-associated deaths pursuant to subpara- 17 graph (C), the State, through the State mater- 18 nal mortality review committee established 19 under subsection (a), shall investigate each 20 case, utilizing the case abstraction form de- 21 scribed in subsection (c), and prepare de-identi- 22 fied case summaries, which shall be reviewed by 23 the committee and included in applicable re- 24 ports. For purposes of subsection (a), under the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 279 •S 2474 IS processes established under subparagraphs (A), 1 (B), and (C), a State department of health or 2 vital statistics unit of a State shall provide to 3 the State maternal mortality review committee 4 access to information collected pursuant to such 5 subparagraphs as necessary to carry out this 6 subparagraph. Data and information collected 7 for the case summary and review are for pur- 8 poses of public health activities, in accordance 9 with HIPAA privacy and security law (as de- 10 fined in section 3009(a)(2) of the Public Health 11 Service Act). Such case investigations shall in- 12 clude data and information obtained through— 13 ‘‘(i) medical examiner and autopsy re- 14 ports of the woman involved; 15 ‘‘(ii) medical records of the woman, 16 including such records related to health 17 care prior to pregnancy, prenatal and post- 18 natal care, labor and delivery care, emer- 19 gency room care, hospital discharge 20 records, and any care delivered up until 21 the time of death of the woman for pur- 22 poses of public health activities, in accord- 23 ance with HIPAA privacy and security law 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 280 •S 2474 IS (as defined in section 3009(a)(2) of the 1 Public Health Service Act); 2 ‘‘(iii) oral and written interviews of in- 3 dividuals directly involved in the maternal 4 care of the woman during and immediately 5 following the pregnancy of the woman, in- 6 cluding health care, mental health, and so- 7 cial service providers, as applicable; 8 ‘‘(iv) optional oral or written inter- 9 views of the family of the woman; 10 ‘‘(v) socioeconomic and other relevant 11 background information about the woman; 12 ‘‘(vi) information collected in subpara- 13 graph (C)(i); and 14 ‘‘(vii) other information on the cause 15 of death of the woman, such as social serv- 16 ices and child welfare reports. 17 ‘‘(2) STATE MATERNAL MORTALITY REVIEW 18 COMMITTEES.— 19 ‘‘(A) DUTIES.— 20 ‘‘(i) REQUIRED COMMITTEE ACTIVI- 21 TIES.—For purposes of subsection (a), a 22 maternal mortality review committee estab- 23 lished by a State pursuant to a grant 24 under such subsection shall carry out the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 281 •S 2474 IS following pregnancy-related death and 1 pregnancy-associated death review activi- 2 ties and shall include all information rel- 3 evant to the death involved on the case ab- 4 straction form developed under subsection 5 (d): 6 ‘‘(I) With respect to a case of 7 pregnancy-related or pregnancy-asso- 8 ciated death of a woman, review the 9 case summaries prepared under sub- 10 paragraphs (A), (B), (C), and (D) of 11 paragraph (1). 12 ‘‘(II) Review aggregate statistical 13 reports developed by the vital statis- 14 tics unit of the State under paragraph 15 (1)(C) regarding pregnancy-related 16 and pregnancy-associated deaths to 17 identify trends, patterns, and dispari- 18 ties in adverse outcomes and address 19 medical, non-medical, and system-re- 20 lated factors that may have contrib- 21 uted to such pregnancy-related and 22 pregnancy-associated deaths and dis- 23 parities. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 282 •S 2474 IS ‘‘(III) Develop recommendations, 1 based on the review of the case sum- 2 maries under paragraph (1)(D) and 3 aggregate statistical reports under 4 subclause (II), to improve maternal 5 care, social and health services, and 6 public health policy and institutions, 7 including with respect to improving 8 access to maternal care, improving the 9 availability of social services, and 10 eliminating disparities in maternal 11 care and outcomes. 12 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI- 13 TIES.—For purposes of subsection (a), a 14 maternal mortality review committee estab- 15 lished by a State under such subsection 16 may present findings and recommendations 17 regarding a specific case or set of cir- 18 cumstances directly to a health care facil- 19 ity or its local or State professional organi- 20 zation for the purpose of instituting policy 21 changes, educational activities, or other- 22 wise improving the quality of care provided 23 by the facilities. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 283 •S 2474 IS ‘‘(B) COMPOSITION OF MATERNAL MOR- 1 TALITY REVIEW COMMITTEES.— 2 ‘‘(i) IN GENERAL.—Each State mater- 3 nal mortality review committee established 4 pursuant to a grant under subsection (a) 5 shall be multi-disciplinary, consisting of 6 health care and social service providers, 7 public health officials, other persons with 8 professional expertise on maternal health 9 and mortality, and patient and community 10 advocates who represent those communities 11 within such State that are the most af- 12 fected by maternal mortality. Membership 13 on such a committee of a State shall be re- 14 viewed annually by the State department 15 of health to ensure that membership rep- 16 resentation requirements are being fulfilled 17 in accordance with this paragraph. 18 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 19 such review committee shall include— 20 ‘‘(I) representatives from medical 21 specialities providing care to pregnant 22 and postpartum patients, including 23 obstetricians (including generalists 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 284 •S 2474 IS and maternal fetal medicine special- 1 ists), and family practice physicians; 2 ‘‘(II) certified nurse midwives, 3 certified midwives, and advanced prac- 4 tice nurses; 5 ‘‘(III) hospital-based nurses; 6 ‘‘(IV) representatives of the State 7 department of health maternal and 8 child health department; 9 ‘‘(V) social service providers or 10 social workers; 11 ‘‘(VI) the chief medical exam- 12 iners or designees; 13 ‘‘(VII) facility representatives, 14 such as from hospitals or free-stand- 15 ing birth centers; and 16 ‘‘(VIII) community or patient ad- 17 vocates who represent those commu- 18 nities within the State that are the 19 most affected by maternal mortality. 20 ‘‘(iii) ADDITIONAL MEMBERS.—Each 21 such review committee may also include 22 representatives from other relevant aca- 23 demic, health, social service, or policy pro- 24 fessions, or community organizations, on 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 285 •S 2474 IS an ongoing basis, or as needed, as deter- 1 mined beneficial by the review committee, 2 including— 3 ‘‘(I) anesthesiologists; 4 ‘‘(II) emergency physicians; 5 ‘‘(III) pathologists; 6 ‘‘(IV) epidemiologists or biostat- 7 isticians; 8 ‘‘(V) intensivists; 9 ‘‘(VI) vital statistics officers; 10 ‘‘(VII) nutritionists; 11 ‘‘(VIII) mental health profes- 12 sionals; 13 ‘‘(IX) substance abuse treatment 14 specialists; 15 ‘‘(X) representatives of relevant 16 advocacy groups; 17 ‘‘(XI) academics; 18 ‘‘(XII) representatives of bene- 19 ficiaries of the State plan under the 20 Medicaid program under title XIX; 21 ‘‘(XIII) paramedics; 22 ‘‘(XIV) lawyers; 23 ‘‘(XV) risk management special- 24 ists; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 286 •S 2474 IS ‘‘(XVI) representatives of the de- 1 partments of health or public health 2 of major cities in the State involved; 3 and 4 ‘‘(XVII) policy makers. 5 ‘‘(iv) DIVERSE COMMUNITY MEMBER- 6 SHIP.—The composition of such a com- 7 mittee, with respect to a State, shall in- 8 clude— 9 ‘‘(I) representatives from diverse 10 communities, particularly those com- 11 munities within such State most se- 12 verely affected by pregnancy-related 13 deaths or pregnancy-associated deaths 14 and by a lack of access to relevant 15 maternal care services, from commu- 16 nity maternal child health organiza- 17 tions, and from minority advocacy 18 groups; 19 ‘‘(II) members, including health 20 care providers, from different geo- 21 graphic regions in the State, including 22 any rural, urban, and tribal areas; 23 and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 287 •S 2474 IS ‘‘(III) health care and social serv- 1 ice providers who work in commu- 2 nities that are diverse with regard to 3 race, ethnicity, immigration status, 4 Indigenous status, and English pro- 5 ficiency. 6 ‘‘(v) MATERNAL MORTALITY REVIEW 7 STAFF.—Staff of each such review com- 8 mittee shall include— 9 ‘‘(I) vital health statisticians, ma- 10 ternal child health statisticians, or 11 epidemiologists; 12 ‘‘(II) a coordinator of the State 13 maternal mortality review committee, 14 to be designated by the State; and 15 ‘‘(III) administrative staff. 16 ‘‘(C) OPTION FOR STATES TO FORM RE- 17 GIONAL MATERNAL MORTALITY REVIEWS.— 18 States with a low rate of occurrence of preg- 19 nancy-associated or pregnancy-related deaths 20 may choose to partner with one or more neigh- 21 boring States to fulfill the activities described in 22 paragraph (1)(C). In such a case, with respect 23 to States in such a partnership, any require- 24 ment under this section relating to the report- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 288 •S 2474 IS ing of information related to such activities 1 shall be deemed to be fulfilled by each such 2 State if a single such report is submitted for 3 the partnership. 4 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI- 5 TIES.—For purposes of subsection (a), a State de- 6 partment of health of a State receiving a grant 7 under such subsection shall— 8 ‘‘(A) in consultation with the maternal 9 mortality review committee of the State and in 10 conjunction with relevant professional organiza- 11 tions, develop a plan for ongoing health care 12 provider education, based on the findings and 13 recommendations of the committee, in order to 14 improve the quality of maternal care; and 15 ‘‘(B) take steps to widely disseminate the 16 findings and recommendations of the State ma- 17 ternal mortality review committees of the State 18 and to implement the recommendations of such 19 committee. 20 ‘‘(c) CASE ABSTRACTION FORM.— 21 ‘‘(1) DEVELOPMENT.—The Director of the Cen- 22 ters for Disease Control and Prevention shall de- 23 velop a uniform, comprehensive case abstraction 24 form and make such form available to States for 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 289 •S 2474 IS State maternal mortality review committees for use 1 by such committees in order to— 2 ‘‘(A) ensure that the cases and information 3 collected and reviewed by such committees can 4 be pooled for review by the Department of 5 Health and Human Services and its agencies; 6 and 7 ‘‘(B) preserve the uniformity of the infor- 8 mation and its use for Federal public health 9 purposes. 10 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 11 Each State may modify the form developed under 12 paragraph (1) for implementation and use by such 13 State or by the State maternal mortality review com- 14 mittee of such State by including on such form addi- 15 tional information to be collected, but may not alter 16 the standard questions on such form, in order to en- 17 sure that the information can be collected and re- 18 viewed centrally at the Federal level. 19 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY 20 FOR PURPOSES OF HIPAA.—For purposes of applying 21 HIPAA privacy and security law (as defined in section 22 3009(a)(2) of the Public Health Service Act), a State ma- 23 ternal mortality review committee of a State established 24 pursuant to this section to carry out activities described 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 290 •S 2474 IS in subsection (b)(2)(A) shall be deemed to be a public 1 health authority described in section 164.501 (and ref- 2 erenced in section 164.512(b)(1)(i)) of title 45, Code of 3 Federal Regulations (or any successor regulation), car- 4 rying out public health activities and purposes described 5 in such section 164.512(b)(1)(i) (or any such successor 6 regulation). 7 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 8 ‘‘(1) IN GENERAL.—For fiscal year 2012 or a 9 subsequent fiscal year, each State receiving a grant 10 under this section for such year shall, subject to 11 paragraph (3), provide for the public disclosure, and 12 submission to the information clearinghouse estab- 13 lished under paragraph (2), of the information in- 14 cluded in the report of the State under section 15 506(a)(2)(F) for such year (relating to the findings 16 for such year of the State maternal mortality review 17 committee established by the State under this sec- 18 tion). 19 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 20 Secretary of Health and Human Services shall es- 21 tablish an information clearinghouse, that shall be 22 administered by the Director of the Centers for Dis- 23 ease Control and Prevention, that will maintain find- 24 ings and recommendations submitted pursuant to 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 291 •S 2474 IS paragraph (1) and provide such findings and rec- 1 ommendations for public review and research pur- 2 poses by State health departments, maternal mor- 3 tality review committees, and health providers and 4 institutions. 5 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 6 no case shall any individually identifiable health in- 7 formation be provided to the public, or submitted to 8 the information clearinghouse, under paragraph (1). 9 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE 10 PROCEEDINGS.— 11 ‘‘(1) IN GENERAL.—All proceedings and activi- 12 ties of a State maternal mortality review committee 13 under this section, opinions of members of such a 14 committee formed as a result of such proceedings 15 and activities, and records obtained, created, or 16 maintained pursuant to this section, including 17 records of interviews, written reports, and state- 18 ments procured by the Department of Health and 19 Human Services or by any other person, agency, or 20 organization acting jointly with the Department, in 21 connection with morbidity and mortality reviews 22 under this section, shall be confidential, and not sub- 23 ject to discovery, subpoena, or introduction into evi- 24 dence in any civil, criminal, legislative, or other pro- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 292 •S 2474 IS ceeding. Such records shall not be open to public in- 1 spection. 2 ‘‘(2) TESTIMONY OF MEMBERS OF COM- 3 MITTEE.— 4 ‘‘(A) IN GENERAL.—Members of a State 5 maternal mortality review committee under this 6 section may not be questioned in any civil, 7 criminal, legislative, or other proceeding regard- 8 ing information presented in, or opinions 9 formed as a result of, a meeting or communica- 10 tion of the committee. 11 ‘‘(B) CLARIFICATION.—Nothing in this 12 subsection shall be construed to prevent a mem- 13 ber of such a committee from testifying regard- 14 ing information that was obtained independent 15 of such member’s participation on the com- 16 mittee, or that is public information. 17 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE- 18 SEARCH PURPOSES.—Nothing in this subsection 19 shall prohibit the publishing by such a committee or 20 the Department of Health and Human Services of 21 statistical compilations and research reports that— 22 ‘‘(A) are based on confidential information, 23 relating to morbidity and mortality review; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 293 •S 2474 IS ‘‘(B) do not contain identifying informa- 1 tion or any other information that could be 2 used to ultimately identify the individuals con- 3 cerned. 4 ‘‘(g) DEFINITIONS.—For purposes of this section: 5 ‘‘(1) The term ‘pregnancy-associated death’ 6 means the death of a woman while pregnant or dur- 7 ing the one-year period following the date of the end 8 of pregnancy, irrespective of the cause of such death. 9 ‘‘(2) The term ‘pregnancy-related death’ means 10 the death of a woman while pregnant or during the 11 one-year period following the date of the end of 12 pregnancy, irrespective of the duration or site of the 13 pregnancy, from any cause related to or aggravated 14 by the pregnancy or its management, but not from 15 any accidental or incidental cause. 16 ‘‘(3) The term ‘woman of childbearing age’ 17 means a woman who is at least 10 years of age and 18 not more than 54 years of age.’’. 19 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT- 20 TEES IN REQUIRED REPORTS.— 21 (1) STATE TRIENNIAL REPORTS.—Paragraph 22 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 23 is amended by inserting after subparagraph (E) the 24 following new subparagraph: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 294 •S 2474 IS ‘‘(F) In the case of a State receiving a 1 grant under section 514, beginning for the first 2 fiscal year beginning after 3 years after the 3 date of establishment of the State maternal 4 mortality review committee established by the 5 State pursuant to such grant and once every 3 6 years thereafter, information containing the 7 findings and recommendations of such com- 8 mittee and information on the implementation 9 of such recommendations during the period in- 10 volved.’’. 11 (2) ANNUAL REPORTS TO CONGRESS.—Para- 12 graph (3) of such section is amended— 13 (A) in subparagraph (D), at the end, by 14 striking ‘‘and’’; 15 (B) in subparagraph (E), at the end, by 16 striking the period and inserting ‘‘; and’’; and 17 (C) by adding at the end the following new 18 subparagraph: 19 ‘‘(F) For fiscal year 2012 and each subse- 20 quent fiscal year, taking into account the find- 21 ings, recommendations, and implementation in- 22 formation submitted by States pursuant to 23 paragraph (2)(F), on the status of pregnancy- 24 related deaths and pregnancy-associated deaths 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 295 •S 2474 IS in the United States and including rec- 1 ommendations on methods to prevent such 2 deaths in the United States.’’. 3 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 4 HEALTH OUTCOMES. 5 Part B of title III of the Public Health Service Act 6 is amended by inserting after section 317V, as added, the 7 following new section: 8 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 9 HEALTH OUTCOMES. 10 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta- 11 tion with relevant national stakeholder organizations, such 12 as national medical specialty organizations, national ma- 13 ternal child health organizations, and national health dis- 14 parity organizations, carry out the following activities to 15 eliminate disparities in maternal health outcomes: 16 ‘‘(1) Conduct research into the determinants 17 and the distribution of disparities in maternal care, 18 health risks, and health outcomes, and improve the 19 capacity of the performance measurement infrastruc- 20 ture to measure such disparities. 21 ‘‘(2) Expand access to services that have been 22 demonstrated to improve the quality and outcomes 23 of maternity care for vulnerable populations. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 296 •S 2474 IS ‘‘(3) Establish a demonstration project to com- 1 pare the effectiveness of interventions to reduce dis- 2 parities in maternity services and outcomes, and im- 3 plement and assess effective interventions. 4 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 5 ONSTRATION PROJECT.—The demonstration project 6 under subsection (a)(3) shall be conducted in no more 7 than 8 States, which shall be selected by the Secretary 8 based on— 9 ‘‘(1) applications submitted by States, which 10 specify which regions and populations the State in- 11 volved will serve under the demonstration project; 12 ‘‘(2) criteria designed by the Secretary to en- 13 sure that, as a whole, the demonstration project is, 14 to the greatest extent possible, representative of the 15 demographic and geographic composition of commu- 16 nities most affected by disparities; 17 ‘‘(3) criteria designed by the Secretary to en- 18 sure that a variety of type of models are tested 19 through the demonstration project and that such 20 models include interventions that have an existing 21 evidence base for effectiveness; and 22 ‘‘(4) criteria designed by the Secretary to as- 23 sure that the demonstration projects and models will 24 be carried out in consultation with local and regional 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 297 •S 2474 IS provider organizations, such as community health 1 centers, hospital systems, and medical societies rep- 2 resenting providers of maternity services. 3 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 4 The demonstration project under subsection (a)(3) shall 5 begin on January 1, 2012, and end on December 31, 6 2016. 7 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 8 The Secretary may make grants to States and health care 9 providers participating in the demonstration project under 10 subsection (a)(3) for the purpose of collecting data nec- 11 essary for the evaluation and monitoring of such project. 12 ‘‘(e) REPORTS.— 13 ‘‘(1) STATE REPORTS.—Each State that par- 14 ticipates in the demonstration project under sub- 15 section (a)(3) shall report to the Secretary, in a 16 time, form, and manner specified by the Secretary, 17 the data necessary to— 18 ‘‘(A) monitor the— 19 ‘‘(i) outcomes of the project; 20 ‘‘(ii) costs of the project; and 21 ‘‘(iii) quality of maternity care pro- 22 vided under the project; and 23 ‘‘(B) evaluate the rationale for the selec- 24 tion of the items and services included in any 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 298 •S 2474 IS bundled payment made by the State under the 1 project. 2 ‘‘(2) FINAL REPORT.—Not later than December 3 31, 2017, the Secretary shall submit to Congress a 4 report on the results of the demonstration project 5 under subsection (a)(3).’’. 6 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 7 UNEXPECTED INFANT DEATH AND SUDDEN 8 UNEXPLAINED DEATH IN CHILDHOOD. 9 (a) ESTABLISHMENT.—The Secretary of Health and 10 Human Services acting through the Administrator of the 11 Health Resources and Services Administration and in con- 12 sultation with the Director of the Centers for Disease Con- 13 trol and Prevention and the Director of the National Insti- 14 tutes of Health (in this section referred to as the ‘‘Sec- 15 retary’’) shall establish and implement a culturally com- 16 petent public health awareness and education campaign 17 to provide information that is focused on decreasing the 18 risk factors for sudden unexpected infant death and sud- 19 den unexplained death in childhood, including educating 20 individuals about safe sleep environments, sleep positions, 21 and reducing exposure to smoking during pregnancy and 22 after birth. 23 (b) TARGETED POPULATIONS.—The campaign under 24 subsection (a) shall be designed to reduce health dispari- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 299 •S 2474 IS ties through the targeting of populations with high rates 1 of sudden unexpected infant death and sudden unex- 2 plained death in childhood. 3 (c) CONSULTATION.—In establishing and imple- 4 menting the campaign under subsection (a), the Secretary 5 shall consult with national organizations representing 6 health care providers, including nurses and physicians, 7 parents, child care providers, children’s advocacy and safe- 8 ty organizations, maternal and child health programs and 9 women’s, infants, and children nutrition professionals, and 10 other individuals and groups determined necessary by the 11 Secretary for such establishment and implementation. 12 (d) GRANTS.— 13 (1) IN GENERAL.—In carrying out the cam- 14 paign under subsection (a), the Secretary shall 15 award grants to national organizations, State and 16 local health departments, and community-based or- 17 ganizations for the conduct of education and out- 18 reach programs for nurses, parents, child care pro- 19 viders, public health agencies, and community orga- 20 nizations. 21 (2) APPLICATION.—To be eligible to receive a 22 grant under paragraph (1), an entity shall submit to 23 the Secretary an application at such time, in such 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 300 •S 2474 IS manner, and containing such information as the Sec- 1 retary may require. 2 SEC. 508. REDUCING TEENAGE PREGNANCIES. 3 Title III of the Public Health Service Act (42 U.S.C. 4 241 et seq.) is amended by adding at the end the following 5 new part: 6 ‘‘PART W—YOUTH PREGNANCY PREVENTION 7 PROGRAMS 8 ‘‘SEC. 399OO. PURPOSE. 9 ‘‘It is the purpose of this part to develop and carry 10 out research and demonstration projects on new and exist- 11 ing program interventions to provide youth in racial or 12 ethnic minority or immigrant communities the information 13 and skills needed to reduce teenage pregnancies, build 14 healthy relationships, and improve overall health and well- 15 being. 16 ‘‘SEC. 399OO–1. DEMONSTRATION GRANTS TO REDUCE 17 TEENAGE PREGNANCIES. 18 ‘‘(a) IN GENERAL.—The Secretary shall award com- 19 petitive grants to eligible entities for establishing or ex- 20 panding programs to provide youth in racial or ethnic mi- 21 nority or immigrant communities the information and 22 skills needed to avoid teenage pregnancy and develop 23 healthy relationships. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 301 •S 2474 IS ‘‘(b) PRIORITY.—In awarding grants under this sec- 1 tion, the Secretary shall give priority to applicants— 2 ‘‘(1) proposing to carry out projects in racial or 3 ethnic minority or immigrant communities; 4 ‘‘(2) that have a demonstrated history of effec- 5 tively working with such targeted communities; or 6 ‘‘(3) that have a demonstrated history of engag- 7 ing in a meaningful and significant partnership with 8 such targeted communities. 9 ‘‘(c) PROGRAM SETTINGS.—Programs funded 10 through a grant under subsection (a) shall be provided— 11 ‘‘(1) through classroom-based settings, such as 12 school health education, humanities, language arts, 13 or family and consumer science education; after- 14 school programs; community-based programs; work- 15 force development programs; and health care set- 16 tings; or 17 ‘‘(2) in collaboration with systems that serve 18 large numbers of at-risk youth such as juvenile jus- 19 tice or foster care systems. 20 ‘‘(d) PROJECT REQUIREMENTS.—As a condition of 21 receipt of a grant under this section, an entity shall agree 22 that, with respect to information and skills provided 23 through the grant— 24 ‘‘(1) such information and skills will be— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 302 •S 2474 IS ‘‘(A) age-appropriate; 1 ‘‘(B) evidence-based or evidence-informed; 2 ‘‘(C) provided in accordance with section 3 399OO–5(b); and 4 ‘‘(D) culturally sensitive and relevant to 5 the target populations; and 6 ‘‘(2) any information provided about contracep- 7 tives shall include the health benefits and side ef- 8 fects of all contraceptives and barrier methods. 9 ‘‘(e) EVALUATION.—Of the total amount made avail- 10 able to carry out this section for a fiscal year, the Sec- 11 retary, acting through the Director of the Centers for Dis- 12 ease Control and Prevention and other agencies as appro- 13 priate, shall allot up to 10 percent of such amount to carry 14 out a rigorous, independent evaluation to determine the 15 extent and the effectiveness of activities funded through 16 this section during such fiscal year in changing attitudes 17 and behavior of teenagers with respect to healthy relation- 18 ships and childbearing. 19 ‘‘(f) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGA- 20 NIZATIONS.—Of the total amount made available to carry 21 out this section for a fiscal year, the Secretary shall re- 22 serve 5 percent of such amount to award grants under 23 this section to Indian tribes and tribal organizations in 24 such manner, and subject to such requirements, as the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 303 •S 2474 IS Secretary, in consultation with Indian tribes and tribal or- 1 ganizations, determines appropriate. 2 ‘‘(g) ELIGIBLE ENTITY DEFINED.— 3 ‘‘(1) IN GENERAL.—In this section, the term 4 ‘eligible entity’ means a State, local, or tribal agen- 5 cy; a school or postsecondary institution; an after- 6 school program; a nonprofit organization; or a com- 7 munity or faith-based organization. 8 ‘‘(2) PREVENTING EXCLUSION OF SMALLER 9 COMMUNITY-BASED ORGANIZATIONS.—In carrying 10 out this section, the Secretary shall ensure that the 11 amounts and requirements of grants provided under 12 this section do not preclude receipt of such grants 13 by community-based organizations with a dem- 14 onstrated history of effectively working with adoles- 15 cents in racial or ethnic minority or immigrant com- 16 munities or engaged in meaningful and significant 17 partnership with such communities. 18 ‘‘SEC. 399OO–2. MULTIMEDIA CAMPAIGNS TO REDUCE 19 TEENAGE PREGNANCIES. 20 ‘‘(a) IN GENERAL.—The Secretary shall award com- 21 petitive grants to public and private entities to carry out 22 multimedia campaigns to provide public education and in- 23 crease public awareness regarding teenage pregnancy and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 304 •S 2474 IS related social and emotional issues, such as violence pre- 1 vention. 2 ‘‘(b) PRIORITY.—In awarding grants under this sec- 3 tion, the Secretary shall give priority to applicants pro- 4 posing to carry out campaigns developed for racial or eth- 5 nic minority or immigrant communities. 6 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi- 7 tion of receipt of a grant under this section, an entity shall 8 agree to use the grant to carry out multimedia campaigns 9 described in subsection (a) that— 10 ‘‘(1) at a minimum, shall provide information 11 on— 12 ‘‘(A) the prevention of teenage pregnancy; 13 and 14 ‘‘(B) healthy relationship development; and 15 ‘‘(2) may provide information on the prevention 16 of dating violence. 17 ‘‘SEC. 399OO–3. RESEARCH ON REDUCING TEENAGE PREG- 18 NANCIES AND TEENAGE DATING VIOLENCE 19 AND IMPROVING HEALTHY RELATIONSHIPS. 20 ‘‘(a) IN GENERAL.—The Secretary, acting through 21 the Director of the Centers for Disease Control and Pre- 22 vention, shall make grants to public and private entities 23 to conduct, support, or coordinate research on teenage 24 pregnancy, dating violence, and healthy relationships 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 305 •S 2474 IS among racial or ethnic minority or immigrant communities 1 that— 2 ‘‘(1) improves data collection on— 3 ‘‘(A) sexual and reproductive health, in- 4 cluding teenage pregnancies and births, among 5 all minority communities and subpopulations in 6 which such data are not collected, including 7 American Indian and Alaska Native youth; 8 ‘‘(B) sexual behavior, reproductive and sex- 9 ual coercion, and teenage contraceptive use pat- 10 terns at the State level, as appropriate; and 11 ‘‘(C) teenage pregnancies among youth in 12 and aging out of foster care or juvenile justice 13 systems and the underlying factors that lead to 14 teenage pregnancy among youth in foster care 15 or juvenile justice systems; 16 ‘‘(2) investigates— 17 ‘‘(A) the variance in the rates of teenage 18 pregnancy by— 19 ‘‘(i) racial and ethnic group (such as 20 Hispanic, Asian-American, African-Amer- 21 ican, Pacific Islander, American Indian, 22 and Alaska Native); and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 306 •S 2474 IS ‘‘(ii) socioeconomic status, including 1 as based on the income of the family and 2 education attainment; 3 ‘‘(B) factors affecting the risk for youth of 4 teenage pregnancy or dating abuse, including 5 the physical and social environment, level of ac- 6 culturation, access to health care, aspirations 7 for the future, and history of physical or sexual 8 violence or abuse; 9 ‘‘(C) the role that violence and abuse play 10 in teenage sex, pregnancy, and childbearing; 11 ‘‘(D) strategies to address the dispropor- 12 tionate rates of teenage pregnancies and dating 13 violence in racial or ethnic minority or immi- 14 grant communities; 15 ‘‘(E) how effective interventions can be 16 replicated or adapted in other settings to serve 17 racial or ethnic minority or immigrant commu- 18 nities; and 19 ‘‘(F) the effectiveness of media campaigns 20 in addressing healthy relationship development, 21 dating violence prevention, and teenage preg- 22 nancy; and 23 ‘‘(3) tests research-based strategies for address- 24 ing high rates of unintended teenage pregnancy 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 307 •S 2474 IS through programs that emphasize healthy relation- 1 ships and violence prevention. 2 ‘‘(b) PRIORITY.—In carrying out this section, the 3 Secretary shall give priority to research that incor- 4 porates— 5 ‘‘(1) interdisciplinary approaches; 6 ‘‘(2) a strong emphasis on community-based 7 participatory research; or 8 ‘‘(3) translational research. 9 ‘‘SEC. 399OO–4. HHS ADOLESCENT HEALTH WORK GROUP. 10 ‘‘(a) PURPOSE.—Not later than 30 days after the 11 date of the enactment of this part, the Secretary shall di- 12 rect the interagency adolescent health workgroup within 13 the Office of Adolescent Health of the Department of 14 Health and Human Services to— 15 ‘‘(1) include in the work of the group strategies 16 for teenage dating violence prevention and healthy 17 teenage relationships with a particular focus among 18 racial or ethnic minority or immigrant communities; 19 and 20 ‘‘(2) with respect to including such strategies, 21 consult, to the greatest extent possible, with the 22 Federal Interagency Workgroup on Teen Dating Vi- 23 olence formed under the leadership of the National 24 Institute of Justice of the Department of Justice. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 308 •S 2474 IS ‘‘(b) REPORT REQUIREMENT.—The Secretary, 1 through the Office of Adolescent Health, shall periodically 2 submit to Congress a report that— 3 ‘‘(1) includes a review of the evidence-based 4 programs on preventing teenage pregnancy, which 5 are carried out and identified by the Office; and 6 ‘‘(2) identifies the programs of the Department 7 of Health and Human Services that include teenage 8 dating violence prevention and the promotion of 9 healthy teenage relationships as part of a strategy to 10 prevent teenage pregnancy. 11 ‘‘SEC. 399OO–5. GENERAL GRANT PROVISIONS. 12 ‘‘(a) APPLICATIONS.—To seek a grant under this 13 part, an entity shall submit an application to the Secretary 14 in such form, in such manner, and containing such agree- 15 ments, assurances, and information as the Secretary may 16 require. 17 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 18 made under this part only if the applicant involved agrees 19 that information, activities, and services provided under 20 the grant— 21 ‘‘(1) will be evidence-based or evidence in- 22 formed; 23 ‘‘(2) will be factually and medically accurate 24 and complete; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 309 •S 2474 IS ‘‘(3) if directed to a particular population 1 group, will be provided in an appropriate language 2 and cultural context. 3 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 4 ‘‘(1) IN GENERAL.—Of the total amount made 5 available to carry out this part for a fiscal year, the 6 Secretary shall use 10 percent to provide, directly or 7 through a competitive grant process, training and 8 technical assistance to the grant recipients under 9 this part, including by disseminating research and 10 information regarding effective and promising prac- 11 tices, providing consultation and resources on a 12 broad array of teenage and unintended pregnancy 13 and violence prevention strategies, and developing 14 resources and materials. 15 ‘‘(2) COLLABORATION.—In carrying out this 16 subsection, the Secretary shall collaborate with enti- 17 ties that have expertise in the prevention of teenage 18 pregnancy, healthy relationship development, minor- 19 ity health and health disparities, and violence pre- 20 vention. 21 ‘‘SEC. 399OO–6. DEFINITIONS. 22 ‘‘In this part: 23 ‘‘(1) MEDICALLY ACCURATE AND COMPLETE.— 24 The term ‘medically accurate and complete’ means, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 310 •S 2474 IS with respect to information, activities, or services, 1 verified or supported by the weight of research con- 2 ducted in compliance with accepted scientific meth- 3 ods and— 4 ‘‘(A) published in peer-reviewed journals, 5 where applicable; or 6 ‘‘(B) comprising information that leading 7 professional organizations and agencies with 8 relevant expertise in the field recognize as accu- 9 rate, objective, and complete. 10 ‘‘(2) RACIAL OR ETHNIC MINORITY OR IMMI- 11 GRANT COMMUNITIES.—The term ‘racial or ethnic 12 minority or immigrant communities’ means commu- 13 nities with a substantial number of residents who 14 are members of racial or ethnic minority groups or 15 who are immigrants. 16 ‘‘(3) REPRODUCTIVE AND SEXUAL COERCION.— 17 The term ‘reproductive and sexual coercion’— 18 ‘‘(A) means, with respect to a person, coer- 19 cive behavior that interferes with the ability of 20 such person to control the reproductive deci- 21 sionmaking of such person, such as inten- 22 tionally exposing such person to sexually trans- 23 mitted infections; in the case such person is a 24 female, attempting to impregnate such person 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 311 •S 2474 IS against her will; intentionally interfering with 1 the person’s birth control; or threatening or act- 2 ing violent if the person does not comply with 3 the perpetrator’s wishes regarding contracep- 4 tion or the decision whether to terminate or 5 continue a pregnancy; and 6 ‘‘(B) includes a range of behaviors that a 7 partner may use related to sexual decision- 8 making to pressure or coerce a person to have 9 sex without using physical force, such as re- 10 peatedly pressuring a partner to have sex when 11 he or she does not want to; threatening to end 12 a relationship if a person does not have sex; 13 and threatening retaliation if notified of a posi- 14 tive sexually transmitted disease test result. 15 ‘‘(4) YOUTH.—The term ‘youth’ means individ- 16 uals who are 11 to 19 years of age. 17 ‘‘SEC. 399OO–7. REPORTS. 18 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 19 1 year after the date of the enactment of this part, the 20 Secretary shall submit to Congress a report on the use 21 of funds provided pursuant to this part. 22 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 23 than March 1, 2016, the Secretary shall submit to Con- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 312 •S 2474 IS gress a report on the impact that the programs under this 1 part had on reducing teenage pregnancies.’’. 2 SEC. 509. GESTATIONAL DIABETES. 3 Part B of title III of the Public Health Service Act 4 (42 U.S.C. 243 et seq.) is amended by adding after section 5 317H the following: 6 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 7 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 8 TIONAL DIABETES.— 9 ‘‘(1) IN GENERAL.—The Secretary, acting 10 through the Director of the Centers for Disease 11 Control and Prevention, in consultation with the Di- 12 abetes Mellitus Interagency Coordinating Committee 13 established under section 429 and representatives of 14 appropriate national health organizations, shall de- 15 velop a multisite gestational diabetes research 16 project within the diabetes program of the Centers 17 for Disease Control and Prevention to expand and 18 enhance surveillance data and public health research 19 on gestational diabetes. 20 ‘‘(2) AREAS TO BE ADDRESSED.—The research 21 project developed under paragraph (1) shall ad- 22 dress— 23 ‘‘(A) procedures to establish accurate and 24 efficient systems for the collection of gestational 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 313 •S 2474 IS diabetes data within each State and common- 1 wealth, territory, or possession of the United 2 States; 3 ‘‘(B) the progress of collaborative activities 4 with the National Vital Statistics System, the 5 National Center for Health Statistics, and 6 State health departments with respect to the 7 standard birth certificate, in order to improve 8 surveillance of gestational diabetes; 9 ‘‘(C) postpartum methods of tracking 10 women with gestational diabetes after delivery 11 as well as targeted interventions proven to 12 lower the incidence of type 2 diabetes in that 13 population; 14 ‘‘(D) variations in the distribution of diag- 15 nosed and undiagnosed gestational diabetes, 16 and of impaired fasting glucose tolerance and 17 impaired fasting glucose, within and among 18 groups of women; and 19 ‘‘(E) factors and culturally sensitive inter- 20 ventions that influence risks and reduce the in- 21 cidence of gestational diabetes and related com- 22 plications during childbirth, including cultural, 23 behavioral, racial, ethnic, geographic, demo- 24 graphic, socioeconomic, and genetic factors. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 314 •S 2474 IS ‘‘(3) REPORT.—Not later than 2 years after the 1 date of the enactment of this section, and annually 2 thereafter, the Secretary shall generate a report on 3 the findings and recommendations of the research 4 project including prevalence of gestational diabetes 5 in the multisite area and disseminate the report to 6 the appropriate Federal and non-Federal agencies. 7 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 8 SEARCH.—The Secretary shall expand and intensify public 9 health research regarding gestational diabetes. Such re- 10 search may include— 11 ‘‘(1) developing and testing novel approaches 12 for improving postpartum diabetes testing or screen- 13 ing and for preventing type 2 diabetes in women 14 with a history of gestational diabetes; and 15 ‘‘(2) conducting public health research to fur- 16 ther understanding of the epidemiologic, 17 socioenvironmental, behavioral, translation, and bio- 18 medical factors and health systems that influence 19 the risk of gestational diabetes and the development 20 of type 2 diabetes in women with a history of gesta- 21 tional diabetes. 22 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 23 RATE OF GESTATIONAL DIABETES.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 315 •S 2474 IS ‘‘(1) IN GENERAL.—The Secretary, acting 1 through the Director of the Centers for Disease 2 Control and Prevention, shall award grants, on a 3 competitive basis, to eligible entities for demonstra- 4 tion projects that implement evidence-based inter- 5 ventions to reduce the incidence of gestational diabe- 6 tes, the recurrence of gestational diabetes in subse- 7 quent pregnancies, and the development of type 2 di- 8 abetes in women with a history of gestational diabe- 9 tes. 10 ‘‘(2) PRIORITY.—In making grants under this 11 subsection, the Secretary shall give priority to 12 projects focusing on— 13 ‘‘(A) helping women who have 1 or more 14 risk factors for developing gestational diabetes; 15 ‘‘(B) working with women with a history of 16 gestational diabetes during a previous preg- 17 nancy; 18 ‘‘(C) providing postpartum care for women 19 with gestational diabetes; 20 ‘‘(D) tracking cases where women with a 21 history of gestational diabetes developed type 2 22 diabetes; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 316 •S 2474 IS ‘‘(E) educating mothers with a history of 1 gestational diabetes about the increased risk of 2 their child developing diabetes; 3 ‘‘(F) working to prevent gestational diabe- 4 tes and prevent or delay the development of 5 type 2 diabetes in women with a history of ges- 6 tational diabetes; and 7 ‘‘(G) achieving outcomes designed to assess 8 the efficacy and cost-effectiveness of interven- 9 tions that can inform decisions on long-term 10 sustainability, including third-party reimburse- 11 ment. 12 ‘‘(3) APPLICATION.—An eligible entity desiring 13 to receive a grant under this subsection shall submit 14 to the Secretary— 15 ‘‘(A) an application at such time, in such 16 manner, and containing such information as the 17 Secretary may require; and 18 ‘‘(B) a plan to— 19 ‘‘(i) lower the rate of gestational dia- 20 betes during pregnancy; or 21 ‘‘(ii) develop methods of tracking 22 women with a history of gestational diabe- 23 tes and develop effective interventions to 24 lower the incidence of the recurrence of 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 317 •S 2474 IS gestational diabetes in subsequent preg- 1 nancies and the development of type 2 dia- 2 betes. 3 ‘‘(4) USES OF FUNDS.—An eligible entity re- 4 ceiving a grant under this subsection shall use the 5 grant funds to carry out demonstration projects de- 6 scribed in paragraph (1), including— 7 ‘‘(A) expanding community-based health 8 promotion education, activities, and incentives 9 focused on the prevention of gestational diabe- 10 tes and development of type 2 diabetes in 11 women with a history 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 women with, and at risk for, gesta- 16 tional diabetes, the recurrence of gestational di- 17 abetes in subsequent pregnancies, and, for 18 women with a history of gestational diabetes, 19 the development of type 2 diabetes; and 20 ‘‘(C) training and encouraging health care 21 providers— 22 ‘‘(i) to promote risk assessment, high- 23 quality care, and self-management for ges- 24 tational diabetes and the recurrence of ges- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 318 •S 2474 IS tational diabetes in subsequent preg- 1 nancies; and 2 ‘‘(ii) to prevent the development of 3 type 2 diabetes in women with a history of 4 gestational diabetes, and its complications 5 in the practice settings of the health care 6 providers. 7 ‘‘(5) REPORT.—Not later than 4 years after the 8 date of the enactment of this section, the Secretary 9 shall prepare and submit to the Congress a report 10 concerning the results of the demonstration projects 11 conducted through the grants awarded under this 12 subsection. 13 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 14 this subsection, the term ‘eligible entity’ means a 15 nonprofit organization (such as a nonprofit academic 16 center or community health center) or a State, trib- 17 al, or local health agency. 18 ‘‘(d) POSTPARTUM FOLLOW-UP REGARDING GESTA- 19 TIONAL DIABETES.—The Secretary, acting through the 20 Director of the Centers for Disease Control and Preven- 21 tion, shall work with the State- and tribal-based diabetes 22 prevention and control programs assisted by the Centers 23 to encourage postpartum follow-up after gestational diabe- 24 tes, as medically appropriate, for the purpose of reducing 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 319 •S 2474 IS the incidence of gestational diabetes, the recurrence of 1 gestational diabetes in subsequent pregnancies, the devel- 2 opment of type 2 diabetes in women with a history of ges- 3 tational diabetes, and related complications.’’. 4 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 5 INFORMATION PROGRAMS. 6 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 7 CATION PROGRAM.— 8 (1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall develop and dissemi- 11 nate to the public information on emergency contra- 12 ception. 13 (2) DISSEMINATION.—The Secretary may dis- 14 seminate information under paragraph (1) directly 15 or through arrangements with nonprofit organiza- 16 tions, consumer groups, institutions of higher edu- 17 cation, clinics, the media, and Federal, State, and 18 local agencies. 19 (3) INFORMATION.—The information dissemi- 20 nated under paragraph (1) shall include, at a min- 21 imum, a description of emergency contraception and 22 an explanation of the use, safety, efficacy, and avail- 23 ability of such contraception. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 320 •S 2474 IS (b) EMERGENCY CONTRACEPTION INFORMATION 1 PROGRAM FOR HEALTH CARE PROVIDERS.— 2 (1) IN GENERAL.—The Secretary, acting 3 through the Administrator of the Health Resources 4 and Services Administration and in consultation 5 with major medical and public health organizations, 6 shall develop and disseminate to health care pro- 7 viders information on emergency contraception. 8 (2) INFORMATION.—The information dissemi- 9 nated under paragraph (1) shall include, at a min- 10 imum— 11 (A) information describing the use, safety, 12 efficacy, and availability of emergency contra- 13 ception; 14 (B) a recommendation regarding the use of 15 such contraception in appropriate cases; and 16 (C) information explaining how to obtain 17 copies of the information developed under sub- 18 section (a) for distribution to the patients of 19 the providers. 20 (c) DEFINITIONS.—In this section: 21 (1) EMERGENCY CONTRACEPTION.—The term 22 ‘‘emergency contraception’’ means a drug or device 23 (as the terms are defined in section 201 of the Fed- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 321 •S 2474 IS eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 1 or a drug regimen that— 2 (A) is used postcoitally; 3 (B) prevents pregnancy primarily by pre- 4 venting or delaying ovulation, and does not ter- 5 minate an established pregnancy; and 6 (C) is approved by the Food and Drug Ad- 7 ministration. 8 (2) HEALTH CARE PROVIDER.—The term 9 ‘‘health care provider’’ means an individual who is li- 10 censed or certified under State law to provide health 11 care services and who is operating within the scope 12 of such license. Such term shall include a phar- 13 macist. 14 (3) INSTITUTION OF HIGHER EDUCATION.—The 15 term ‘‘institution of higher education’’ has the same 16 meaning given such term in section 101(a) of the 17 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 18 (4) SECRETARY.—The term ‘‘Secretary’’ means 19 the Secretary of Health and Human Services. 20 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP- 21 MENT. 22 (a) IN GENERAL.—The Secretary may award a grant 23 to each eligible State to conduct programs of sex education 24 described in subsection (b), including education on both 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 322 •S 2474 IS abstinence and contraception for the prevention of teenage 1 pregnancy and sexually transmitted diseases, including 2 HIV/AIDS. 3 (b) REQUIREMENTS FOR SEX EDUCATION PRO- 4 GRAMS.—A program of sex education described in this 5 subsection is a program that— 6 (1) is age appropriate and medically accurate; 7 (2) stresses the value of abstinence while not ig- 8 noring those young people who have been or are sex- 9 ually active; 10 (3) provides information about the health bene- 11 fits and side effects of contraceptive and barrier 12 methods used— 13 (A) as a means to prevent pregnancy; and 14 (B) to reduce the risk of contracting sexu- 15 ally transmitted disease, including HIV/AIDS; 16 (4) encourages family communication between 17 parent and child about sexuality; 18 (5) cultivates a respectful dialogue about sexu- 19 ality, including sexual orientation and gender iden- 20 tity, and embraces the principles of nondiscrimina- 21 tion based on sexual orientation and gender identity; 22 (6) counters the perpetuation of narrow gender 23 roles, including the sexualization of female children, 24 adolescents, and adults; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 323 •S 2474 IS (7) teaches young people the skills to make re- 1 sponsible decisions about sexuality, including how to 2 avoid unwanted verbal, physical, and sexual ad- 3 vances and how to avoid making verbal, physical, 4 and sexual advances that are not wanted by the 5 other party; 6 (8) develops healthy relationships, including the 7 prevention of dating and sexual violence; 8 (9) teaches young people how alcohol and drug 9 use can affect responsible decisionmaking; and 10 (10) does not teach or promote religion. 11 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro- 12 gram of sex education, a State may expend grant funds 13 awarded under subsection (a) to carry out educational and 14 motivational activities that help young people— 15 (1) gain knowledge about the physical, emo- 16 tional, biological, and hormonal changes of adoles- 17 cence and subsequent stages of human maturation; 18 (2) develop the knowledge and skills necessary 19 to ensure and protect their sexual and reproductive 20 health from unintended pregnancy and sexually 21 transmitted disease, including HIV/AIDS, through- 22 out their lifespan; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 324 •S 2474 IS (3) gain knowledge about the specific involve- 1 ment and responsibility of each individual in sexual 2 decisionmaking; 3 (4) develop healthy attitudes and values about 4 adolescent growth and development, body image, 5 gender roles, racial and ethnic diversity, sexual ori- 6 entation and gender identity, and other subjects; 7 (5) develop and practice healthy life skills in- 8 cluding goal-setting, decisionmaking, negotiation, 9 communication, and stress management; and 10 (6) promote self-esteem and positive inter- 11 personal skills focusing on relationship dynamics, in- 12 cluding friendships, dating, romantic involvement, 13 marriage, and family interactions. 14 (d) MATCHING FUNDS.—The Secretary may not 15 make payments to a State under this section in an amount 16 exceeding Federal medical assistance percentage for such 17 State (as such term is defined in section 1905(b) of the 18 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 19 the programs conducted by the State under this section. 20 (e) EVALUATION OF PROGRAMS.— 21 (1) IN GENERAL.—For the purpose of evalu- 22 ating the effectiveness of programs of sex education 23 carried out with a grant under this section, evalua- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 325 •S 2474 IS tions shall be carried out in accordance with para- 1 graphs (2) and (3). 2 (2) NATIONAL EVALUATION.— 3 (A) METHOD.—The Secretary shall pro- 4 vide for a national evaluation of a representa- 5 tive sample of programs of sex education car- 6 ried out with grants under this section to deter- 7 mine— 8 (i) the effectiveness of such programs 9 in helping to delay the initiation of sexual 10 intercourse and other high-risk behaviors; 11 (ii) the effectiveness of such programs 12 in preventing adolescent pregnancy; 13 (iii) the effectiveness of such pro- 14 grams in preventing sexually transmitted 15 disease, including HIV/AIDS; 16 (iv) the effectiveness of such programs 17 in increasing contraceptive knowledge and 18 contraceptive behaviors when sexual inter- 19 course occurs; and 20 (v) a list of best practices based upon 21 essential programmatic components of 22 evaluated programs that have led to suc- 23 cess described in clauses (i) through (iv). 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 326 •S 2474 IS (B) GRANT CONDITION.—A condition for 1 the receipt of a grant to a State under this sec- 2 tion is that the State cooperate with the evalua- 3 tion under subparagraph (A). 4 (C) REPORT.—The Secretary shall submit 5 to the Congress— 6 (i) not later than the end of each fis- 7 cal year during the 5-year period beginning 8 with fiscal year 2012, an interim report on 9 the national evaluation under subpara- 10 graph (A); and 11 (ii) not later than March 31, 2017, a 12 final report providing the results of such 13 national evaluation. 14 (3) INDIVIDUAL STATE EVALUATIONS.—A con- 15 dition for the receipt of a grant under this section 16 is that the State evaluate of the programs of sex 17 education funded through such grant in accordance 18 with the following requirements: 19 (A) The evaluation will be conducted by an 20 external, independent entity. 21 (B) The purposes of the evaluation will be 22 the determination of— 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 327 •S 2474 IS (i) the effectiveness of such programs 1 in helping to delay the initiation of sexual 2 intercourse and other high-risk behaviors; 3 (ii) the effectiveness of such programs 4 in preventing adolescent pregnancy; 5 (iii) the effectiveness of such pro- 6 grams in preventing sexually transmitted 7 disease, including HIV/AIDS; and 8 (iv) the effectiveness of such programs 9 in increasing contraceptive and barrier 10 method knowledge and contraceptive be- 11 haviors when sexual intercourse occurs. 12 (f) LIMITATIONS ON USE OF FUNDS.— 13 (1) LIMITATIONS ON SECRETARY.—Of the 14 amounts appropriated for a fiscal year for purposes 15 of this section, the Secretary may not use more 16 than— 17 (A) 7 percent of such amounts for admin- 18 istrative expenses related to carrying out this 19 section for that fiscal year; and 20 (B) 10 percent of such amounts for the 21 national evaluation under subsection (e)(2). 22 (2) LIMITATIONS TO STATES.—Of amounts pro- 23 vided to an eligible State under this subsection, the 24 State may not use more than 10 percent of the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 328 •S 2474 IS grant to conduct any evaluation under subsection 1 (e)(3). 2 (g) NONDISCRIMINATION REQUIRED.—Programs 3 funded under this section shall not discriminate on the 4 basis of sex, race, ethnicity, national origin, disability, reli- 5 gion, marital status, familial status, sexual orientation, or 6 gender identity. Nothing in this section shall be construed 7 to invalidate or limit rights, remedies, procedures, or legal 8 standards available to victims of discrimination under any 9 other Federal law or any law of a State or a political sub- 10 division of a State, including title VI of the Civil Rights 11 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 12 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 13 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 14 794), and the Americans with Disabilities Act of 1990 (42 15 U.S.C. 12101 et seq.). 16 (h) DEFINITIONS.—For purposes of this section: 17 (1) The term ‘‘age appropriate’’ means, with re- 18 spect to topics, messages, and teaching methods, 19 those suitable to particular ages or age groups of 20 children, adolescents, and adults, based on devel- 21 oping cognitive, emotional, and behavioral capacity 22 typical for the age or age group. 23 (2) The term ‘‘eligible State’’ means a State 24 that submits to the Secretary an application for a 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 329 •S 2474 IS grant under this section that is in such form, is 1 made in such manner, and contains such agree- 2 ments, assurances, and information as the Secretary 3 determines to be necessary to carry out this section. 4 (3) The term ‘‘HIV/AIDS’’ means the human 5 immunodeficiency virus, and includes acquired im- 6 mune deficiency syndrome. 7 (4) The term ‘‘medically accurate’’, with respect 8 to information, means information that is supported 9 by research, recognized as accurate and objective by 10 leading medical, psychological, psychiatric, and pub- 11 lic health organizations and agencies, and, published 12 in journals that are peer reviewed. 13 (5) The term ‘‘State’’ means the 50 States, the 14 District of Columbia, the Commonwealth of Puerto 15 Rico, the Commonwealth of the Northern Mariana 16 Islands, American Samoa, Guam, the United States 17 Virgin Islands, and any other territory or possession 18 of the United States. 19 TITLE VI—MENTAL HEALTH 20 SEC. 601. COMMUNITY MENTAL HEALTH AND ADDICTION 21 SAFETY NET EQUITY ACT. 22 (a) FEDERALLY QUALIFIED BEHAVIORAL HEALTH 23 CENTERS.—Section 1913 of the Public Health Service Act 24 (42 U.S.C. 300x–3) is amended— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 330 •S 2474 IS (1) in subsection (a)(2)(A), by striking ‘‘com- 1 munity mental health services’’ and inserting ‘‘be- 2 havioral health services (of the type offered by feder- 3 ally qualified behavioral health centers consistent 4 with subsection (c)(3))’’; 5 (2) in subsection (b)— 6 (A) by striking paragraph (1) and insert- 7 ing the following: 8 ‘‘(1) services under the plan will be provided 9 only through appropriate, qualified community pro- 10 grams (which may include federally qualified behav- 11 ioral health centers, child mental health programs, 12 psychosocial rehabilitation programs, mental health 13 peer-support programs, and mental health primary 14 consumer-directed programs); and’’; and 15 (B) in paragraph (2), by striking ‘‘commu- 16 nity mental health centers’’ and inserting ‘‘fed- 17 erally qualified behavioral health centers’’; and 18 (3) by striking subsection (c) and inserting the 19 following: 20 ‘‘(c) CRITERIA FOR FEDERALLY QUALIFIED BEHAV- 21 IORAL HEALTH CENTERS.— 22 ‘‘(1) IN GENERAL.—The Administrator shall 23 certify, and recertify at least every 5 years, federally 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 331 •S 2474 IS qualified behavioral health centers as meeting the 1 criteria specified in this subsection. 2 ‘‘(2) REGULATIONS.—Not later than 18 months 3 after the date of the enactment of this section, the 4 Administrator shall issue final regulations for certi- 5 fying nonprofit or local government centers as cen- 6 ters under paragraph (1). 7 ‘‘(3) CRITERIA.—The criteria referred to in 8 subsection (b)(2) are that the center performs each 9 of the following: 10 ‘‘(A) Provide services in locations that en- 11 sure services will be promptly available, be 12 physically accessible, provide reasonable policy 13 modifications, and be provided in a manner 14 which preserves human dignity and assures con- 15 tinuity of care. 16 ‘‘(B) Provide services in a mode of service 17 delivery appropriate for the target population. 18 ‘‘(C) Provide individuals with a choice of 19 service options where there is more than one ef- 20 ficacious treatment. 21 ‘‘(D) Employ a core staff of clinical staff 22 that is multidisciplinary and culturally and lin- 23 guistically competent. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 332 •S 2474 IS ‘‘(E) Provide services, within the limits of 1 the capacities of the center, to any individual 2 residing or employed in the service area of the 3 center, regardless of the ability of the individual 4 to pay. 5 ‘‘(F) Provide, directly or through contract, 6 to the extent covered for adults in the State 7 Medicaid plan under title XIX of the Social Se- 8 curity Act and for children in accordance with 9 section 1905(r) of such Act regarding early and 10 periodic screening, diagnosis, and treatment, 11 each of the following services: 12 ‘‘(i) Screening, assessment, and diag- 13 nosis, including risk assessment. 14 ‘‘(ii) Person-centered treatment plan- 15 ning or similar processes, including risk as- 16 sessment and crisis planning. 17 ‘‘(iii) Outpatient clinic mental health 18 services, including screening, assessment, 19 diagnosis, psychotherapy, substance abuse 20 counseling, medication management, and 21 integrated treatment for mental illness and 22 substance abuse which shall be evidence- 23 based (including cognitive behavioral ther- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 333 •S 2474 IS apy and other such therapies which are 1 evidence-based). 2 ‘‘(iv) Outpatient clinic primary care 3 services (which includes obstetrical and 4 gynecological care and psychiatric and 5 mental health care), including screening 6 and monitoring of key health indicators 7 and health risk (including screening for di- 8 abetes, hypertension, and cardiovascular 9 disease and monitoring of weight, height, 10 body mass index (BMI), blood pressure, 11 blood glucose or HbA1C, and lipid profile). 12 ‘‘(v) Crisis mental health services, in- 13 cluding 24-hour mobile crisis teams, emer- 14 gency crisis intervention services, and cri- 15 sis stabilization. 16 ‘‘(vi) Targeted case management 17 (services to assist individuals gaining ac- 18 cess to needed medical, social, educational, 19 and other home- and community-based 20 services and applying for income security 21 and other benefits to which they may be 22 entitled). 23 ‘‘(vii) Psychiatric rehabilitation serv- 24 ices including skills training, assertive com- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 334 •S 2474 IS munity treatment, family psychoeducation, 1 disability self-management, supported em- 2 ployment, supported housing services, 3 therapeutic foster care services, and such 4 other evidence-based practices as the Sec- 5 retary may require. 6 ‘‘(viii) Peer support and counselor 7 services and family supports. 8 ‘‘(G) Maintain linkages, and where possible 9 enter into formal contracts with the following: 10 ‘‘(i) Inpatient psychiatric facilities and 11 substance abuse detoxification and residen- 12 tial programs. 13 ‘‘(ii) Adult and youth peer support 14 and counselor services. 15 ‘‘(iii) Family support services for fam- 16 ilies of children with serious mental dis- 17 orders. 18 ‘‘(iv) Other home- and community- 19 based or regional services, supports, and 20 providers, including schools, child welfare 21 agencies, juvenile and criminal justice 22 agencies and facilities, housing agencies 23 and programs, employers, and other social 24 services. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 335 •S 2474 IS ‘‘(v) Onsite or offsite access to pri- 1 mary care services (which includes obstet- 2 rical and gynecological care and psychiatric 3 and mental health care). 4 ‘‘(vi) Enabling services, including out- 5 reach, transportation, and translation. 6 ‘‘(vii) Health and wellness services, in- 7 cluding services for tobacco cessation.’’. 8 (b) MEDICAID COVERAGE AND PAYMENT FOR FED- 9 ERALLY QUALIFIED BEHAVIORAL HEALTH CENTER 10 SERVICES.— 11 (1) PAYMENT FOR SERVICES PROVIDED BY 12 FEDERALLY QUALIFIED BEHAVIORAL HEALTH CEN- 13 TERS.—Section 1902(bb) of the Social Security Act 14 (42 U.S.C. 1396a(bb)) is amended— 15 (A) in the heading, by striking ‘‘AND 16 RURAL HEALTH CLINICS’’ and inserting ‘‘, 17 FEDERALLY QUALIFIED BEHAVIORAL HEALTH 18 CENTERS, AND RURAL HEALTH CLINICS’’; 19 (B) in paragraph (1), by inserting ‘‘(and 20 beginning with fiscal year 2012 with respect to 21 services furnished on or after January 1, 2012, 22 and each succeeding fiscal year, for services de- 23 scribed in section 1905(a)(2)(D) furnished by a 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 336 •S 2474 IS federally qualified behavioral health center)’’ 1 after ‘‘by a rural health clinic’’; 2 (C) in paragraph (2)— 3 (i) by striking the heading and insert- 4 ing ‘‘INITIAL FISCAL YEAR’’; 5 (ii) by inserting ‘‘(or, in the case of 6 services described in section 1905(a)(2)(D) 7 furnished by a federally qualified behav- 8 ioral health center, for services furnished 9 on and after January 1, 2012, during fis- 10 cal year 2012)’’ after ‘‘January 1, 2001, 11 during fiscal year 2001’’; 12 (iii) by inserting ‘‘(or, in the case of 13 services described in section 1905(a)(2)(D) 14 furnished by a federally qualified behav- 15 ioral health center, during fiscal years 16 2010 and 2011)’’ after ‘‘1999 and 2000’’; 17 and 18 (iv) by inserting ‘‘(or, in the case of 19 services described in section 1905(a)(2)(D) 20 furnished by a federally qualified behav- 21 ioral health center, during fiscal year 22 2012)’’ before the period; 23 (D) in paragraph (3)— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 337 •S 2474 IS (i) in the heading, by striking ‘‘FIS- 1 CAL YEAR 2002 AND SUCCEEDING’’ and in- 2 serting ‘‘SUCCEEDING’’; and 3 (ii) by inserting ‘‘(or, in the case of 4 services described in section 1905(a)(2)(D) 5 furnished by a federally qualified behav- 6 ioral health center, for services furnished 7 during fiscal year 2013 or a succeeding fis- 8 cal year)’’ after ‘‘2002 or a succeeding fis- 9 cal year’’; 10 (E) in paragraph (4)— 11 (i) by inserting ‘‘(or as a federally 12 qualified behavioral health center after fis- 13 cal year 2011)’’ after ‘‘or rural health clin- 14 ic after fiscal year 2000’’; 15 (ii) by striking ‘‘furnished by the cen- 16 ter or’’ and inserting ‘‘furnished by the 17 federally qualified health center, services 18 described in section 1905(a)(2)(D) fur- 19 nished by the federally qualified behavioral 20 health center, or’’; 21 (iii) in the second sentence, by strik- 22 ing ‘‘or rural health clinic’’ and inserting 23 ‘‘, federally qualified behavioral health cen- 24 ter, or rural health clinic’’; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 338 •S 2474 IS (F) in paragraph (5), in each of subpara- 1 graphs (A) and (B), by striking ‘‘or rural 2 health clinic’’ and inserting ‘‘, federally quali- 3 fied behavioral health center, or rural health 4 clinic’’; and 5 (G) in paragraph (6), by striking ‘‘or to a 6 rural health clinic’’ and inserting ‘‘, to a feder- 7 ally qualified behavioral health center for serv- 8 ices described in section 1905(a)(2)(D), or to a 9 rural health clinic’’. 10 (2) INCLUSION OF FEDERALLY QUALIFIED BE- 11 HAVIORAL HEALTH CENTER SERVICES IN THE TERM 12 MEDICAL ASSISTANCE.—Section 1905(a)(2) of the 13 Social Security Act (42 U.S.C. 1396d(a)(2)) is 14 amended— 15 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 16 (B) by inserting before the semicolon at 17 the end the following: ‘‘, and (D) federally 18 qualified behavioral health center services (as 19 defined in subsection (l)(4))’’. 20 (3) DEFINITION OF FEDERALLY QUALIFIED BE- 21 HAVIORAL HEALTH CENTER SERVICES.—Section 22 1905(l) of the Social Security Act (42 U.S.C. 23 1396d(l)) is amended by adding at the end the fol- 24 lowing paragraph: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 339 •S 2474 IS ‘‘(4)(A) The term ‘federally qualified behavioral 1 health center services’ means services furnished to 2 an individual at a federally qualified behavioral 3 health center (as defined by subparagraph (B)). 4 ‘‘(B) The term ‘federally qualified behavioral 5 health center’ means an entity that is certified under 6 section 1913(c) of the Public Health Service Act as 7 meeting the criteria described in paragraph (3) of 8 such section.’’. 9 (c) MENTAL HEALTH AND ADDICTION SAFETY NET 10 STUDIES.— 11 (1) PAPERWORK REDUCTION STUDY.— 12 (A) IN GENERAL.—Not later than 12 13 months after the date of the enactment of this 14 Act, the Institute of Medicine shall submit to 15 the appropriate committees of Congress a re- 16 port that evaluates the combined paperwork 17 burden of federally qualified behavioral health 18 centers certified section 1913(c) of the Public 19 Health Service Act, as inserted by subsection 20 (a). 21 (B) SCOPE.—In preparing the report 22 under subparagraph (A), the Institute of Medi- 23 cine shall examine licensing, certification, serv- 24 ice definitions, claims payment, billing codes, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 340 •S 2474 IS and financial auditing requirements utilized by 1 the Office of Management and Budget, the 2 Centers for Medicare & Medicaid Services, the 3 Health Resources and Services Administration, 4 the Substance Abuse and Mental Health Serv- 5 ices Administration, the Office of the Inspector 6 General, State Medicaid agencies, State depart- 7 ments of health, State departments of edu- 8 cation, and State and local juvenile justice and 9 social services agencies to— 10 (i) establish an estimate of the com- 11 bined nationwide cost of complying with 12 the requirements described in this subpara- 13 graph, in terms of both administrative 14 funding and staff time; 15 (ii) establish an estimate of the per 16 capita cost to each federally qualified be- 17 havioral health center certified under sec- 18 tion 1913(c) of the Public Health Service 19 Act to comply with the requirements de- 20 scribed in this subparagraph, in terms of 21 both administrative funding and staff time; 22 and 23 (iii) make administrative and statu- 24 tory recommendations to Congress, which 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 341 •S 2474 IS may include a uniform methodology, to re- 1 duce the paperwork burden experienced by 2 such federally qualified behavioral health 3 centers. 4 (2) WAGE STUDY.— 5 (A) IN GENERAL.—Not later than 12 6 months after the date of the enactment of this 7 Act, the Institute of Medicine shall conduct a 8 nationwide analysis, and submit a report to the 9 appropriate committees of Congress, concerning 10 the compensation structure of professional and 11 paraprofessional personnel employed by feder- 12 ally qualified behavioral health centers certified 13 under section 1913(c) of the Public Health 14 Service Act, as inserted by subsection (a), as 15 compared with the compensation structure of 16 comparable health safety net providers and rel- 17 evant private sector health care employers. 18 (B) SCOPE.—In preparing the report 19 under subparagraph (A), the Institute of Medi- 20 cine shall examine compensation disparities, if 21 such disparities are determined to exist, by type 22 of personnel, type of provider or private sector 23 employer, and by geographic region. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 342 •S 2474 IS SEC. 602. MINORITY FELLOWSHIP PROGRAM. 1 Title V of the Public Health Service Act is amended 2 by inserting after section 506B of such Act (42 U.S.C. 3 290aa–5b) the following: 4 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 5 ‘‘(a) FELLOWSHIPS.—The Administrator shall main- 6 tain a program, to be known as the Minority Fellowship 7 Program, under which the Administrator awards grants 8 or contracts to national associations or other appropriate 9 entities for the financial support of graduate students, 10 postdoctoral fellows, and residents in the professions of 11 psychology, psychiatry, social work, psychiatric advance- 12 practice nursing, and marriage and family therapy to stu- 13 dents who demonstrate a commitment to clinical or re- 14 search careers focused on racial and ethnic minority popu- 15 lations. 16 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup- 17 port provided to an individual pursuant to subsection (a) 18 shall be for a term of not more than 12 months and may 19 be renewed thereafter.’’. 20 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 21 PROGRAM. 22 Part D of title V of the Public Health Service Act 23 (42 U.S.C. 290dd et seq.) is amended by adding at the 24 end the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 343 •S 2474 IS ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 1 PROVISION OF BEHAVIORAL HEALTH CARE 2 IN PRIMARY CARE SETTINGS. 3 ‘‘(a) GRANTS.—The Secretary, acting through the 4 Director of the Office of Minority Health of the Adminis- 5 tration, shall award grants to eligible entities for the pur- 6 pose of providing technical assistance and training regard- 7 ing the effective development and implementation of inte- 8 grated interprofessional health care teams that provide be- 9 havioral health care. 10 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 11 a grant under this section, an entity shall be a federally 12 qualified health center (as defined in section 1861(aa) of 13 the Social Security Act) serving a high proportion of indi- 14 viduals from racial and ethnic minority groups (as defined 15 in section 1707(g)).’’. 16 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 17 MENTAL HEALTH DISPARITIES RESEARCH 18 GAPS. 19 Not later than 6 months after the date of the enact- 20 ment of this Act, the Director of the National Institute 21 on Minority Health and Health Disparities shall enter into 22 an arrangement with the Institute of Medicine (or, if the 23 Institute declines to enter into such an arrangement, an- 24 other appropriate entity)— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 344 •S 2474 IS (1) to conduct a study with respect to mental 1 and behavioral health disparities in racial and ethnic 2 minority groups (as defined in section 1707(g) of 3 the Public Health Service Act (42 U.S.C. 300u– 4 6(g)); and 5 (2) to submit to the Congress a report on the 6 results of such study, including— 7 (A) a compilation of information on the dy- 8 namics of mental disorders in such racial and 9 ethnic minority groups; 10 (B) an identification of gaps in knowledge 11 and research needs; and 12 (C) recommendations for an interprofes- 13 sional research agenda at the National Insti- 14 tutes of Health aimed at reducing and ulti- 15 mately eliminating mental and behavioral health 16 disparities in such racial and ethnic minority 17 groups. 18 TITLE VII—ADDRESSING HIGH 19 IMPACT MINORITY DISEASES 20 Subtitle A—Cancer 21 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 22 (a) SHORT TITLE.—This section may be cited as the 23 ‘‘Lung Cancer Mortality Reduction Act of 2012’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 345 •S 2474 IS (b) FINDINGS.—Congress makes the following find- 1 ings: 2 (1) Lung cancer is the leading cause of cancer 3 death for both men and women, accounting for 28 4 percent of all cancer deaths. 5 (2) Lung cancer kills more people annually 6 than breast cancer, prostate cancer, colon cancer, 7 liver cancer, melanoma, and kidney cancer combined. 8 (3) Since the National Cancer Act of 1971 9 (Public Law 92–218; 85 Stat. 778), coordinated and 10 comprehensive research has raised the 5-year sur- 11 vival rates for breast cancer to 88 percent, for pros- 12 tate cancer to 99 percent, and for colon cancer to 13 64 percent. 14 (4) However, the 5-year survival rate for lung 15 cancer is still only 15 percent and a similar coordi- 16 nated and comprehensive research effort is required 17 to achieve increases in lung cancer survivability 18 rates. 19 (5) Sixty percent of lung cancer cases are now 20 diagnosed nonsmokers or former smokers. 21 (6) Two-thirds of nonsmokers diagnosed with 22 lung cancer are women. 23 (7) Certain minority populations, such as Afri- 24 can-American males, have disproportionately high 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 346 •S 2474 IS rates of lung cancer incidence and mortality, not- 1 withstanding their similar smoking rate. 2 (8) Members of the baby boomer generation are 3 entering their sixties, the most common age at which 4 people develop lung cancer. 5 (9) Tobacco addiction and exposure to other 6 lung cancer carcinogens such as Agent Orange and 7 other herbicides and battlefield emissions are serious 8 problems among military personnel and war vet- 9 erans. 10 (10) Significant and rapid improvements in 11 lung cancer mortality can be expected through great- 12 er use and access to lung cancer screening tests for 13 at-risk individuals. 14 (11) Additional strategies are necessary to fur- 15 ther enhance the existing tests and therapies avail- 16 able to diagnose and treat lung cancer in the future. 17 (12) The August 2001 Report of the Lung 18 Cancer Progress Review Group of the National Can- 19 cer Institute stated that funding for lung cancer re- 20 search was ‘‘far below the levels characterized for 21 other common malignancies and far out of propor- 22 tion to its massive health impact’’. 23 (13) The Report of the Lung Cancer Progress 24 Review Group identified as its ‘‘highest priority’’ the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 347 •S 2474 IS creation of integrated, multidisciplinary, multi-insti- 1 tutional research consortia organized around the 2 problem of lung cancer rather than around specific 3 research disciplines. 4 (14) The United States must enhance its re- 5 sponse to the issues raised in the Report of the 6 Lung Cancer Progress Review Group, and this can 7 be accomplished through the establishment of a co- 8 ordinated effort designed to reduce the lung cancer 9 mortality rate by 50 percent by 2015 and targeted 10 funding to support this coordinated effort. 11 (c) SENSE OF CONGRESS CONCERNING INVESTMENT 12 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 13 gress that— 14 (1) lung cancer mortality reduction should be 15 made a national public health priority; and 16 (2) a comprehensive mortality reduction pro- 17 gram coordinated by the Secretary of Health and 18 Human Services is justified and necessary to ade- 19 quately address and reduce lung cancer mortality. 20 (d) LUNG CANCER MORTALITY REDUCTION PRO- 21 GRAM.— 22 (1) IN GENERAL.—Subpart 1 of part C of title 23 IV of the Public Health Service Act (42 U.S.C. 285 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 348 •S 2474 IS et seq.) is amended by adding at the end the fol- 1 lowing: 2 ‘‘SEC. 417G. LUNG CANCER MORTALITY REDUCTION PRO- 3 GRAM. 4 ‘‘(a) IN GENERAL.—Not later than 6 months after 5 the date of the enactment of this section, the Secretary, 6 in consultation with the Secretary of Defense, the Sec- 7 retary of Veterans Affairs, the Director of the National 8 Institutes of Health, the Director of the Centers for Dis- 9 ease Control and Prevention, the Commissioner of Food 10 and Drugs, the Administrator of the Centers for Medicare 11 & Medicaid Services, the Director of the National Institute 12 on Minority Health and Health Disparities, and other 13 members of the Lung Cancer Advisory Board established 14 under section 546 of the Lung Cancer Mortality Reduc- 15 tion Act of 2012, shall implement a comprehensive pro- 16 gram, to be known as the Lung Cancer Mortality Reduc- 17 tion Program, to achieve a reduction of at least 25 percent 18 in the mortality rate of lung cancer by 2017. 19 ‘‘(b) REQUIREMENTS.—The Program shall include at 20 least the following: 21 ‘‘(1) With respect to the National Institutes of 22 Health— 23 ‘‘(A) a strategic review and prioritization 24 by the National Cancer Institute of research 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 349 •S 2474 IS grants to achieve the goal of the Lung Cancer 1 Mortality Reduction Program in reducing lung 2 cancer mortality; 3 ‘‘(B) the provision of funds to enable the 4 Airway Biology and Disease Branch of the Na- 5 tional Heart, Lung, and Blood Institute to ex- 6 pand its research programs to include pre- 7 dispositions to lung cancer, the interrelationship 8 between lung cancer and other pulmonary and 9 cardiac disease, and the diagnosis and treat- 10 ment of these interrelationships; 11 ‘‘(C) the provision of funds to enable the 12 National Institute of Biomedical Imaging and 13 Bioengineering to expedite the development of 14 computer assisted diagnostic, surgical, treat- 15 ment, and drug-testing innovations to reduce 16 lung cancer mortality, such as through expan- 17 sion of the Institute’s Quantum Grant Program 18 and Image-Guided Interventions programs; and 19 ‘‘(D) the provision of funds to enable the 20 National Institute of Environmental Health 21 Sciences to implement research programs rel- 22 ative to the lung cancer incidence. 23 ‘‘(2) With respect to the Food and Drug Ad- 24 ministration— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 350 •S 2474 IS ‘‘(A) activities under section 529 of the 1 Federal Food, Drug, and Cosmetic Act; and 2 ‘‘(B) activities under section 561 of the 3 Federal Food, Drug, and Cosmetic Act to ex- 4 pand access to investigational drugs and devices 5 for the diagnosis, monitoring, or treatment of 6 lung cancer. 7 ‘‘(3) With respect to the Centers for Disease 8 Control and Prevention, the establishment of an 9 early disease research and management program 10 under section 1511. 11 ‘‘(4) With respect to the Agency for Healthcare 12 Research and Quality, the conduct of a biannual re- 13 view of lung cancer screening, diagnostic, and treat- 14 ment protocols, including consideration of how lung 15 cancer screening and treatment affect men and 16 women differently, and the issuance of updated 17 guidelines. 18 ‘‘(5) The cooperation and coordination of all 19 minority and health disparity programs within the 20 Department of Health and Human Services to en- 21 sure that all aspects of the Lung Cancer Mortality 22 Reduction Program under this section adequately 23 address the burden of lung cancer on minority and 24 rural populations. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 351 •S 2474 IS ‘‘(6) The cooperation and coordination of all to- 1 bacco control and cessation programs within agen- 2 cies of the Department of Health and Human Serv- 3 ices to achieve the goals of the Lung Cancer Mor- 4 tality Reduction Program under this section with 5 particular emphasis on the coordination of drug and 6 other cessation treatments with early detection pro- 7 tocols.’’. 8 (2) FEDERAL FOOD, DRUG, AND COSMETIC 9 ACT.—Subchapter B of chapter V of the Federal 10 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 11 seq.) is amended by adding at the end the following: 12 ‘‘DRUGS RELATING TO LUNG CANCER 13 ‘‘SEC. 529. (a) IN GENERAL.—The provisions of this 14 subchapter shall apply to a drug described in subsection 15 (b) to the same extent and in the same manner as such 16 provisions apply to a drug for a rare disease or condition. 17 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 18 subsection is— 19 ‘‘(1) a chemoprevention drug for precancerous 20 conditions of the lung; 21 ‘‘(2) a drug for targeted therapeutic treat- 22 ments, including any vaccine, for lung cancer; and 23 ‘‘(3) a drug to curtail or prevent nicotine addic- 24 tion. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 352 •S 2474 IS ‘‘(c) BOARD.—The Board established under the Lung 1 Cancer Mortality Reduction Act of 2012 shall monitor the 2 program implemented under this section.’’. 3 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 4 tion 561(e) of the Federal Food, Drug, and Cos- 5 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 6 serting before the period the following: ‘‘and shall 7 include expanding access to drugs under section 8 529, with substantial consideration being given to 9 whether the totality of information available to the 10 Secretary regarding the safety and effectiveness of 11 an investigational drug, as compared to the risk of 12 morbidity and death from the disease, indicates that 13 a patient may obtain more benefit than risk if treat- 14 ed with the drug’’. 15 (4) CDC.—Title XV of the Public Health Serv- 16 ice Act (42 U.S.C. 300k et seq.) is amended by add- 17 ing at the end the following: 18 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 19 PROGRAM. 20 ‘‘The Secretary shall establish and implement an 21 early disease research and management program targeted 22 at the high incidence and mortality rates of lung cancer 23 among minority and low-income populations.’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 353 •S 2474 IS (e) DEPARTMENT OF DEFENSE AND THE DEPART- 1 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 2 and the Secretary of Veterans Affairs shall coordinate 3 with the Secretary of Health and Human Services— 4 (1) in the development of the Lung Cancer 5 Mortality Reduction Program under section 417H; 6 (2) in the implementation within the Depart- 7 ment of Defense and the Department of Veterans 8 Affairs of an early detection and disease manage- 9 ment research program for military personnel and 10 veterans whose smoking history and exposure to car- 11 cinogens during active duty service has increased 12 their risk for lung cancer; and 13 (3) in the implementation of coordinated care 14 programs for military personnel and veterans diag- 15 nosed with lung cancer. 16 (f) LUNG CANCER ADVISORY BOARD.— 17 (1) IN GENERAL.—The Secretary of Health and 18 Human Services shall convene a Lung Cancer Advi- 19 sory Board (referred to in this section as the 20 ‘‘Board’’)— 21 (A) to monitor the programs established 22 under this section (and the amendments made 23 by this section); and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 354 •S 2474 IS (B) to provide annual reports to the Con- 1 gress concerning benchmarks, expenditures, 2 lung cancer statistics, and the public health im- 3 pact of such programs. 4 (2) COMPOSITION.—The Board shall be com- 5 posed of— 6 (A) the Secretary of Health and Human 7 Services; 8 (B) the Secretary of Defense; 9 (C) the Secretary of Veterans Affairs; and 10 (D) two representatives each from the 11 fields of clinical medicine focused on lung can- 12 cer, lung cancer research, imaging, drug devel- 13 opment, and lung cancer advocacy, to be ap- 14 pointed by the Secretary of Health and Human 15 Services. 16 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 17 REACH, SCREENING, TESTING, ACCESS, AND 18 TREATMENT EFFECTIVENESS. 19 (a) SHORT TITLE.—This section may be cited as the 20 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 21 and Treatment Effectiveness Act of 2012’’ or the ‘‘PROS- 22 TATE Act’’. 23 (b) FINDINGS.—Congress makes the following find- 24 ings: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 355 •S 2474 IS (1) Prostate cancer is the second leading cause 1 of cancer death among men. 2 (2) In 2010, more than 217,730 new patients 3 were diagnosed with prostate cancer and more than 4 32,000 men died from this disease. 5 (3) Roughly 2,000,000 Americans are living 6 with a diagnosis of prostate cancer and its con- 7 sequences. 8 (4) While prostate cancer generally affects older 9 individuals, younger men are also at risk for the dis- 10 ease, and when prostate cancer appears in early 11 middle age it frequently takes on a more aggressive 12 form. 13 (5) There are significant racial and ethnic dis- 14 parities that demand attention, namely African- 15 Americans have prostate cancer mortality rates that 16 are more than double those in the White population. 17 (6) Underserved rural populations have higher 18 rates of mortality compared to their urban counter- 19 parts, and innovative and cost-efficient methods to 20 improve rural access to high quality care should take 21 advantage of advances in telehealth to diagnose and 22 treat prostate cancer when appropriate. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 356 •S 2474 IS (7) Certain veterans populations may have 1 nearly twice the incidence of prostate cancer as the 2 general population of the United States. 3 (8) Urologists may constitute the specialists 4 who diagnose and treat the vast majority of prostate 5 cancer patients. 6 (9) Although much basic and translational re- 7 search has been completed and much is currently 8 known, there are still many unanswered questions. 9 For example, it is not fully understood how much of 10 known disparities are attributable to disease eti- 11 ology, access to care, or education and awareness in 12 the community. 13 (10) Causes of prostate cancer are not known. 14 There is not good information regarding how to dif- 15 ferentiate accurately, early on, between aggressive 16 and indolent forms of the disease. As a result, there 17 is significant overtreatment in prostate cancer. 18 There are no treatments that can durably arrest 19 growth or cure prostate cancer once it has metasta- 20 sized. 21 (11) A significant proportion (roughly 23 to 54 22 percent) of cases may be clinically indolent and 23 ‘‘overdiagnosed’’, resulting in significant overtreat- 24 ment. More accurate tests will allow men and their 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 357 •S 2474 IS families to face less physical, psychological, financial, 1 and emotional trauma and billions of dollars could 2 be saved in private and public health care systems 3 in an area that has been identified by the Medicare 4 program as one of eight high-volume, high-cost areas 5 in the Resource Utilization Report program author- 6 ized by Congress under the Medicare Improvements 7 for Patients and Providers Act of 2008. 8 (12) Prostate cancer research and health care 9 programs across Federal agencies should be coordi- 10 nated to improve accountability and actively encour- 11 age the translation of research into practice, to iden- 12 tify and implement best practices, in order to foster 13 an integrated and consistent focus on effective pre- 14 vention, diagnosis, and treatment of this disease. 15 (c) PROSTATE CANCER COORDINATION AND EDU- 16 CATION.— 17 (1) INTERAGENCY PROSTATE CANCER COORDI- 18 NATION AND EDUCATION TASK FORCE.—Not later 19 than 180 days after the date of the enactment of 20 this section, the Secretary of Veterans Affairs, in co- 21 operation with the Secretary of Defense and the Sec- 22 retary of Health and Human Services, shall estab- 23 lish an Interagency Prostate Cancer Coordination 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 358 •S 2474 IS and Education Task Force (in this section referred 1 to as the ‘‘Prostate Cancer Task Force’’). 2 (2) DUTIES.—The Prostate Cancer Task Force 3 shall— 4 (A) develop a summary of advances in 5 prostate cancer research supported or con- 6 ducted by Federal agencies relevant to the diag- 7 nosis, prevention, and treatment of prostate 8 cancer, including psychosocial impairments re- 9 lated to prostate cancer treatment, and compile 10 a list of best practices that warrant broader 11 adoption in health care programs; 12 (B) consider establishing, and advocating 13 for, a guidance to enable physicians to allow 14 screening of men who are over age 74, on a 15 case-by-case basis, taking into account quality 16 of life and family history of prostate cancer; 17 (C) share and coordinate information on 18 Federal research and health care program ac- 19 tivities, including activities related to— 20 (i) determining how to improve re- 21 search and health care programs, including 22 psychosocial impairments related to pros- 23 tate cancer treatment; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 359 •S 2474 IS (ii) identifying any gaps in the overall 1 research inventory and in health care pro- 2 grams; 3 (iii) identifying opportunities to pro- 4 mote translation of research into practice; 5 and 6 (iv) maximizing the effects of Federal 7 efforts by identifying opportunities for col- 8 laboration and leveraging of resources in 9 research and health care programs that 10 serve those susceptible to or diagnosed 11 with prostate cancer; 12 (D) develop a comprehensive interagency 13 strategy and advise relevant Federal agencies in 14 the solicitation of proposals for collaborative, 15 multidisciplinary research and health care pro- 16 grams, including proposals to evaluate factors 17 that may be related to the etiology of prostate 18 cancer, that would— 19 (i) result in innovative approaches to 20 study emerging scientific opportunities or 21 eliminate knowledge gaps in research to 22 improve the prostate cancer research port- 23 folio of the Federal Government; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 360 •S 2474 IS (ii) outline key research questions, 1 methodologies, and knowledge gaps; and 2 (iii) ensure consistent action, as out- 3 lined by section 402(b) of the Public 4 Health Service Act; 5 (E) develop a coordinated message related 6 to screening and treatment for prostate cancer 7 to be reflected in educational and beneficiary 8 materials for Federal health programs as such 9 documents are updated; and 10 (F) not later than 2 years after the date 11 of the establishment of the Prostate Cancer 12 Task Force, submit to the Expert Advisory 13 Panel to be reviewed and returned within 30 14 days, and then within 90 days submitted to 15 Congress recommendations— 16 (i) regarding any appropriate changes 17 to research and health care programs, in- 18 cluding recommendations to improve the 19 research portfolio of the Department of 20 Veterans Affairs, Department of Defense, 21 National Institutes of Health, and other 22 Federal agencies to ensure that scientif- 23 ically based strategic planning is imple- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 361 •S 2474 IS mented in support of research and health 1 care program priorities; 2 (ii) designed to ensure that the re- 3 search and health care programs and ac- 4 tivities of the Department of Veterans Af- 5 fairs, the Department of Defense, the De- 6 partment of Health and Human Services, 7 and other Federal agencies are free of un- 8 necessary duplication; 9 (iii) regarding public participation in 10 decisions relating to prostate cancer re- 11 search and health care programs to in- 12 crease the involvement of patient advo- 13 cates, community organizations, and med- 14 ical associations representing a broad geo- 15 graphical area; 16 (iv) on how to best disseminate infor- 17 mation on prostate cancer research and 18 progress achieved by health care programs; 19 (v) about how to expand partnerships 20 between public entities, including Federal 21 agencies, and private entities to encourage 22 collaborative, cross-cutting research and 23 health care delivery; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 362 •S 2474 IS (vi) assessing any cost savings and ef- 1 ficiencies realized through the efforts iden- 2 tified and supported in this section and 3 recommending expansion of those efforts 4 that have proved most promising while also 5 ensuring against any conflicts in directives 6 from other congressional or statutory man- 7 dates or enabling statutes; 8 (vii) identifying key priority action 9 items from among the recommendations; 10 and 11 (viii) with respect to the level of fund- 12 ing needed by each agency to implement 13 the recommendations contained in the re- 14 port. 15 (3) MEMBERS OF THE PROSTATE CANCER TASK 16 FORCE.—The Prostate Cancer Task Force described 17 in subsection (a) shall be composed of representa- 18 tives from such Federal agencies, as each Secretary 19 determines necessary, to coordinate a uniform mes- 20 sage relating to prostate cancer screening and treat- 21 ment where appropriate, including representatives of 22 the following: 23 (A) The Department of Veterans Affairs, 24 including representatives of each relevant pro- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 363 •S 2474 IS gram areas of the Department of Veterans Af- 1 fairs. 2 (B) The Prostate Cancer Research Pro- 3 gram of the Congressionally Directed Medical 4 Research Program of the Department of De- 5 fense. 6 (C) The Department of Health and 7 Human Services, including at a minimum rep- 8 resentatives of the following: 9 (i) The National Institutes of Health. 10 (ii) National research institutes and 11 centers, including the National Cancer In- 12 stitute, the National Institute of Allergy 13 and Infectious Diseases, and the Office of 14 Minority Health. 15 (iii) The Centers for Medicare & Med- 16 icaid Services. 17 (iv) The Food and Drug Administra- 18 tion. 19 (v) The Centers for Disease Control 20 and Prevention. 21 (vi) The Agency for Healthcare Re- 22 search and Quality. 23 (vii) The Health Resources and Serv- 24 ices Administration. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 364 •S 2474 IS (4) APPOINTING EXPERT ADVISORY PANELS.— 1 The Prostate Cancer Task Force shall appoint ex- 2 pert advisory panels, as determined appropriate, to 3 provide input and concurrence from individuals and 4 organizations from the medical, prostate cancer pa- 5 tient and advocate, research, and delivery commu- 6 nities with expertise in prostate cancer diagnosis, 7 treatment, and research, including practicing urolo- 8 gists, primary care providers, and others and indi- 9 viduals with expertise in education and outreach to 10 underserved populations affected by prostate cancer. 11 (5) MEETINGS.—The Prostate Cancer Task 12 Force shall convene not less than twice a year, or 13 more frequently as the Secretary determines to be 14 appropriate. 15 (6) SUBMISSION OF RECOMMENDATIONS TO 16 CONGRESS.—The Secretary of Veterans Affairs shall 17 submit to Congress any recommendations submitted 18 to the Secretary under paragraph (2)(E). 19 (7) FEDERAL ADVISORY COMMITTEE ACT.— 20 (A) IN GENERAL.—Except as provided in 21 subparagraph (B), the Federal Advisory Com- 22 mittee Act (5 U.S.C. App.) shall apply to the 23 Prostate Cancer Task Force. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 365 •S 2474 IS (B) EXCEPTION.—Section 14(a)(2)(B) of 1 such Act (relating to the termination of advi- 2 sory committees) shall not apply to the Prostate 3 Cancer Task Force. 4 (8) SUNSET DATE.—The Prostate Cancer Task 5 Force shall terminate at the end of fiscal year 2016. 6 (d) PROSTATE CANCER RESEARCH.— 7 (1) RESEARCH COORDINATION.—The Secretary 8 of Veterans Affairs, in coordination with the Secre- 9 taries of Defense and of Health and Human Serv- 10 ices, shall establish and carry out a program to co- 11 ordinate and intensify prostate cancer research as 12 needed. Specifically, such research program shall— 13 (A) develop advances in diagnostic and 14 prognostic methods and tests, including bio- 15 markers and an improved prostate cancer 16 screening blood test, including improvements or 17 alternatives to the prostate specific antigen test 18 and additional tests to distinguish indolent from 19 aggressive disease; 20 (B) better understand the etiology of the 21 disease (including an analysis of lifestyle factors 22 proven to be involved in higher rates of prostate 23 cancer, such as obesity and diet, and in dif- 24 ferent ethnic, racial, and socioeconomic groups, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 366 •S 2474 IS such as the African-American, Latino, and 1 American Indian populations and men with a 2 family history of prostate cancer) to improve 3 prevention efforts; 4 (C) expand basic research into prostate 5 cancer, including studies of fundamental molec- 6 ular and cellular mechanisms; 7 (D) identify and provide clinical testing of 8 novel agents for the prevention and treatment 9 of prostate cancer; 10 (E) establish clinical registries for prostate 11 cancer; 12 (F) use the National Institute of Bio- 13 medical Imaging and Bioengineering and the 14 National Cancer Institute for assessment of ap- 15 propriate imaging modalities; and 16 (G) address such other matters relating to 17 prostate cancer research as may be identified by 18 the Federal agencies participating in the pro- 19 gram under this section. 20 (2) PROSTATE CANCER ADVISORY BOARD.— 21 There is established in the Office of the Chief Sci- 22 entist of the Food and Drug Administration a Pros- 23 tate Cancer Scientific Advisory Board. Such board 24 shall be responsible for accelerating real-time shar- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 367 •S 2474 IS ing of the latest research data and accelerating 1 movement of new medicines to patients. 2 (3) UNDERSERVED MINORITY GRANT PRO- 3 GRAM.—In carrying out such program, the Secretary 4 shall— 5 (A) award grants to eligible entities to 6 carry out components of the research outlined 7 in paragraph (1); 8 (B) integrate and build upon existing 9 knowledge gained from comparative effective- 10 ness research; and 11 (C) recognize and address— 12 (i) the racial and ethnic disparities in 13 the incidence and mortality rates of pros- 14 tate cancer and men with a family history 15 of prostate cancer; 16 (ii) any barriers in access to care and 17 participation in clinical trials that are spe- 18 cific to racial, ethnic, and other under- 19 served minorities and men with a family 20 history of prostate cancer; 21 (iii) needed outreach and educational 22 efforts to raise awareness in these commu- 23 nities; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 368 •S 2474 IS (iv) appropriate access and utilization 1 of imaging modalities. 2 (e) TELEHEALTH AND RURAL ACCESS PILOT 3 PROJECT.— 4 (1) IN GENERAL.—The Secretary of Veterans 5 Affairs, the Secretary of Defense, and the Secretary 6 of Health and Human Services (in this section re- 7 ferred to as the ‘‘Secretaries’’) shall establish 4-year 8 telehealth pilot projects for the purpose of analyzing 9 the clinical outcomes and cost effectiveness associ- 10 ated with telehealth services in a variety of geo- 11 graphic areas that contain high proportions of medi- 12 cally underserved populations, including African- 13 Americans, Latinos, American Indians, and those in 14 rural areas. Such projects shall promote efficient use 15 of specialist care through better coordination of pri- 16 mary care and physician extender teams in under- 17 served areas and more effectively employ tumor 18 boards to better counsel patients. 19 (2) ELIGIBLE ENTITIES.— 20 (A) IN GENERAL.—The Secretaries shall 21 select eligible entities to participate in the pilot 22 projects under this section. 23 (B) PRIORITY.—In selecting eligible enti- 24 ties to participate in the pilot projects under 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 369 •S 2474 IS this section, the Secretaries shall give priority 1 to such entities located in medically under- 2 served areas, particularly those that include Af- 3 rican-Americans, Latinos, and facilities of the 4 Indian Health Service, and those in rural areas. 5 (3) EVALUATION.—The Secretaries shall, 6 through the pilot projects, evaluate— 7 (A) the effective and economic delivery of 8 care in diagnosing and treating prostate cancer 9 with the use of telehealth services in medically 10 underserved and tribal areas including collabo- 11 rative uses of health professionals and integra- 12 tion of the range of telehealth and other tech- 13 nologies; 14 (B) the effectiveness of improving the ca- 15 pacity of nonmedical providers and nonspecial- 16 ized medical providers to provide health services 17 for prostate cancer in medically underserved 18 and tribal areas, including the exploration of in- 19 novative medical home models with collabora- 20 tion between urologists, other relevant medical 21 specialists, including oncologists, radiologists, 22 and primary care teams and coordination of 23 care through the efficient use of primary care 24 teams and physician extenders; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 370 •S 2474 IS (C) the effectiveness of using telehealth 1 services to provide prostate cancer treatment in 2 medically underserved areas, including the use 3 of tumor boards to facilitate better patient 4 counseling. 5 (4) REPORT.—Not later than 12 months after 6 the completion of the pilot projects under this sub- 7 section, the Secretaries shall submit to Congress a 8 report describing the outcomes of such pilot projects, 9 including any cost savings and efficiencies realized, 10 and providing recommendations, if any, for expand- 11 ing the use of telehealth services. 12 (f) EDUCATION AND AWARENESS.— 13 (1) IN GENERAL.—The Secretary of Veterans 14 Affairs shall develop a national education campaign 15 for prostate cancer. Such campaign shall involve the 16 use of written educational materials and public serv- 17 ice announcements consistent with the findings of 18 the Prostate Cancer Task Force under subsection 19 (c), that are intended to encourage men to seek 20 prostate cancer screening when appropriate. 21 (2) RACIAL DISPARITIES AND THE POPULATION 22 OF MEN WITH A FAMILY HISTORY OF PROSTATE 23 CANCER.—In developing the national campaign 24 under paragraph (1), the Secretary shall ensure that 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 371 •S 2474 IS such educational materials and public service an- 1 nouncements are more readily available in commu- 2 nities experiencing racial disparities in the incidence 3 and mortality rates of prostate cancer and by men 4 of any race classification with a family history of 5 prostate cancer. 6 (3) GRANTS.—In carrying out the national 7 campaign under this section, the Secretary shall 8 award grants to nonprofit private entities to enable 9 such entities to test alternative outreach and edu- 10 cation strategies. 11 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 12 BREAST AND CERVICAL CANCER PATIENTS 13 IN THE TERRITORIES. 14 (a) ELIMINATION OF FUNDING LIMITATIONS.— 15 (1) IN GENERAL.—Section 1108(g)(4) of the 16 Social Security Act (42 U.S.C. 1308(g)(4)) is 17 amended by adding at the end the following: ‘‘With 18 respect to fiscal years beginning with fiscal year 19 2012, payment for medical assistance for individuals 20 who are eligible for such assistance only on the basis 21 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 22 taken into account in applying subsection (f) (as in- 23 creased in accordance with paragraphs (1), (2), and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 372 •S 2474 IS (3) of this subsection) to such commonwealth or ter- 1 ritory for such fiscal year.’’. 2 (2) TECHNICAL AMENDMENT.—Section 3 1108(g)(4) of such Act is further amended by strik- 4 ing ‘‘(3), and (4)’’ and inserting ‘‘and (3)’’. 5 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 6 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 7 1396d(b)) is amended by adding at the end the following: 8 ‘‘Notwithstanding the first sentence of this subsection, 9 with respect to medical assistance described in clause (4) 10 of such sentence that is furnished in Puerto Rico, the 11 United States Virgin Islands, Guam, the Commonwealth 12 of the Northern Mariana Islands, or American Samoa in 13 a fiscal year, the Federal medical assistance percentage 14 is equal to the highest such percentage applied under such 15 clause for such fiscal year for any of the 50 States or the 16 District of Columbia that provides such medical assistance 17 for any portion of such fiscal year.’’ 18 (c) EFFECTIVE DATE.—The amendments made by 19 this section shall apply to payment for medical assistance 20 for items and services furnished on or after October 1, 21 2011. 22 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 373 •S 2474 IS SEC. 704. CANCER PREVENTION AND TREATMENT DEM- 1 ONSTRATION FOR ETHNIC AND RACIAL MI- 2 NORITIES. 3 (a) DEMONSTRATION.— 4 (1) IN GENERAL.—The Secretary of Health and 5 Human Services (in this section referred to as the 6 ‘‘Secretary’’) shall conduct demonstration projects 7 (in this section referred to as ‘‘demonstration 8 projects’’) for the purpose of developing models and 9 evaluating methods that— 10 (A) improve the quality of items and serv- 11 ices provided to target individuals in order to 12 facilitate reduced disparities in early detection 13 and treatment of cancer; 14 (B) improve clinical outcomes, satisfaction, 15 quality of life, and appropriate use of Medicare- 16 covered services and referral patterns among 17 those target individuals with cancer; 18 (C) eliminate disparities in the rate of pre- 19 ventive cancer screening measures, such as Pap 20 smears, prostate cancer screenings, and CT 21 scans for lung cancer among target individuals; 22 (D) promote collaboration with community- 23 based organizations to ensure cultural com- 24 petency of health care professionals and lin- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 374 •S 2474 IS guistic access for persons with limited-English 1 proficiency; and 2 (E) encourage the incorporation of commu- 3 nity health workers to increase the efficiency 4 and appropriateness of cancer screening pro- 5 grams. 6 (2) COMMUNITY HEALTH WORKER DEFINED.— 7 In this section, the term ‘‘community health worker’’ 8 includes a community health advocate, a lay health 9 worker, a community health representative, a peer 10 health promoter, a community health outreach work- 11 ers, and promotores de salud, who promotes health 12 or nutrition within the community in which the indi- 13 vidual resides. 14 (3) TARGET INDIVIDUAL DEFINED.—In this 15 section, the term ‘‘target individual’’ means an indi- 16 vidual of a racial and ethnic minority group, as de- 17 fined in section 1707(g)(1) of the Public Health 18 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 19 tled to benefits under part A, and enrolled under 20 part B, of title XVIII of the Social Security Act. 21 (b) PROGRAM DESIGN.— 22 (1) INITIAL DESIGN.—Not later than 1 year 23 after the date of the enactment of this Act, the Sec- 24 retary shall evaluate best practices in the private 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 375 •S 2474 IS sector, community programs, and academic research 1 of methods that reduce disparities among individuals 2 of racial and ethnic minority groups in the preven- 3 tion and treatment of cancer and shall design the 4 demonstration projects based on such evaluation. 5 (2) NUMBER AND PROJECT AREAS.—Not later 6 than 2 years after the date of the enactment of this 7 Act, the Secretary shall implement at least nine 8 demonstration projects, including the following: 9 (A) Two projects for each of the four fol- 10 lowing major racial and ethnic minority groups: 11 (i) American Indians and Alaska Na- 12 tives, Eskimos and Aleuts. 13 (ii) Asian-Americans. 14 (iii) Blacks/African-Americans. 15 (iv) Hispanic/Latinos. 16 (v) Native Hawaiians and other Pa- 17 cific Islanders. 18 The two projects must target different ethnic 19 subpopulations. 20 (B) One project within the Pacific Islands 21 or United States insular areas. 22 (C) At least one project each in a rural 23 area and inner-city area. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 376 •S 2474 IS (3) EXPANSION OF PROJECTS; IMPLEMENTA- 1 TION OF DEMONSTRATION PROJECT RESULTS.—If 2 the initial report under subsection (c) contains an 3 evaluation that demonstration projects— 4 (A) reduce expenditures under the Medi- 5 care program under title XVIII of the Social 6 Security Act; or 7 (B) do not increase expenditures under the 8 Medicare program and reduce racial and ethnic 9 health disparities in the quality of health care 10 services provided to target individuals and in- 11 crease satisfaction of beneficiaries and health 12 care providers; 13 the Secretary shall continue the existing demonstra- 14 tion projects and may expand the number of dem- 15 onstration projects. 16 (c) REPORT TO CONGRESS.— 17 (1) IN GENERAL.—Not later than 2 years after 18 the date the Secretary implements the initial dem- 19 onstration projects, and biannually thereafter, the 20 Secretary shall submit to Congress a report regard- 21 ing the demonstration projects. 22 (2) CONTENTS OF REPORT.—Each report under 23 paragraph (1) shall include the following: 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 377 •S 2474 IS (A) A description of the demonstration 1 projects. 2 (B) An evaluation of— 3 (i) the cost effectiveness of the dem- 4 onstration projects; 5 (ii) the quality of the health care serv- 6 ices provided to target individuals under 7 the demonstration projects; and 8 (iii) beneficiary and health care pro- 9 vider satisfaction under the demonstration 10 projects. 11 (C) Any other information regarding the 12 demonstration projects that the Secretary de- 13 termines to be appropriate. 14 (d) WAIVER AUTHORITY.—The Secretary shall waive 15 compliance with the requirements of title XVIII of the So- 16 cial Security Act to such extent and for such period as 17 the Secretary determines is necessary to conduct dem- 18 onstration projects. 19 SEC. 705. REDUCING CANCER TREATMENT DISPARITIES 20 WITHIN MEDICARE. 21 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 22 IN QUALITY OF CANCER CARE.— 23 (1) DEVELOPMENT OF MEASURES.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 378 •S 2474 IS (A) IN GENERAL.—The Secretary of 1 Health and Human Services (in this section re- 2 ferred to as the ‘‘Secretary’’) shall enter into an 3 agreement with an entity that specializes in de- 4 veloping quality measures for cancer care under 5 which the entity shall— 6 (i) develop a uniform set of measures 7 to evaluate disparities in the quality of 8 cancer care; and 9 (ii) annually update such set of meas- 10 ures. 11 (B) MEASURES TO BE INCLUDED.—Such 12 set of measures shall include, with respect to 13 the treatment of cancer, measures of patient 14 outcomes, the process for delivering medical 15 care related to such treatment, patient coun- 16 seling and engagement in decisionmaking, pa- 17 tient experience of care, resource use, and prac- 18 tice capabilities, such as care coordination. 19 (2) ENDORSEMENT OF MEASURES.—Any meas- 20 ure included in the set of measures developed pursu- 21 ant to this subsection must have been endorsed by 22 the entity with a contract under section 1890(a) of 23 the Social Security Act (42 U.S.C. 1395aaa(a)). 24 (b) ESTABLISHMENT OF REPORTING PROCESS.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 379 •S 2474 IS (1) IN GENERAL.—The Secretary shall establish 1 a reporting process that provides for a method for 2 health care providers specified under paragraph (2) 3 to submit to the Secretary and make public data on 4 the performance of such providers during each re- 5 porting period through use of the measures devel- 6 oped pursuant to subsection (a). Such data shall be 7 submitted in a form and manner and at a time spec- 8 ified by the Secretary. 9 (2) SPECIFICATION OF PROVIDERS TO REPORT 10 ON MEASURES.—The Secretary shall specify the 11 classes of Medicare providers of services and sup- 12 pliers, including hospitals, cancer centers, physi- 13 cians, primary care providers, and specialty pro- 14 viders, that will be required under such process to 15 publicly report on the measures developed pursuant 16 to subsection (a). 17 (3) ASSESSMENT OF CHANGES.—Within this re- 18 porting process, the Secretary shall also establish a 19 format that assesses changes in both the absolute 20 and relative disparities over time. These measures 21 shall be presented in an easily comprehensible for- 22 mat, such as those presented in the final publica- 23 tions relating to Healthy People 2010 or the Na- 24 tional Healthcare Disparities Report. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 380 •S 2474 IS (4) INITIAL IMPLEMENTATION.—The Secretary 1 shall implement the reporting process under this 2 subsection for reporting periods beginning not later 3 than 6 months after the date that measures are first 4 developed pursuant to subsection (a). 5 Subtitle B—Viral Hepatitis and 6 Liver Cancer Control and Pre- 7 vention 8 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 9 AND PREVENTION. 10 (a) SHORT TITLE.—This subtitle may be cited as the 11 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 12 Act of 2012’’. 13 (b) FINDINGS.—Congress finds the following: 14 (1) Approximately 5,300,000 Americans are 15 chronically infected with the hepatitis B virus (re- 16 ferred to in this section as ‘‘HBV’’), the hepatitis C 17 virus (referred to in this section as ‘‘HCV’’), or 18 both. 19 (2) In the United States, chronic HBV and 20 HCV are the most common cause of liver cancer, 21 one of the most lethal and fastest growing cancers 22 in this country. It is the most common cause of 23 chronic liver disease, liver cirrhosis, and the most 24 common indication for liver transplantation. It is 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 381 •S 2474 IS also a leading cause of death in Americans living 1 with HIV/AIDS, many of whom are coinfected with 2 chronic HBV, chronic HCV, or both. At least 15,000 3 deaths per year in the United States can be attrib- 4 uted to chronic HBV and HCV. 5 (3) According to the Centers for Disease Con- 6 trol and Prevention (referred to in this section as 7 the ‘‘CDC’’), approximately 2 percent of the popu- 8 lation of the United States is living with chronic 9 HBV, chronic HCV, or both. The CDC has recog- 10 nized HCV as the Nation’s most common chronic 11 bloodborne virus infection and HBV as the deadliest 12 vaccine-preventable disease. 13 (4) HBV is easily transmitted and is 100 times 14 more infectious than HIV. According to the CDC, 15 HBV is transmitted through percutaneous (i.e., 16 puncture through the skin) or mucosal contact with 17 infectious blood or body fluids. HCV is transmitted 18 by percutaneous exposures to infectious blood. 19 (5) The CDC conservatively estimates that in 20 2008 approximately 18,000 Americans were newly 21 infected with HCV and more than 38,000 Americans 22 were newly infected with HBV. 23 (6) There were 6 outbreaks reported to CDC 24 for investigation in 2008 related to health care ac- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 382 •S 2474 IS quired infection of HBV and HCV, potentially ex- 1 posing more than 52,000 Americans to the viruses, 2 in 2009–2010 there were 15 outbreaks in which 3 more than 30,000 people were potentially exposed. 4 (7) Chronic HBV and chronic HCV usually do 5 not cause symptoms early in the course of the dis- 6 ease, but after many years of a clinically ‘‘silent’’ 7 phase, more than 50 percent of infected individuals 8 will develop cirrhosis, end-stage liver disease, or liver 9 cancer. Since most of those with chronic HBV and 10 HCV are unaware of their infection, they do not 11 know to take precautions to prevent the spread of 12 their infection and can unknowingly exacerbate their 13 own disease progression. 14 (8) HBV and HCV disproportionately affect 15 certain populations in the United States. Although 16 representing only 5 percent of the population, Asian- 17 Americans and Pacific Islanders account for over 18 half of the 1,400,000 domestic chronic HBV cases. 19 Baby boomers (those born between 1946 and 1964) 20 account for more than half of domestic chronic hepa- 21 titis C cases. In addition, African-Americans, 22 Latinos, and American Indian/Alaskan Natives are 23 among the groups which have disproportionately 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 383 •S 2474 IS high rates of HBV and/or HCV infections in the 1 United States. 2 (9) For both chronic HBV and chronic HCV, 3 behavioral changes can slow disease progression if 4 diagnosis is made early. Early diagnosis, which is 5 determined through simple blood tests, can reduce 6 the risk of transmission and disease progression 7 through education and vaccination of household 8 members and other susceptible persons at risk. 9 (10) For those chronically infected with HBV 10 or HCV, regular monitoring can lead to the early de- 11 tection of liver cancer at a stage where cure is still 12 possible. Liver cancer is the third deadliest cancer in 13 the United States however, liver cancer has received 14 little funding for research, prevention, or treatment. 15 (11) Treatment for chronic HCV can eradicate 16 the disease in approximately 75 percent of those cur- 17 rently treated. The treatment of chronic HBV can 18 effectively suppress viral replication in the over- 19 whelming majority (>80%) of those treated thereby 20 reducing the risk of transmission and progression to 21 liver scarring or liver cancer even though a complete 22 cure is much less common than for HCV. 23 (12) To combat the HBV and HCV epidemics 24 in the United States, in May 2011, the Department 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 384 •S 2474 IS of Health and Human Services released Combating 1 the Silent Epidemic of Viral Hepatitis: Action Plan 2 for the Prevention, Care & Treatment of Viral Hepa- 3 titis (hereafter referred to as the HHS Action Plan). 4 The Institute of Medicine (IOM) of the National 5 Academies 2010 reported on the Federal response to 6 HBV and HCV titled: Hepatitis and Liver Cancer: 7 A National Strategy for Prevention and Control of 8 Hepatitis B and C. These recommendations and 9 guidelines provide a framework for HBV and HCV 10 prevention, education, control, research, and medical 11 management programs. 12 (13) The annual health care costs attributable 13 to HBV and HCV in the United States are signifi- 14 cant. For HBV, it is estimated to be approximately 15 $1,000,000,000 to 2,000,000,000 ($1,000 to $2,000 16 per infected person). More than $1,000,000,000 is 17 spent each year for HBV-related hospitalizations. 18 The indirect costs of chronic HBV infection are 19 harder to measure, but include reduced physical and 20 emotional quality of life, reduced economic produc- 21 tivity, long-term disability, and premature death. 22 For HCV, medical costs for patients are expected to 23 increase from $30,000,000,000 in 2009 to over 24 $85,000,000,000 in 2024. Avoiding these costs by 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 385 •S 2474 IS screening and diagnosing individuals earlier—and 1 connecting them to appropriate treatment and care 2 will save lives and critical health care dollars. Cur- 3 rently, without a comprehensive screening, testing 4 and diagnosis program, most patients are diagnosed 5 too late when they need a liver transplant costing at 6 least $314,000 for uncomplicated cases or when they 7 have liver cancer or end stage liver disease which 8 costs $30,980 to $110,576 per hospital admission. 9 As health care costs continue to grow, it is critical 10 that the Federal Government invests in effective 11 mechanisms to avoid documented cost drivers. 12 (14) According to the IOM report in 2010, 13 chronic HBV and HCV infections cause substantial 14 morbidity and mortality despite being preventable 15 and treatable. Deficiencies in the implementation of 16 established guidelines for the prevention, diagnosis, 17 and medical management of chronic HBV and HCV 18 infections perpetuate personal and economic bur- 19 dens. Existing grants are not sufficient for the scale 20 of the health burden presented by HBV and HCV. 21 (15) Screening and testing for HBV and HCV 22 is aligned with the Healthy People 2020 goal; In- 23 crease immunization rates and reduce preventable 24 infectious diseases. Awareness of disease and access 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 386 •S 2474 IS to prevention and treatment remain essential compo- 1 nents for reducing infectious disease transmission. 2 (16) Federal support is necessary to increase 3 knowledge and awareness of HBV and HCV and to 4 assist State and local prevention and control efforts 5 in reducing the morbidity and mortality of these 6 epidemics. 7 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 8 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 9 AND MEDICAL MANAGEMENT PLAN.—Title III of the 10 Public Health Service Act (42 U.S.C. 241 et seq.) is 11 amended— 12 (1) by striking section 317N (42 U.S.C. 247b– 13 15); and 14 (2) by adding at the end the following: 15 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 16 TITIS B AND HEPATITIS C PREVENTION, EDU- 17 CATION, RESEARCH, AND MEDICAL MANAGE- 18 MENT PLAN 19 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 20 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 21 ennial assessment of the Secretary’s plan for the preven- 22 tion, control, and medical management of, and education 23 and research relating to, hepatitis B and hepatitis C, for 24 the purposes of— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 387 •S 2474 IS ‘‘(1) incorporating into such plan new knowl- 1 edge or observations relating to hepatitis B and hep- 2 atitis C (such as knowledge and observations that 3 may be derived from clinical, laboratory, and epide- 4 miological research and disease detection, preven- 5 tion, and surveillance outcomes); 6 ‘‘(2) addressing gaps in the coverage or effec- 7 tiveness of the plan; and 8 ‘‘(3) evaluating and, if appropriate, updating 9 recommendations, guidelines, or educational mate- 10 rials of the Centers for Disease Control and Preven- 11 tion or the National Institutes of Health for health 12 care providers or the public on viral hepatitis in 13 order to be consistent with the plan. 14 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 15 Not later than October 1 of the first even-numbered year 16 beginning after the date of the enactment of this part, 17 and October 1 of each even-numbered year thereafter, the 18 Secretary shall publish in the Federal Register a notice 19 of the results of the assessments conducted under para- 20 graph (1). Such notice shall include— 21 ‘‘(1) a description of any revisions to the plan 22 referred to in subsection (a) as a result of the as- 23 sessment; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 388 •S 2474 IS ‘‘(2) an explanation of the basis for any such 1 revisions, including the ways in which such revisions 2 can reasonably be expected to further promote the 3 original goals and objectives of the plan; and 4 ‘‘(3) in the case of a determination by the Sec- 5 retary that the plan does not need revision, an expla- 6 nation of the basis for such determination. 7 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 8 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 9 Secretary, acting through the Director of the Centers for 10 Disease Control and Prevention, the Administrator of the 11 Health Resources and Services Administration, and the 12 Administrator of the Substance Abuse and Mental Health 13 Services Administration, and in accordance with the plan 14 referred to in section 399NN(a), shall implement pro- 15 grams to increase awareness and enhance knowledge and 16 understanding of hepatitis B and hepatitis C. Such pro- 17 grams shall include— 18 ‘‘(1) the conduct of culturally and language ap- 19 propriate health education in primary and secondary 20 schools, college campuses, public awareness cam- 21 paigns, and community outreach activities (especially 22 to the ethnic communities with high rates of chronic 23 hepatitis B and chronic hepatitis C and other high- 24 risk groups) to promote public awareness and knowl- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 389 •S 2474 IS edge about the value of hepatitis A and hepatitis B 1 immunization, risk factors, the transmission and 2 prevention of hepatitis B and hepatitis C, the value 3 of screening for the early detection of hepatitis B 4 and hepatitis C, and options available for the treat- 5 ment of chronic hepatitis B and chronic hepatitis C; 6 ‘‘(2) the promotion of immunization programs 7 that increase awareness and access to hepatitis A 8 and hepatitis B vaccines for susceptible adults and 9 children; 10 ‘‘(3) the training of health care professionals 11 regarding the importance of vaccinating individuals 12 infected with hepatitis C and individuals who are at 13 risk for hepatitis C infection against hepatitis A and 14 hepatitis B; 15 ‘‘(4) the training of health care professionals 16 regarding the importance of vaccinating individuals 17 chronically infected with hepatitis B and individuals 18 who are at risk for chronic hepatitis B infection 19 against the hepatitis A virus; 20 ‘‘(5) the training of health care professionals 21 and health educators to make them aware of the 22 high rates of chronic hepatitis B and chronic hepa- 23 titis C in certain adult ethnic populations, and the 24 importance of prevention, detection, and medical 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 390 •S 2474 IS management of hepatitis B and hepatitis C and of 1 liver cancer screening; 2 ‘‘(6) the development and distribution of health 3 education curricula (including information relating 4 to the special needs of individuals infected with hep- 5 atitis B and hepatitis C, such as the importance of 6 prevention and early intervention, regular moni- 7 toring, the recognition of psychosocial needs, appro- 8 priate treatment, and liver cancer screening) for in- 9 dividuals providing hepatitis B and hepatitis C coun- 10 seling; and 11 ‘‘(7) support for the implementation curricula 12 described in paragraph (6) by State and local public 13 health agencies. 14 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 15 PROGRAMS.— 16 ‘‘(1) IN GENERAL.—The Secretary, acting 17 through the Director of the Centers for Disease 18 Control and Prevention, shall support the integra- 19 tion of activities described in paragraph (2) into ex- 20 isting clinical and public health programs at State, 21 local, territorial, and tribal levels (including commu- 22 nity health clinics, programs for the prevention and 23 treatment of HIV/AIDS, sexually transmitted dis- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 391 •S 2474 IS eases, and substance abuse, and programs for indi- 1 viduals in correctional settings). 2 ‘‘(2) ACTIVITIES.— 3 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 4 ‘‘(i) IN GENERAL.—The Secretary 5 shall establish a mechanism by which to 6 support and promote the development of 7 State, local, territorial, and tribal vol- 8 untary hepatitis B and hepatitis C testing 9 programs to screen the high-prevalence 10 populations to aid in the early identifica- 11 tion of chronically infected individuals. 12 ‘‘(ii) CONFIDENTIALITY OF THE TEST 13 RESULTS.—The Secretary shall prohibit 14 the use of the results of a hepatitis B or 15 hepatitis C test conducted by a testing pro- 16 gram developed or supported under this 17 subparagraph for any of the following: 18 ‘‘(I) Issues relating to health in- 19 surance. 20 ‘‘(II) To screen or determine 21 suitability for employment. 22 ‘‘(III) To discharge a person 23 from employment. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 392 •S 2474 IS ‘‘(B) COUNSELING REGARDING VIRAL HEP- 1 ATITIS.—The Secretary shall support State, 2 local, territorial, and tribal programs in a wide 3 variety of settings, including those providing 4 primary and specialty health care services in 5 nonprofit private and public sectors, to— 6 ‘‘(i) provide individuals with ongoing 7 risk factors for hepatitis B and hepatitis C 8 infection with client-centered education 9 and counseling which concentrates on— 10 ‘‘(I) promoting testing of individ- 11 uals that have been exposed to their 12 blood, family members, and their sex- 13 ual partners; and 14 ‘‘(II) changing behaviors that 15 place individuals at risk for infection; 16 ‘‘(ii) provide individuals chronically in- 17 fected with hepatitis B or hepatitis C with 18 education, health information, and coun- 19 seling to reduce their risk of— 20 ‘‘(I) dying from end-stage liver 21 disease and liver cancer; and 22 ‘‘(II) transmitting viral hepatitis 23 to others; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 393 •S 2474 IS ‘‘(iii) provide women chronically in- 1 fected with hepatitis B or hepatitis C who 2 are pregnant or of childbearing age with 3 culturally and language appropriate health 4 information, such as how to prevent hepa- 5 titis B perinatal infection, and to alleviate 6 fears associated with pregnancy or raising 7 a family. 8 ‘‘(C) IMMUNIZATION.—The Secretary shall 9 support State, local, territorial, and tribal ef- 10 forts to expand the current vaccination pro- 11 grams to protect every child in the country and 12 all susceptible adults, particularly those infected 13 with hepatitis C and high-prevalence ethnic 14 populations and other high-risk groups, from 15 the risks of acute and chronic hepatitis B infec- 16 tion by— 17 ‘‘(i) ensuring continued funding for 18 hepatitis B vaccination for all children 19 19 years of age or younger through the Vac- 20 cines for Children Program; 21 ‘‘(ii) ensuring that the recommenda- 22 tions of the Advisory Committee on Immu- 23 nization Practices are followed regarding 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 394 •S 2474 IS the birth dose of hepatitis B vaccinations 1 for newborns; 2 ‘‘(iii) requiring proof of hepatitis B 3 vaccination for entry into public or private 4 daycare, preschool, elementary school, sec- 5 ondary school, and institutions of higher 6 education; 7 ‘‘(iv) expanding the availability of 8 hepatitis B vaccination for all susceptible 9 adults to protect them from becoming 10 acutely or chronically infected, including 11 ethnic and other populations with high 12 prevalence rates of chronic hepatitis B in- 13 fection; 14 ‘‘(v) expanding the availability of hep- 15 atitis B vaccination for all susceptible 16 adults, particularly those in their reproduc- 17 tive age (women and men less than 45 18 years of age), to protect them from the 19 risk of hepatitis B infection; 20 ‘‘(vi) ensuring the vaccination of indi- 21 viduals infected, or at risk for infection, 22 with hepatitis C against hepatitis A, hepa- 23 titis B, and other infectious diseases, as 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 395 •S 2474 IS appropriate, for which such individuals 1 may be at increased risk; and 2 ‘‘(vii) ensuring the vaccination of indi- 3 viduals infected, or at risk for infection, 4 with hepatitis B against hepatitis A virus 5 and other infectious diseases, as appro- 6 priate, for which such individuals may be 7 at increased risk. 8 ‘‘(D) MEDICAL REFERRAL.—The Secretary 9 shall support State, local, territorial, and tribal 10 programs that support— 11 ‘‘(i) referral of persons chronically in- 12 fected with hepatitis B or hepatitis C— 13 ‘‘(I) for medical evaluation to de- 14 termine the appropriateness for 15 antiviral treatment to reduce the risk 16 of progression to cirrhosis and liver 17 cancer; and 18 ‘‘(II) for ongoing medical man- 19 agement including regular monitoring 20 of liver function and screening for 21 liver cancer; and 22 ‘‘(ii) referral of persons infected with 23 acute or chronic hepatitis B infection or 24 acute or chronic hepatitis C infection for 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 396 •S 2474 IS drug and alcohol abuse treatment where 1 appropriate. 2 ‘‘(3) INCREASED SUPPORT FOR ADULT VIRAL 3 HEPATITIS COORDINATORS.—The Secretary, acting 4 through the Director of the Centers for Disease 5 Control and Prevention, shall provide increased sup- 6 port to Adult Viral Hepatitis Coordinators in State, 7 local, territorial, and tribal health departments in 8 order to enhance the additional management, net- 9 working, and technical expertise needed to ensure 10 successful integration of hepatitis B and hepatitis C 11 prevention and control activities into existing public 12 health programs. 13 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 14 ‘‘(1) IN GENERAL.—The Secretary, acting 15 through the Director of the Centers for Disease 16 Control and Prevention, shall support the establish- 17 ment and maintenance of a national chronic and 18 acute hepatitis B and hepatitis C surveillance pro- 19 gram, in order to identify— 20 ‘‘(A) trends in the incidence of acute and 21 chronic hepatitis B and acute and chronic hepa- 22 titis C; 23 ‘‘(B) trends in the prevalence of acute and 24 chronic hepatitis B and acute and chronic hepa- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 397 •S 2474 IS titis C infection among groups that may be dis- 1 proportionately affected; and 2 ‘‘(C) trends in liver cancer and end-stage 3 liver disease incidence and deaths, caused by 4 chronic hepatitis B and chronic hepatitis C in 5 the high-risk ethnic populations. 6 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 7 STUDIES.—The Secretary, acting through the Direc- 8 tor of the Centers for Disease Control and Preven- 9 tion, shall prepare a report outlining the population- 10 based seroprevalence studies currently underway, fu- 11 ture planned studies, the criteria involved in deter- 12 mining which seroprevalence studies to conduct, 13 defer, or suspend, and the scope of those studies, the 14 economic and clinical impact of hepatitis B and hep- 15 atitis C, and the impact of chronic hepatitis B and 16 chronic hepatitis C infections on the quality of life. 17 Not later than one year after the date of the enact- 18 ment of this part, the Secretary shall submit the re- 19 port to the Committee on Energy and Commerce of 20 the House of Representatives and the Committee on 21 Health, Education, Labor, and Pensions of the Sen- 22 ate. 23 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 24 not disclose any individually identifiable information 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 398 •S 2474 IS identified under paragraph (1) or derived through 1 studies under paragraph (2). 2 ‘‘(d) RESEARCH.—The Secretary, acting through the 3 Director of the Centers for Disease Control and Preven- 4 tion, the Director of the National Cancer Institute, and 5 the Director of the National Institutes of Health, shall— 6 ‘‘(1) conduct epidemiologic and community- 7 based research to develop, implement, and evaluate 8 best practices for hepatitis B and hepatitis C pre- 9 vention especially in the ethnic populations with high 10 rates of chronic hepatitis B and chronic hepatitis C 11 and other high-risk groups; 12 ‘‘(2) conduct research on hepatitis B and hepa- 13 titis C natural history, pathophysiology, improved 14 treatments and prevention (such as the hepatitis C 15 vaccine), and noninvasive tests that help to predict 16 the risk of progression to liver cirrhosis and liver 17 cancer; 18 ‘‘(3) conduct research that will lead to better 19 noninvasive or blood tests to screen for liver cancer, 20 and more effective treatments of liver cancer caused 21 by chronic hepatitis B and chronic hepatitis C; and 22 ‘‘(4) conduct research comparing the effective- 23 ness of screening, diagnostic, management, and 24 treatment approaches for chronic hepatitis B, chron- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 399 •S 2474 IS ic hepatitis C, and liver cancer in the affected com- 1 munities. 2 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 3 FECTED POPULATIONS.—In carrying out this section, the 4 Secretary shall provide expanded support for individuals 5 with limited access to health education, testing, and health 6 care services and groups that may be disproportionately 7 affected by hepatitis B and hepatitis C. 8 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 9 shall develop benchmarks for evaluating the effectiveness 10 of the programs and activities conducted under this sec- 11 tion and make determinations as to whether such bench- 12 marks have been achieved. 13 ‘‘SEC. 399NN–2. GRANTS. 14 ‘‘(a) IN GENERAL.—The Secretary may award grants 15 to, or enter into contracts or cooperative agreements with, 16 States, political subdivisions of States, territories, Indian 17 tribes, or nonprofit entities that have special expertise re- 18 lating to hepatitis B, hepatitis C, or both, to carry out 19 activities under this part. 20 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 21 tract, or cooperative agreement under subsection (a), an 22 entity shall prepare and submit to the Secretary an appli- 23 cation at such time, in such manner, and containing such 24 information as the Secretary may require.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 400 •S 2474 IS (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC- 1 TIVITIES.—Paragraph (6) of section 501(d) of the Public 2 Health Service Act (42 U.S.C. 290aa(d)) is amended by 3 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber- 4 culosis, or hepatitis’’. 5 Subtitle C—Acquired Bone Marrow 6 Failure Diseases 7 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 8 (a) SHORT TITLE.—This subtitle may be cited as the 9 ‘‘Bone Marrow Failure Disease Research and Treatment 10 Act of 2012’’. 11 (b) FINDINGS.—The Congress finds the following: 12 (1) Between 20,000 and 30,000 Americans are 13 diagnosed each year with myelodysplastic syndromes, 14 aplastic anemia, paroxysmal nocturnal hemo- 15 globinuria, and other acquired bone marrow failure 16 diseases. 17 (2) Acquired bone marrow failure diseases have 18 a debilitating and often fatal impact on those diag- 19 nosed with these diseases. 20 (3) While some treatments for acquired bone 21 marrow failure diseases can prolong and improve the 22 quality of patients’ lives, there is no single cure for 23 these diseases. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 401 •S 2474 IS (4) The prevalence of acquired bone marrow 1 failure diseases in the United States will continue to 2 grow as the general public ages. 3 (5) Evidence exists suggesting that acquired 4 bone marrow failure diseases occur more often in 5 minority populations, particularly in Asian-American 6 and Hispanic/Latino populations. 7 (6) The National Heart, Lung, and Blood Insti- 8 tute and the National Cancer Institute have con- 9 ducted important research into the causes of and 10 treatments for acquired bone marrow failure dis- 11 eases. 12 (7) The National Marrow Donor Program Reg- 13 istry has made significant contributions to the fight 14 against bone marrow failure diseases by connecting 15 millions of potential marrow donors with individuals 16 and families suffering from these conditions. 17 (8) Despite these advances, a more comprehen- 18 sive Federal strategic effort among numerous Fed- 19 eral agencies is needed to discover a cure for ac- 20 quired bone marrow failure disorders. 21 (9) Greater Federal surveillance of acquired 22 bone marrow failure diseases is needed to gain a bet- 23 ter understanding of the causes of acquired bone 24 marrow failure diseases. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 402 •S 2474 IS (10) The Federal Government should increase 1 its research support for and engage with public and 2 private organizations in developing a comprehensive 3 approach to combat and cure acquired bone marrow 4 failure diseases. 5 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 6 DISEASE REGISTRY.—Part B of the Public Health Service 7 Act (42 U.S.C. 311 et seq.) is amended by inserting after 8 section 317W, as added, the following: 9 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 10 DISEASE REGISTRY. 11 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 12 ‘‘(1) IN GENERAL.—Not later than 6 months 13 after the date of the enactment of this section, the 14 Secretary, acting through the Director of the Cen- 15 ters for Disease Control and Prevention, shall— 16 ‘‘(A) develop a system to collect data on 17 acquired bone marrow failure diseases; and 18 ‘‘(B) establish and maintain a national and 19 publicly available registry, to be known as the 20 National Acquired Bone Marrow Failure Dis- 21 ease Registry, in accordance with paragraph 22 (3). 23 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 24 MITTEE.—In carrying out this subsection, the Sec- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 403 •S 2474 IS retary shall take into consideration the recommenda- 1 tions of the Advisory Committee on Acquired Bone 2 Marrow Failure Diseases established under sub- 3 section (b). 4 ‘‘(3) PURPOSES OF REGISTRY.—The National 5 Acquired Bone Marrow Failure Disease Registry— 6 ‘‘(A) shall identify the incidence and preva- 7 lence of acquired bone marrow failure diseases 8 in the United States; 9 ‘‘(B) shall be used to collect and store data 10 on acquired bone marrow failure diseases, in- 11 cluding data concerning— 12 ‘‘(i) the age, race or ethnicity, general 13 geographic location, sex, and family history 14 of individuals who are diagnosed with ac- 15 quired bone marrow failure diseases, and 16 any other characteristics of such individ- 17 uals determined appropriate by the Sec- 18 retary; 19 ‘‘(ii) the genetic and environmental 20 factors that may be associated with devel- 21 oping acquired bone marrow failure dis- 22 eases; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 404 •S 2474 IS ‘‘(iii) treatment approaches for deal- 1 ing with acquired bone marrow failure dis- 2 eases; 3 ‘‘(iv) outcomes for individuals treated 4 for acquired bone marrow failure diseases, 5 including outcomes for recipients of stem 6 cell therapeutic products as contained in 7 the database established pursuant to sec- 8 tion 379A; and 9 ‘‘(v) any other factors pertaining to 10 acquired bone marrow failure diseases de- 11 termined appropriate by the Secretary; and 12 ‘‘(C) shall be made available— 13 ‘‘(i) to the general public; and 14 ‘‘(ii) to researchers to facilitate fur- 15 ther research into the causes of, and treat- 16 ments for, acquired bone marrow failure 17 diseases in accordance with standard prac- 18 tices of the Centers for Disease Control 19 and Preventions. 20 ‘‘(b) ADVISORY COMMITTEE.— 21 ‘‘(1) ESTABLISHMENT.—Not later than 6 22 months after the date of the enactment of this sec- 23 tion, the Secretary, acting through the Director of 24 the Centers for Disease Control and Prevention, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 405 •S 2474 IS shall establish an advisory committee, to be known 1 as the Advisory Committee on Acquired Bone Mar- 2 row Failure Diseases. 3 ‘‘(2) MEMBERS.—The members of the Advisory 4 Committee on Acquired Bone Marrow Failure Dis- 5 eases shall be appointed by the Secretary, acting 6 through the Director of the Centers for Disease 7 Control and Prevention, and shall include at least 8 one representative from each of the following: 9 ‘‘(A) A national patient advocacy organiza- 10 tion with experience advocating on behalf of pa- 11 tients suffering from acquired bone marrow 12 failure diseases. 13 ‘‘(B) The National Institutes of Health, in- 14 cluding at least one representative from each 15 of— 16 ‘‘(i) the National Cancer Institute; 17 ‘‘(ii) the National Heart, Lung, and 18 Blood Institute; and 19 ‘‘(iii) the Office of Rare Diseases. 20 ‘‘(C) The Centers for Disease Control and 21 Prevention. 22 ‘‘(D) Clinicians with experience in— 23 ‘‘(i) diagnosing or treating acquired 24 bone marrow failure diseases; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 406 •S 2474 IS ‘‘(ii) medical data registries. 1 ‘‘(E) Epidemiologists who have experience 2 with data registries. 3 ‘‘(F) Publicly or privately funded research- 4 ers who have experience researching acquired 5 bone marrow failure diseases. 6 ‘‘(G) The entity operating the C.W. Bill 7 Young Cell Transplantation Program estab- 8 lished pursuant to section 379 and the entity 9 operating the C.W. Bill Young Cell Transplan- 10 tation Program Outcomes Database. 11 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 12 mittee on Acquired Bone Marrow Failure Diseases 13 shall provide recommendations to the Secretary on 14 the establishment and maintenance of the National 15 Acquired Bone Marrow Failure Disease Registry, in- 16 cluding recommendations on the collection, mainte- 17 nance, and dissemination of data. 18 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 19 shall make the recommendations of the Advisory 20 Committee on Acquired Bone Marrow Failure Dis- 21 ease publicly available. 22 ‘‘(c) GRANTS.—The Secretary, acting through the 23 Director of the Centers for Disease Control and Preven- 24 tion, may award grants to, and enter into contracts and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 407 •S 2474 IS cooperative agreements with, public or private nonprofit 1 entities for the management of, as well as the collection, 2 analysis, and reporting of data to be included in, the Na- 3 tional Acquired Bone Marrow Failure Disease Registry. 4 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 5 quired bone marrow failure disease’ means— 6 ‘‘(1) myelodysplastic syndromes (MDS); 7 ‘‘(2) aplastic anemia; 8 ‘‘(3) paroxysmal nocturnal hemoglobinuria 9 (PNH); 10 ‘‘(4) pure red cell aplasia; 11 ‘‘(5) acute myeloid leukemia that has pro- 12 gressed from myelodysplastic syndromes; or 13 ‘‘(6) large granular lymphocytic leukemia.’’. 14 (d) PILOT STUDIES THROUGH THE AGENCY FOR 15 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 16 (1) PILOT STUDIES.—The Secretary of Health 17 and Human Services, acting through the Adminis- 18 trator of the Agency for Toxic Substances and Dis- 19 ease Registry, shall conduct pilot studies to deter- 20 mine which environmental factors, including expo- 21 sure to toxins, may cause acquired bone marrow fail- 22 ure diseases. 23 (2) COLLABORATION WITH THE RADIATION IN- 24 JURY TREATMENT NETWORK.—In carrying out the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 408 •S 2474 IS directives of this section, the Secretary may collabo- 1 rate with the Radiation Injury Treatment Network 2 of the C.W. Bill Young Cell Transplantation Pro- 3 gram established pursuant to section 379 of the 4 Public Health Service Act (42 U.S.C. 274j) to— 5 (A) augment data for the pilot studies au- 6 thorized by this section; 7 (B) access technical assistance that may be 8 provided by the Radiation Injury Treatment 9 Network; or 10 (C) perform joint research projects. 11 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 12 BONE MARROW FAILURE DISEASES.—Title XVII of the 13 Public Health Service Act (42 U.S.C. 300u et seq.) is 14 amended by inserting after section 1707A the following: 15 ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE 16 MARROW FAILURE DISEASES 17 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL 18 SERVICES.— 19 ‘‘(1) IN GENERAL.—Not later than 6 months 20 after the date of the enactment of this section, the 21 Secretary, acting through the Deputy Assistant Sec- 22 retary for Minority Health, shall establish and co- 23 ordinate outreach and informational programs tar- 24 geted to minority populations affected by acquired 25 bone marrow failure diseases. 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 409 •S 2474 IS ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 1 cused outreach and informational programs author- 2 ized by this section— 3 ‘‘(A) shall make information about treat- 4 ment options and clinical trials for acquired 5 bone marrow failure diseases publicly available, 6 and 7 ‘‘(B) shall provide referral services for 8 treatment options and clinical trials, 9 at the national minority health resource center sup- 10 ported under section 1707(b)(8) (including by means 11 of the center’s Web site, through appropriate loca- 12 tions such as the center’s knowledge center, and 13 through appropriate programs such as the center’s 14 resource persons network) and through minority 15 health consultants located at each Department of 16 Health and Human Services regional office. 17 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 18 ISLANDER OUTREACH.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Deputy Assistant Secretary for Minority 21 Health, shall undertake a coordinated outreach ef- 22 fort to connect Hispanic, Asian-American, and Pa- 23 cific Islander communities with comprehensive serv- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 410 •S 2474 IS ices focused on treatment of, and information about, 1 acquired bone marrow failure diseases. 2 ‘‘(2) COLLABORATION.—In carrying out this 3 subsection, the Secretary may collaborate with public 4 health agencies, nonprofit organizations, community 5 groups, and online entities to disseminate informa- 6 tion about treatment options and clinical trials for 7 acquired bone marrow failure diseases. 8 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 9 ‘‘(1) IN GENERAL.—Not later than 6 months 10 after the date of the enactment of this section, the 11 Secretary, acting through the Deputy Assistant Sec- 12 retary for Minority Health, shall award grants to, or 13 enter into cooperative agreements with, entities to 14 perform research on acquired bone marrow failure 15 diseases. 16 ‘‘(2) REQUIREMENT.—Grants and cooperative 17 agreements authorized by this subsection shall be 18 awarded or entered into on a competitive, peer-re- 19 viewed basis. 20 ‘‘(3) SCOPE OF RESEARCH.—Research funded 21 under this section shall examine factors affecting the 22 incidence of acquired bone marrow failure diseases 23 in minority populations. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 411 •S 2474 IS ‘‘(d) DEFINITION.—In this section, the term ‘ac- 1 quired bone marrow failure disease’ has the meaning given 2 to such term in section 317X(d).’’. 3 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 4 QUIRED BONE MARROW FAILURE DISEASES.—The Sec- 5 retary of Health and Human Services, acting through the 6 Director of the Agency for Healthcare Research and Qual- 7 ity, shall award grants to entities to improve diagnostic 8 practices and quality of care with respect to patients with 9 acquired bone marrow failure diseases. 10 (g) DEFINITION.—In this section, the term ‘‘acquired 11 bone marrow failure disease’’ means— 12 (1) myelodysplastic syndromes (MDS); 13 (2) aplastic anemia; 14 (3) paroxysmal nocturnal hemoglobinuria 15 (PNH); 16 (4) pure red cell aplasia; 17 (5) acute myeloid leukemia that progressed 18 from myelodysplastic syndromes; or 19 (6) large granular lymphocytic leukemia. 20 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 412 •S 2474 IS Subtitle D—Cardiovascular Dis- 1 ease, Chronic Disease, and 2 Other Disease Issues 3 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 4 NORITY PATIENTS. 5 (a) IN GENERAL.—The Secretary, acting through the 6 Director of the Agency for Healthcare Research and Qual- 7 ity, shall convene a series of meetings to develop guidelines 8 for disease screening for minority patient populations 9 which have a higher than average risk for many chronic 10 diseases and cancers. 11 (b) PARTICIPANTS.—In convening meetings under 12 subsection (a), the Secretary shall ensure that meeting 13 participants include representatives of— 14 (1) professional societies and associations; 15 (2) minority health organizations; 16 (3) health care researchers and providers, in- 17 cluding those with expertise in minority health; 18 (4) Federal health agencies, including the Of- 19 fice of Minority Health, the National Institute on 20 Minority Health and Health Disparities, and the 21 National Institutes of Health; and 22 (5) other experts determined appropriate by the 23 Secretary. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 413 •S 2474 IS (c) DISEASES.—Screening guidelines for minority 1 populations shall be developed as appropriate under sub- 2 section (a) for— 3 (1) hypertension; 4 (2) hypercholesterolemia; 5 (3) diabetes; 6 (4) cardiovascular disease; 7 (5) cancers, including breast, prostate, colon, 8 cervical, and lung cancer; 9 (6) asthma; 10 (7) diabetes; 11 (8) kidney diseases; 12 (9) eye diseases and disorders, including glau- 13 coma; 14 (10) HIV/AIDS and sexually transmitted dis- 15 eases; 16 (11) uterine fibroids; 17 (12) autoimmune disease; 18 (13) mental health conditions; 19 (14) dental health conditions and oral diseases; 20 (15) environmental and related health illnesses 21 and conditions; 22 (16) Sickle cell disease; 23 (17) violence and injury prevention and control; 24 (18) genetic and related conditions; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 414 •S 2474 IS (19) heart disease and stroke; 1 (20) tuberculosis; 2 (21) chronic obstructive pulmonary disease; and 3 (22) other diseases determined appropriate by 4 the Secretary. 5 (d) DISSEMINATION.—Not later than 24 months 6 after the date of enactment of this title, the Secretary 7 shall publish and disseminate to health care provider orga- 8 nizations the guidelines developed under subsection (a). 9 SEC. 732. COVERAGE OF THE SHINGLES VACCINE UNDER 10 THE MEDICARE PROGRAM. 11 (a) IN GENERAL.—Section 1861 of the Social Secu- 12 rity Act (42 U.S.C. 1395x) is amended— 13 (1) in subsection (s)(10)(A), by inserting ‘‘, 14 shingles vaccine and its administration,’’ before 15 ‘‘and, subject to’’; and 16 (2) in subsection (ww)(2)(A), by inserting 17 ‘‘shingles,’’ after ‘‘Pneumococcal,’’. 18 (b) EFFECTIVE DATE.—The amendments made by 19 subsection (a) shall apply to shingles vaccine furnished on 20 or after January 1 of the first calendar year beginning 21 more than 60 days after the date of the enactment of this 22 Act. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 415 •S 2474 IS SEC. 733. CDC WISEWOMAN SCREENING PROGRAM. 1 Section 1509 of the Public Health Service Act (42 2 U.S.C. 300n–4a) is amended— 3 (1) in subsection (a)— 4 (A) by striking the heading and inserting 5 ‘‘IN GENERAL.—’’; and 6 (B) in the matter preceding paragraph (1), 7 by striking ‘‘may make grants’’ and all that fol- 8 lows through ‘‘purpose’’ and inserting the fol- 9 lowing: ‘‘may make grants to such States for 10 the purpose’’; and 11 (2) in subsection (d)(1), by striking ‘‘there are 12 authorized’’ and all that follows through the period 13 and inserting ‘‘there are authorized to be appro- 14 priated $23,000,000 for fiscal year 2012, 15 $25,300,000 for fiscal year 2013, $27,800,000 for 16 fiscal year 2014, $30,800,000 for fiscal year 2015, 17 and $34,000,000 for fiscal year 2016.’’. 18 SEC. 734. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 19 AND MINORITIES. 20 Part P of title III of the Public Health Service Act 21 (42 U.S.C. 280g et seq.) is amended by adding at the end 22 the following: 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 416 •S 2474 IS ‘‘SEC. 399V–7. REPORT ON CARDIOVASCULAR CARE FOR 1 WOMEN AND MINORITIES. 2 ‘‘Not later than September 30, 2014, and annually 3 thereafter, the Secretary shall prepare and submit to the 4 Congress a report on the quality of and access to care 5 for women and minorities with heart disease, stroke, and 6 other cardiovascular diseases. The report shall contain rec- 7 ommendations for eliminating disparities in, and improv- 8 ing the treatment of, heart disease, stroke, and other car- 9 diovascular diseases in women, racial and ethnic minori- 10 ties, those for whom English is not their primary lan- 11 guage, and individuals with disabilities.’’. 12 SEC. 735. COVERAGE OF COMPREHENSIVE TOBACCO CES- 13 SATION SERVICES IN MEDICAID. 14 (a) REQUIRING COVERAGE OF COUNSELING AND 15 PHARMACOTHERAPY FOR CESSATION OF TOBACCO 16 USE.—Section 1905 of the Social Security Act (42 U.S.C. 17 1396d) is amended— 18 (1) in subsection (a)(4), by striking ‘‘by preg- 19 nant women’’; and 20 (2) in subsection (bb)— 21 (A) by striking ‘‘by pregnant women’’ each 22 place it appears; 23 (B) in paragraph (1), in the matter before 24 subparagraph (A), by inserting ‘‘by individuals’’ 25 before ‘‘who use tobacco’’; and 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 417 •S 2474 IS (C) in paragraph (2)(A), by striking ‘‘with 1 respect to pregnant women’’. 2 (b) EXCEPTION FROM OPTIONAL RESTRICTION 3 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 4 Section 1927(d)(2)(F) of the Social Security Act (42 5 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 6 case of pregnant women’’. 7 (c) REMOVAL OF COST SHARING FOR COUNSELING 8 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 9 USE.— 10 (1) GENERAL COST SHARING LIMITATIONS.— 11 Section 1916 of the Social Security Act (42 U.S.C. 12 1396o) is amended— 13 (A) in subsections (a)(2)(B) and (b)(2)(B), 14 by striking ‘‘, and counseling and 15 pharmacotherapy for cessation of tobacco use 16 by pregnant women (as defined in section 17 1905(bb)) and covered outpatient drugs (as de- 18 fined in subsection (k)(2) of section 1927 and 19 including nonprescription drugs described in 20 subsection (d)(2) of such section) that are pre- 21 scribed for purposes of promoting, and when 22 used to promote, tobacco cessation by pregnant 23 women in accordance with the Guideline re- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 418 •S 2474 IS ferred to in section 1905(bb)(2)(A)’’ each place 1 it appears; and 2 (B) in each of subsections (a)(2)(D) and 3 (b)(2)(D) by inserting ‘‘and counseling and 4 pharmacotherapy for cessation of tobacco use 5 (as defined in section 1905(bb)) and covered 6 outpatient drugs (as defined in subsection 7 (k)(2) of section 1927 and including non- 8 prescription drugs described in subsection 9 (d)(2) of such section) that are prescribed for 10 purposes of promoting, and when used to pro- 11 mote, tobacco cessation in accordance with the 12 Guideline referred to in section 13 1905(bb)(2)(A),’’ after ‘‘section 14 1905(a)(4)(C),’’. 15 (2) APPLICATION TO ALTERNATIVE COST-SHAR- 16 ING.—Section 1916A(b)(3)(B) of such Act (42 17 U.S.C. 1396o–1(b)(3)(B)) is amended— 18 (A) in clause (iii), by striking ‘‘, and coun- 19 seling and pharmacotherapy for cessation of to- 20 bacco use by pregnant women (as defined in 21 section 1905(bb))’’; and 22 (B) by adding at the end the following: 23 ‘‘(xi) Counseling and 24 pharmacotherapy for cessation of tobacco 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 419 •S 2474 IS use (as defined in section 1905(bb)) and 1 covered outpatient drugs (as defined in 2 subsection (k)(2) of section 1927 and in- 3 cluding nonprescription drugs described in 4 subsection (d)(2) of such section) that are 5 prescribed for purposes of promoting, and 6 when used to promote, tobacco cessation in 7 accordance with the Guideline referred to 8 in section 1905(bb)(2)(A).’’. 9 (d) EFFECTIVE DATE.—The amendments made by 10 this section shall take effect on October 1, 2012. 11 SEC. 736. CLINICAL RESEARCH FUNDING FOR ORAL 12 HEALTH. 13 (a) IN GENERAL.—The Secretary of Health and 14 Human Services shall expand and intensify the conduct 15 and support of the research activities of the National In- 16 stitutes of Health and the National Institute of Dental 17 and Craniofacial Research to improve the oral health of 18 the population through the prevention and management 19 of oral diseases and conditions. 20 (b) INCLUDED RESEARCH ACTIVITIES.—Research 21 activities under subsection (a) shall include— 22 (1) comparative effectiveness research and clin- 23 ical disease management research addressing early 24 childhood caries and oral cancer; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 420 •S 2474 IS (2) awarding of grants and contracts to support 1 the training and development of health services re- 2 searchers, comparative effectiveness researchers, and 3 clinical researchers whose research improves the oral 4 health of the population. 5 SEC. 737. PARTICIPATION BY MEDICAID BENEFICIARIES IN 6 APPROVED CLINICAL TRIALS. 7 (a) IN GENERAL.—Title XIX of the Social Security 8 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 9 section 1943 the following new section: 10 ‘‘PARTICIPATION IN AN APPROVED CLINICAL TRIAL 11 ‘‘SEC. 1944. (a) COVERAGE OF ROUTINE PATIENT 12 COSTS ASSOCIATED WITH APPROVED CLINICAL 13 TRIALS.— 14 ‘‘(1) INCLUSION.—Subject to paragraph (2), 15 routine patient costs shall include all items and serv- 16 ices consistent with the medical assistance provided 17 under the State plan that would otherwise be pro- 18 vided to the individual under such State plan if such 19 individual was not enrolled in the approved clinical 20 trial, including any items or services related to the 21 prevention, detection, and treatment of any medical 22 complications that arise as a result of participation 23 in the approved clinical trial. 24 ‘‘(2) EXCLUSION.—For purposes of paragraph 25 (1), routine patient costs does not include— 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 421 •S 2474 IS ‘‘(A) the investigational item, device, or 1 service itself; 2 ‘‘(B) items and services that are provided 3 solely to satisfy data collection and analysis 4 needs and that are not used in the direct clin- 5 ical management of the patient; or 6 ‘‘(C) a service that is clearly inconsistent 7 with widely accepted and established standards 8 of care for a particular diagnosis. 9 ‘‘(3) INFORMATION CONCERNING CLINICAL 10 TRIALS.— 11 ‘‘(A) IN GENERAL.—Subject to subpara- 12 graph (B), the Secretary, in consultation with 13 relevant stakeholders, shall develop a single 14 standardized electronic form for use by the indi- 15 vidual or the referring health care provider to 16 submit to the State agency administering the 17 State plan in order to verify that the clinical 18 trial meets the conditions established for an ap- 19 proved clinical trial (as defined in subsection 20 (c)). 21 ‘‘(B) EXCLUDED INFORMATION.—For pur- 22 poses of subparagraph (A) or any such request 23 by the State agency for information regarding 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 422 •S 2474 IS a clinical trial, an individual or referring health 1 care provider shall not be required to submit— 2 ‘‘(i) the clinical protocol document for 3 the clinical trial; or 4 ‘‘(ii) subject to subparagraph (C), any 5 additional information other than such in- 6 formation as is required pursuant to the 7 form described in subparagraph (A). 8 ‘‘(C) OPTIONAL INFORMATION.—For pur- 9 poses of subparagraphs (A) and (B)(ii), the 10 form may include a requirement that the refer- 11 ring health care provider attest that the indi- 12 vidual is eligible to participate in the clinical 13 trial pursuant to the trial protocol and that 14 their participation in such trial would be appro- 15 priate. 16 ‘‘(D) REVIEW OF INFORMATION.— 17 ‘‘(i) IN GENERAL.—A State plan 18 under this title shall establish a process for 19 timely review by the State agency of the 20 form and information submitted pursuant 21 to subparagraph (A) and, not later than 22 48 hours after receipt of such form, con- 23 firmation that the information provided in 24 such form satisfies the requirements estab- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 423 •S 2474 IS lished under such subparagraph, with such 1 process to include establishment and oper- 2 ation of a 24-hour toll-free telephone num- 3 ber and e-mail address to provide for expe- 4 dited communication. 5 ‘‘(ii) FAILURE TO RESPOND.—If an 6 individual or the referring health care pro- 7 vider does not receive a response or re- 8 quest for additional information from the 9 State agency following the 48-hour period 10 described in clause (i), the information 11 provided in the form may be presumed to 12 satisfy the requirements established under 13 this paragraph. 14 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 15 PROVED CLINICAL TRIALS.— 16 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 17 For purposes of participation in an approved clinical 18 trial by an individual eligible for medical assistance 19 under this title, the State agency administering the 20 State plan shall make reasonable efforts to ensure 21 that the individual is provided with access to a pro- 22 vider who is— 23 ‘‘(A) participating in the approved clinical 24 trial; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 424 •S 2474 IS ‘‘(B) located not more than 25 miles from 1 the residence of the individual (or, if no such 2 provider is available, as close as possible to the 3 residence of the individual); and 4 ‘‘(C) a participating provider under the 5 State plan or has been deemed to be a partici- 6 pating provider under the State plan for pur- 7 poses of providing medical assistance to the in- 8 dividual during their participation in the ap- 9 proved clinical trial. 10 ‘‘(2) INFORMATIONAL MATERIALS.—The State 11 agency administering the plan approved under this 12 title shall develop informational materials and pro- 13 grams to encourage participating providers to make 14 appropriate referrals to physicians and other appro- 15 priate health care professionals who can provide in- 16 dividuals with access to approved clinical trials. 17 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 18 The term ‘approved clinical trial’ has the same meaning 19 as provided under section 2709(d) of the Public Health 20 Service Act.’’. 21 (b) CONFORMING AMENDMENTS.—Section 1902(a) 22 of such Act (42 U.S.C. 1396a(a)) is amended— 23 (1) in paragraph (82)(C), by striking ‘‘and’’ at 24 the end; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 425 •S 2474 IS (2) in paragraph (83), by striking the period at 1 the end and inserting ‘‘; and’’; and 2 (3) by inserting after paragraph (83) the fol- 3 lowing: 4 ‘‘(84) provide that participation in an approved 5 clinical trial and coverage of routine patient costs 6 associated with such trial for an individual eligible 7 for medical assistance under this title is conducted 8 in accordance with the requirements under section 9 1944.’’. 10 (c) EFFECTIVE DATE.— 11 (1) IN GENERAL.—Except as provided in para- 12 graph (2), the amendments made by this section 13 shall apply to calendar quarters beginning on or 14 after October 1, 2012. 15 (2) DELAY PERMITTED FOR STATE PLAN 16 AMENDMENT.—In the case of a State plan for med- 17 ical assistance under title XIX of the Social Security 18 Act which the Secretary of Health and Human Serv- 19 ices determines requires State legislation (other than 20 legislation appropriating funds) in order for the plan 21 to meet the additional requirements imposed by the 22 amendments made by this section, the State plan 23 shall not be regarded as failing to comply with the 24 requirements of such title solely on the basis of its 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 426 •S 2474 IS failure to meet these additional requirements before 1 the first day of the first calendar quarter beginning 2 after the close of the first regular session of the 3 State legislature that begins after the date of enact- 4 ment of this Act. For purposes of the previous sen- 5 tence, in the case of a State that has a 2-year legis- 6 lative session, each year of such session shall be 7 deemed to be a separate regular session of the State 8 legislature. 9 Subtitle E—HIV/AIDS 10 SEC. 741. FINDINGS. 11 The Congress finds the following: 12 (1) Over one million people are estimated to be 13 living with HIV in the United States according to 14 the Centers for Disease Control and Prevention. 15 (2) Annually there are over 17,000 deaths in 16 people with an HIV diagnoses in 40 States and 5 17 dependent areas of the United States. 18 (3) The Centers for Disease Control and Pre- 19 vention estimates that in 2009 there were approxi- 20 mately 48,100 people newly infected with HIV. 21 Though this number seems to be staying relatively 22 stable, the number of new infections is rapidly in- 23 creasing among certain populations especially among 24 young African-American men who have sex with men 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 427 •S 2474 IS who had an overall 48 percent increase in new infec- 1 tions from 2006 to 2009. 2 (4) HIV disproportionately affects certain popu- 3 lations in the United States. Though African-Ameri- 4 cans represent less than 13 percent of the popu- 5 lation, African-Americans account for almost half 6 (46 percent) of all people living with HIV in the 7 United States. Men who have sex with men (MSM) 8 make up approximately 2 percent of the population, 9 but account for over half (53 percent) of individuals 10 living with HIV and are the only risk group in which 11 HIV infections continue to increase. 12 (5) Disparities exist among Latinos; they make 13 up 15 percent of US population and 17 percent of 14 new infections (2006). 15 (6) Though American Indians/Alaska Natives 16 represent less than 1 percent of the total number of 17 HIV/AIDS cases, American Indians and Alaska Na- 18 tives rank third in rates of HIV/AIDS diagnosis, 19 after African-Americans and Latinos. 20 (7) While Asian-Americans, Native Hawaiians, 21 and Pacific Islanders HIV/AIDS cases account for 22 approximately 1 percent of cases nationally, Asian 23 Americans and Pacific Islanders were the only ra- 24 cial/ethnic groups with a statistically significant in- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 428 •S 2474 IS crease in new HIV diagnoses between 2001 and 1 2008. 2 (8) The limited data available on transgender 3 individuals point to a disproportionate burden of 4 HIV infection. 5 (9) Stigma and discrimination contribute to 6 these disparities. 7 (10) For HIV, early detection and treatment 8 can have huge effects. New research suggests that 9 treatment of individuals not only slows disease pro- 10 gression, but can also greatly reduce the risk of 11 transmission to other individuals. 12 (11) To combat the HIV epidemic in the United 13 States, the National HIV/AIDS Strategy (NHAS) 14 from the White House Office of National AIDS Pol- 15 icy provides a framework of increasing access to 16 care, reducing new infections, and eliminating HIV- 17 related health disparities. The vision of NHAS is 18 ‘‘The United States will become a place where new 19 HIV infections are rare and when they do occur, 20 every person, regardless of age, gender, race/eth- 21 nicity, sexual orientation, gender identity, or socio- 22 economic circumstance, will have unfettered access 23 to high quality, life extending care, free from stigma 24 and discrimination.’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 429 •S 2474 IS (12) Although the cost of education, treatment 1 and care, and research are not inconsequential, they 2 are substantially less than the annual health care 3 cost attributable to HIV in the United States. The 4 lifetime cost of HIV care and treatment in 2004 was 5 estimated to be $405,000 to $648,000 dollars annu- 6 ally. Preventing 40,000 new infections in the United 7 States each year would save $12.8 billion annually. 8 SEC. 742. ADDRESSING HIV/AIDS IN COMMUNITIES OF 9 COLOR. 10 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 11 of the Congress that national observance days highlighting 12 the impact of HIV/AIDS on communities of color include 13 the following: 14 (1) National Black HIV/AIDS Awareness Day. 15 (2) National Latino AIDS Awareness Day. 16 (3) National Asian and Pacific Islander HIV/ 17 AIDS Awareness Day. 18 (4) National Native HIV/AIDS Awareness Day. 19 (5) Caribbean American HIV/AIDS Awareness 20 Day. 21 (b) CALL TO ACTION.—It is the sense of the Con- 22 gress that the President should call on members of com- 23 munities of color— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 430 •S 2474 IS (1) to become involved at the local community 1 level in HIV/AIDS testing, policy, and advocacy; 2 (2) to become aware, engaged, and empowered 3 on the HIV/AIDS epidemic within their commu- 4 nities; and 5 (3) to urge members of their communities to re- 6 duce risk factors, practice safe sex and other preven- 7 tive measures, be tested for HIV/AIDS, and seek 8 care when appropriate. 9 SEC. 743. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI- 10 NORITY COMMUNITIES. 11 (a) EXPANDED FUNDING.—The Secretary, in col- 12 laboration with the Deputy Assistant Secretary for Minor- 13 ity Health, the Director of the Centers for Disease Control 14 and Prevention, the Administrator of the Health Re- 15 sources and Services Administration, and the Adminis- 16 trator of the Substance Abuse and Mental Health Services 17 Administration, shall provide funds and carry out activi- 18 ties to expand the Minority HIV/AIDS Initiative. 19 (b) USE OF FUNDS.—The additional funds made 20 available under this section may be used, through the Mi- 21 nority AIDS Initiative, to support the following activities: 22 (1) Providing technical assistance and infra- 23 structure support to reduce HIV/AIDS in minority 24 populations. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 431 •S 2474 IS (2) Increasing minority populations’ access to 1 HIV/AIDS prevention and care services. 2 (3) Building strong community programs and 3 partnerships to address HIV prevention and the 4 health care needs of specific racial and ethnic minor- 5 ity populations. 6 (c) PRIORITY INTERVENTIONS.—Within the racial 7 and ethnic minority populations referred to in subsection 8 (b), priority in conducting intervention services shall be 9 given to— 10 (1) women; 11 (2) youth; 12 (3) men who have sex with men; 13 (4) persons who engage in intravenous drug 14 abuse; 15 (5) homeless individuals; and 16 (6) individuals incarcerated or in the penal sys- 17 tem. 18 SEC. 744. REPEALING INEFFECTIVE AND INCOMPLETE AB- 19 STINENCE-ONLY EDUCATION PROGRAM. 20 (a) IN GENERAL.—Title V of the Social Security Act 21 (42 U.S.C. 701 et seq.) is amended by striking section 22 510. 23 (b) RESCISSION.—Amounts appropriated for each of 24 fiscal years 2010 and 2011 under section 510(d) of the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 432 •S 2474 IS Social Security Act (42 U.S.C. 710(d)) (as in effect on 1 the day before the date of enactment of this Act) that are 2 unobligated as of the date of enactment of this Act are 3 rescinded. 4 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY 5 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION 6 PROGRAM (PREP).—Section 513(f) of the Social Security 7 Act (42 U.S.C. 713(f)) is amended by striking ‘‘for each 8 of fiscal years 2010 through 2014’’ and inserting ‘‘for fis- 9 cal year 2010, $75,000,000 increased by an amount equal 10 to the unobligated portion of funds appropriated for each 11 of fiscal years 2010 and 2011 under section 510(d) that 12 are rescinded under subsection (b), and $125,000,000 for 13 each of fiscal years 2012 through 2014’’. 14 SEC. 745. DENTAL EDUCATION LOAN REPAYMENT PRO- 15 GRAM. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services may enter into an agreement with any 18 dentist under which— 19 (1) the dentist agrees to serve as a dentist for 20 a period of not less than 2 years at a facility with 21 a critical shortage of dentists (as determined by the 22 Secretary) in an area with a high incidence of HIV/ 23 AIDS; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 433 •S 2474 IS (2) the Secretary agrees to make payments in 1 accordance with subsection (b) on the dental edu- 2 cation loans of the dentist. 3 (b) MANNER OF PAYMENTS.—The payments de- 4 scribed in subsection (a) shall be made by the Secretary 5 as follows: 6 (1) Upon completion by the dentist for whom 7 the payments are to be made of the first year of the 8 service specified in the agreement entered into with 9 the Secretary under subsection (a), the Secretary 10 shall pay 30 percent of the principal of and the in- 11 terest on the dental education loans of the dentist. 12 (2) Upon completion by the dentist of the sec- 13 ond year of such service, the Secretary shall pay an- 14 other 30 percent of the principal of and the interest 15 on such loans. 16 (3) Upon completion by that individual of a 17 third year of such service, the Secretary shall pay 18 another 25 percent of the principal of and the inter- 19 est on such loans. 20 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 21 provisions of subpart III of part D of title III of the Public 22 Health Service Act (42 U.S.C. 254l et seq.) shall, except 23 as inconsistent with this section, apply to the program car- 24 ried out under this section in the same manner and to 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 434 •S 2474 IS the same extent as such provisions apply to the National 1 Health Service Corps Loan Repayment Program. 2 (d) REPORTS.—Not later than 18 months after the 3 date of the enactment of this Act, and annually thereafter, 4 the Secretary shall prepare and submit to the Congress 5 a report describing the program carried out under this sec- 6 tion, including statements regarding the following: 7 (1) The number of dentists enrolled in the pro- 8 gram. 9 (2) The number and amount of loan repay- 10 ments. 11 (3) The placement location of loan repayment 12 recipients at facilities described in subsection (a)(1). 13 (4) The default rate and actions required. 14 (5) The amount of outstanding default funds. 15 (6) To the extent that it can be determined, the 16 reason for the default. 17 (7) The demographics of individuals partici- 18 pating in the program. 19 (8) An evaluation of the overall costs and bene- 20 fits of the program. 21 (e) DEFINITIONS.—In this section: 22 (1) The term ‘‘dental education loan’’— 23 (A) means a loan that is incurred for the 24 cost of attendance (including tuition, other rea- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 435 •S 2474 IS sonable educational expenses, and reasonable 1 living costs) at a school of dentistry; and 2 (B) includes only the portion of the loan 3 that is outstanding on the date the dentist in- 4 volved begins the service specified in the agree- 5 ment under subsection (a). 6 (2) The term ‘‘dentist’’ means a graduate of a 7 school of dentistry who has completed postgraduate 8 training in general or pediatric dentistry. 9 (3) The term ‘‘HIV/AIDS’’ means human im- 10 munodeficiency virus and acquired immune defi- 11 ciency syndrome. 12 (4) The term ‘‘school of dentistry’’ has the 13 meaning given to that term in section 799B of the 14 Public Health Service Act (42 U.S.C. 295p). 15 (5) The term ‘‘Secretary’’ means the Secretary 16 of Health and Human Services. 17 SEC. 746. REPORT ON THE IMPLEMENTATION OF THE NA- 18 TIONAL HIV/AIDS STRATEGY. 19 (a) REPORT REQUIRED.—Not later than 6 months 20 after the date of the enactment of this Act, the President, 21 in consultation with the heads of all relevant agencies in- 22 cluding the Department of Education, the Department of 23 Health and Human Services, the Department of Housing 24 and Urban Development, the Department of Justice, the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 436 •S 2474 IS Department of Labor, the Department of Veterans Af- 1 fairs, and the Social Security Administration, shall trans- 2 mit to the Congress and make publicly available a report 3 on the status of the implementation of the National HIV/ 4 AIDS Strategy. 5 (b) CONTENTS.—The report required by subsection 6 (a) shall include a description, analysis, and evaluation 7 of— 8 (1) key steps taken by the Federal Government 9 towards the achievement of the goals of the National 10 HIV/AIDS Strategy, including the goals of— 11 (A) reducing the number of people who be- 12 come infected with HIV; 13 (B) increasing access to care and opti- 14 mizing health outcomes for people living with 15 HIV; and 16 (C) reducing HIV-related health dispari- 17 ties; 18 (2) the extent to which the National HIV/AIDS 19 Strategy has improved coordination of efforts to 20 maximize the effective delivery of HIV/AIDS preven- 21 tion, care, and treatment services at the community 22 level, including coordination— 23 (A) within and among Federal agencies 24 and departments; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 437 •S 2474 IS (B) between the Federal Government and 1 State and local governments and health depart- 2 ments; 3 (C) between the Federal Government and 4 nonprofit foundations and civil society organiza- 5 tions, including community- and faith-based or- 6 ganizations focused on addressing the issue of 7 HIV/AIDS; and 8 (D) between the Federal Government and 9 private businesses; 10 (3) efforts by the Federal Government to edu- 11 cate, involve, and establish and strengthen partner- 12 ships with civil society organizations, including 13 community- and faith-based organizations, in order 14 to implement the National HIV/AIDS Strategy and 15 achieve its goals; 16 (4) how Federal resources are being deployed to 17 implement the Strategy, including— 18 (A) the amount of funding used to date, by 19 each Federal agency and department, to imple- 20 ment the National HIV/AIDS Strategy; 21 (B) a brief summary for each Federal 22 agency and department of the number and 23 function of all Federal employees assisting in 24 implementing the Strategy; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 438 •S 2474 IS (C) an estimate of the amount of funding 1 necessary to implement the National HIV/AIDS 2 Strategy, by each Federal agency and depart- 3 ment, for the next fiscal year; and 4 (5) what additional steps, if any, are necessary 5 to fully implement the National HIV/AIDS Strategy, 6 including— 7 (A) whether any existing statutory laws, 8 policies, or regulations are impeding the imple- 9 mentation of the National HIV/AIDS Strategy, 10 at the Federal, State, or local level, and wheth- 11 er any changes to such laws, policies, or regula- 12 tions are necessary or recommended; and 13 (B) whether any Federal agencies or de- 14 partments require additional statutory authority 15 to effectively carry out their duties as part of 16 the National HIV/AIDS Strategy. 17 (c) USE OF PREVIOUSLY APPROPRIATED FUNDS.— 18 Funding for the report required under subsection (a) shall 19 derive from discretionary funds of the departments and 20 agencies specified in such subsection. 21 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 439 •S 2474 IS SEC. 747. ADDRESSING HIV/AIDS IN THE AFRICAN-AMER- 1 ICAN COMMUNITY. 2 (a) SENSE OF CONGRESS ON NATIONAL BLACK 3 CLERGY HIV/AIDS AWARENESS SUNDAY.—It is the 4 sense of Congress that— 5 (1) there should be established a National 6 Black Clergy HIV/AIDS Awareness Sunday on 7 which the Congress and the President call on mem- 8 bers of the Black clergy— 9 (A) to become involved at the local commu- 10 nity level in HIV/AIDS testing, policy, and ad- 11 vocacy; 12 (B) to discuss the HIV/AIDS epidemic 13 with their congregations and the community at- 14 large; and 15 (C) to urge members of their congregations 16 to reduce risk factors, practice safe sex and 17 other preventive measures, be tested for HIV/ 18 AIDS, and seek care when appropriate; and 19 (2) an appropriate Sunday should be selected 20 for this occasion. 21 (b) SENSE OF CONGRESS ON FEDERAL AGENCIES 22 WITH RESPONSIBILITY FOR PREVENTING, TESTING FOR, 23 AND TREATING HIV/AIDS.—It is the sense of Congress 24 that all Federal agencies with a responsibility for pre- 25 venting, testing for, and treating HIV/AIDS should— 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 440 •S 2474 IS (1) adopt policies for prevention, testing, and 1 treatment that are consistent with the guidelines 2 issued in 2006 by the Centers for Disease Control 3 and Prevention, entitled ‘‘Revised Recommendations 4 for HIV Testing of Adults, Adolescents, and Preg- 5 nant Women in Health-Care Settings’’; and 6 (2) begin a systemic, aggressive approach to im- 7 plementing voluntary, routine testing as part of all 8 health exams, including in emergency rooms, clinics, 9 and private physician offices. 10 (c) SENSE OF CONGRESS ON FEDERAL BUREAU OF 11 PRISONS PROCEDURES FOR INMATES WITH HIV.—It is 12 the sense of Congress that the Federal Bureau of Prisons 13 should implement procedures for— 14 (1) voluntary HIV testing as a routine compo- 15 nent of inmate care; and 16 (2) referral to care as a routine component of 17 release planning for inmates with HIV/AIDS, includ- 18 ing referral to community-based care and faith-based 19 institutions. 20 SEC. 748. NATIONAL BLACK CLERGY FOR THE ELIMI- 21 NATION OF HIV/AIDS. 22 (a) SHORT TITLE.—This section may be cited as the 23 ‘‘National Black Clergy for the Elimination of HIV/AIDS 24 Act of 2012’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 441 •S 2474 IS (b) FINDINGS.—Congress finds the following: 1 (1) It has been estimated that more than 2 1,200,000 people in the United States are living 3 with HIV/AIDS, and approximately 500,000 of them 4 are Black. Blacks are 8 times more likely to have 5 AIDS than their White counterparts. Within the 6 Black community, the subpopulation most dispropor- 7 tionately impacted by HIV/AIDS is Black men who 8 have sex with men (MSM) with prevalence rates 9 twice those of White MSM. Black women account 10 for the majority of new AIDS cases among women 11 and are 23 times more likely to be living with AIDS 12 than White women and 4 times more likely than 13 Latinas. 14 (2) On October 7–8, 2007, 186 Black clergy, 15 consisting of Baptist, COGIC, Methodist, Protes- 16 tant, AME, and Pentecostal, together with, medical, 17 policy, and AIDS leaders, were brought together by 18 the National Black Leadership Commission on 19 AIDS (NBLCA), the oldest and largest Black AIDS 20 organization of its kind in America, hosted by Time 21 Warner, Inc., with other foundation support, to par- 22 ticipate in the National Black Clergy Conclave On 23 HIV/AIDS Policy. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 442 •S 2474 IS (3) The attendees included faith leaders across 1 traditional, mega, and activist churches representing 2 millions of congregants: the National Medical Asso- 3 ciation (NMA) representing 30,000 African-Amer- 4 ican physicians; the National Conference of Black 5 Mayors; the National Caucus of Black State Legisla- 6 tors; and the Health Brain Trust of the Congres- 7 sional Black Caucus and key African-American HIV/ 8 AIDS advocates from across the United States. This 9 group developed a plan of action that has become 10 the National Black Clergy for the Elimination of 11 HIV/AIDS Act of 2012 to respond to the ‘‘on the 12 ground’’ emergency in prevention, care, and treat- 13 ment for AIDS in Black America. 14 (4) In August 2007, the NMA, the oldest and 15 largest organization representing 30,000 African- 16 American physicians, released a consensus report en- 17 titled ‘‘Addressing The HIV/AIDS Crisis In The Af- 18 rican American Community: Fact, Fiction and Pol- 19 icy’’; and specifically called on the next President of 20 the United States to declare HIV/AIDS in African- 21 American communities a public health emergency 22 and worked with NBLCA to organize clergy to advo- 23 cate for the specific needs of Black physicians, their 24 patients, and those at risk in African-American com- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 443 •S 2474 IS munities; and have pledged to advocate and work 1 with clergy to develop, execute, and implement these 2 initiatives as a part of their rightful role of leader- 3 ship in African-American communities and culture. 4 (5) The National Conference of Black Mayors 5 has pledged to work with clergy, medical, and com- 6 munity leaders to develop and support these initia- 7 tives on a local level and to help them to continue 8 to develop a policy agenda leading to the elimination 9 of HIV/AIDS. 10 (6) The National Caucus of Black State Legis- 11 lators pledged to take the initiatives herein to their 12 body and develop plans of action for Black State 13 Legislators to work with local clergy, health depart- 14 ments, and CBOs to adopt and implement these ini- 15 tiatives on a national level. 16 (7) At their April 2008 annual meeting, the 17 National Policy Alliance (NPA), consisting of the 18 Joint Center For Political and Economic Studies 19 (secretariat) and the National Black Caucus of 20 School Board Members, National Black Caucus of 21 Local Elected Officials; the Judicial Council of the 22 National Bar Association; the National Association 23 of Black County Officials; Blacks in Government 24 and the CBC; NCBM; WCM, voted unanimously to 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 444 •S 2474 IS support, endorse, and encourage the passage of the 1 National Black Clergy for the Elimination of HIV/ 2 AIDS Act of 2012 and to organize their respective 3 members to endorse and support the passage of this 4 bill. 5 (8) The World Conference of Black Mayors has 6 ratified its support of these initiatives and legisla- 7 tion, and pledged to assist the clergy to take them 8 internationally. 9 (9) The National Black Leadership Commission 10 on AIDS, the Balm in Gilead, and the Black AIDS 11 Institute have been recognized by the clergy for their 12 tradition and history of service and will work with 13 clergy to conduct community and policy develop- 14 ment, linkages to local departments of health and 15 other services, infrastructure development, education 16 media, and fund development activities. 17 (10) Bishop T.D. Jakes of the Potters House 18 in Dallas, Texas, and Rev. Calvin O. Butts of the 19 Abyssinian Baptist Church in Harlem, New York, 20 and chairman of the National Black Leadership 21 Commission on AIDS have been recognized as the 22 organizers of this group and will help guide and lead 23 the development efforts of fellow clergy through this 24 process. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 445 •S 2474 IS (11) The National Conclave on HIV/AIDS for 1 Black Clergy calls upon the President, Congress, 2 and corporate America to declare the HIV/AIDS cri- 3 sis in the African-American community a ‘‘public 4 health emergency’’. 5 (12) The Black clergy will aggressively seek to 6 have every person under the sphere of their influence 7 tested for HIV in order to know the person’s status. 8 (13) The Black clergy will promote HIV/AIDS 9 awareness to ensure that all Black clergy serving in 10 their denominations and other congregations are 11 equipped to address issues related to this disease in 12 a factual and scientifically sound manner. 13 (14) The Black clergy will use the ABC/D 14 model as a behavioral guideline for prevention initia- 15 tives: 16 (A) A–Abstain. 17 (B) B–Be Faithful. 18 (C) C–Use Condoms. 19 (D) D–Don’t Engage in Risky Behaviors. 20 (c) DEFINITIONS APPLICABLE THROUGHOUT SEC- 21 TION.—In this section— 22 (1) the terms ‘‘HIV’’ and ‘‘HIV/AIDS’’ have 23 the meanings given to such terms in section 2689 of 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 446 •S 2474 IS the Public Health Service Act (42 U.S.C. 300ff–88); 1 and 2 (2) the term ‘‘Secretary’’ means the Secretary 3 of Health and Human Services. 4 (d) SERVICES TO REDUCE HIV/AIDS IN THE AFRI- 5 CAN-AMERICAN COMMUNITY.—For the purpose of reduc- 6 ing HIV/AIDS in the African-American community, the 7 Secretary, acting through the Deputy Assistant Secretary 8 for Minority Health, may make grants to public health 9 agencies and faith-based organizations to conduct— 10 (1) outreach activities related to HIV/AIDS 11 prevention and testing activities; 12 (2) HIV/AIDS prevention activities; and 13 (3) HIV/AIDS testing activities. 14 (e) GRANTS FOR SUBSTANCE ABUSE AND MENTAL 15 HEALTH SERVICES TO PUBLIC HEALTH AGENCIES AND 16 FAITH-BASED ORGANIZATIONS.—The Secretary, acting 17 through the Administrator of the Substance Abuse and 18 Mental Health Services Administration, may make grants 19 to public health agencies and faith-based organizations 20 to— 21 (1) conduct HIV/AIDS and sexually trans- 22 mitted disease outreach, prevention, and testing ac- 23 tivities that are targeted to the African-American 24 community; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 447 •S 2474 IS (2) in connection with such activities, provide 1 substance abuse testing and mental health services 2 to members of such community. 3 (f) SERVICES FOR HIV/AIDS AFFECTED YOUTH 4 WHO ARE SEPARATED FROM THEIR FAMILIES.—The 5 Secretary, acting through the Administrator of the Sub- 6 stance Abuse and Mental Health Services Administration, 7 may make grants to faith- and community-based organiza- 8 tions to provide family reunification services, mental 9 health counseling, HIV/AIDS and sexually transmitted 10 disease testing, and substance abuse testing and treatment 11 to youth who— 12 (1)(A) have run away from home; 13 (B) are homeless; or 14 (C) reside in a detention center or foster care; 15 and 16 (2) are HIV positive or at risk for HIV/AIDS, 17 including young men who have sex with men. 18 (g) PUBLIC HEALTH INTERVENTION AND PREVEN- 19 TION ACTIVITIES.— 20 (1) IN GENERAL.—For the purpose of reducing 21 HIV/AIDS, sexually transmitted diseases, tuber- 22 culosis, and viral hepatitis in African-American com- 23 munities, the Secretary, acting through the Director 24 of the Centers for Disease Control and Prevention, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 448 •S 2474 IS may make grants to faith-based organizations for 1 public health intervention and prevention activities, 2 including the use of rapid testing in traditional and 3 nontraditional settings to increase the number of in- 4 dividuals who know their status at the point of care 5 and are put into treatment. 6 (2) PARTNERSHIPS.—In carrying out this sub- 7 section, the Secretary shall encourage grantees to 8 enter into partnerships with public health agencies. 9 (h) HIV/AIDS PREVENTION AND EDUCATION.— 10 (1) PREVENTION ACTIVITIES.—The Secretary, 11 acting through the Director of the Centers for Dis- 12 ease Control and Prevention, shall expand and inten- 13 sify HIV/AIDS prevention activities in African- 14 American communities. Such activities— 15 (A) shall be targeted to specific popu- 16 lations; 17 (B) shall be comprehensive and accurately 18 based on science and research; and 19 (C) shall include information on absti- 20 nence, the proper use of condoms, risks associ- 21 ated with unprotected sex, and the value of sex- 22 ual delay particularly among young adolescents 23 and teenagers. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 449 •S 2474 IS (2) EDUCATION.—The Secretary, acting 1 through the Director of the Centers for Disease 2 Control and Prevention, shall expand and intensify 3 HIV/AIDS educational activities targeting Black 4 women, youth, and men who have sex with men. 5 (3) COORDINATION.—The Secretary shall carry 6 out this subsection in coordination with public 7 schools of all levels, Black organizations, historically 8 Black colleges and universities, and faith-based or- 9 ganizations and institutions. 10 (i) BUILDING CAPACITY OF COMMUNITIES.— 11 (1) IN GENERAL.—The Secretary, acting 12 through the Director of the Centers for Disease 13 Control and Prevention, shall expand funding to eli- 14 gible entities to build the capacity of African-Amer- 15 ican communities to respond to HIV/AIDS. 16 (2) EMPHASIS.—In carrying out this sub- 17 section, the Secretary shall emphasize the provision 18 of funding for policy development, education, tech- 19 nical assistance, and training— 20 (A) to national and local faith-based orga- 21 nizations; and 22 (B) to organizations with a significant his- 23 tory of working within the African-American 24 community on HIV/AIDS issues, an inter- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 450 •S 2474 IS denominational center of seminaries specializing 1 in the training of African-American clergy, and 2 historically Black colleges and universities. 3 (3) DEFINITION.—In this subsection, the term 4 ‘‘eligible entity’’ means a national or community- 5 based organization with a history and tradition of 6 service to African-American communities. 7 (j) NATIONAL MEDIA OUTREACH CAMPAIGN.— 8 (1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall implement a national 11 media outreach campaign that urges all sexually ac- 12 tive individuals to be tested for and know their HIV/ 13 AIDS status. 14 (2) REQUIREMENTS.—The national media out- 15 reach campaign under this subsection shall— 16 (A) be science-driven and targeted to Afri- 17 can-American men, women, and youth; and 18 (B) give special emphasis to Black women 19 and men who have sex with men. 20 (3) COORDINATION; CONSULTATION.—The Sec- 21 retary shall carry out this subsection— 22 (A) in coordination with Black media out- 23 lets for print, electronic, and Web-based media 24 and Black media associations, including the Na- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 451 •S 2474 IS tional Association of Black Owned Broadcasters 1 and the National Newspaper Publishers Asso- 2 ciation; and 3 (B) in consultation with an advisory board 4 including representatives of the National Med- 5 ical Association, faith leaders, elected and ap- 6 pointed officials, social marketing experts, and 7 business and community stakeholders. 8 (k) RESEARCH TO DEVELOP BEHAVIORAL STRATE- 9 GIES TO REDUCE TRANSMISSION OF HIV/AIDS.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Director of the National Institutes of 12 Health, may conduct or support culturally competent 13 research to develop evidence-based behavioral strate- 14 gies to reduce the transmission of HIV/AIDS within 15 the African-American community. 16 (2) PRIORITY.—In carrying out this subsection, 17 the Secretary shall prioritize research that focuses 18 on populations within the African-American commu- 19 nity that are at increased risk for HIV/AIDS, in- 20 cluding— 21 (A) men who have sex with men; and 22 (B) women. 23 (l) STUDY OF BIOLOGICAL AND BEHAVIORAL FAC- 24 TORS.—The Secretary, acting through the Director of the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 452 •S 2474 IS National Institute on Minority Health and Health Dis- 1 parities, may make grants for— 2 (1) the study of biological and behavioral fac- 3 tors that lead to increased HIV/AIDS prevalence in 4 the African-American community, to be conducted 5 by researchers with a history and tradition of service 6 to Black communities; and 7 (2) behavioral and structural network research 8 and interventions, in collaboration with other insti- 9 tutes and centers of the National Institutes of 10 Health, indigenous faith and national and commu- 11 nity-based organizations with a history and tradition 12 of conducting such research for Black communities, 13 with a special emphasis on Black women and Black 14 men who have sex with men. 15 (m) HEALTH CARE PROFESSIONALS TREATING INDI- 16 VIDUALS WITH HIV/AIDS.—Part E of title VII of the 17 Public Health Service Act (42 U.S.C. 294n et seq.) is 18 amended by adding at the end the following: 19 ‘‘Subpart 4—Health Care Professionals Treating 20 Individuals With HIV/AIDS 21 ‘‘SEC. 781. BETTER CARE FOR INDIVIDUALS WITH HIV/AIDS. 22 ‘‘(a) IN GENERAL.—The Secretary, acting through 23 the Administrator of the Health Resources and Services 24 Administration and in consultation with the African- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 453 •S 2474 IS American church community, may award grants for any 1 of the following: 2 ‘‘(1) Development of curricula for training pri- 3 mary care providers in HIV/AIDS prevention and 4 care. 5 ‘‘(2) Training health care professionals with ex- 6 pertise in HIV/AIDS to provide care to individuals 7 with HIV/AIDS. 8 ‘‘(3) Development by grant recipients under 9 title XXVI and other persons of policies for pro- 10 viding culturally relevant and sensitive treatment to 11 individuals with HIV/AIDS, with particular empha- 12 sis on treatment to African-Americans and children 13 with HIV/AIDS. 14 ‘‘(4) Development and implementation of pro- 15 grams to increase the use of telemedicine to respond 16 to HIV/AIDS-specific health care needs in rural and 17 minority communities, with particular emphasis 18 given to medically underserved communities and the 19 southern States. 20 ‘‘(5) Creation of faith- and community-based 21 certification programs for providers in HIV/AIDS 22 care and support services. 23 ‘‘(6) Establishment of comfort care centers that 24 provide mental, emotional, and psychosocial coun- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 454 •S 2474 IS seling for people with HIV/AIDS and implement ad- 1 ditional protocols to be carried out in the centers 2 that address the needs of children and young adults 3 who are infected with the disease and are 4 transitioning from childhood to adulthood. 5 ‘‘(7) Incentive payments to health care pro- 6 viders supported by the Health Resources and Serv- 7 ices Administration to implement HIV/AIDS testing 8 consistent with the guidelines issued in 2006 by the 9 Centers for Disease Control and Prevention entitled 10 ‘Revised Recommendations for HIV Testing of 11 Adults, Adolescents, and Pregnant Women in 12 Health-Care Settings’. 13 ‘‘(b) DEFINITIONS.—In this section— 14 ‘‘(1) the term ‘HIV/AIDS’ has the meaning 15 given to such term in section 2689; and 16 ‘‘(2) the term ‘primary care’ includes obstetrical 17 and gynecological care and psychiatric and mental 18 health care.’’. 19 (n) REPORT ON IMPACT OF HIV/AIDS IN THE AFRI- 20 CAN-AMERICAN COMMUNITY.— 21 (1) IN GENERAL.—The Secretary shall submit 22 to Congress and the President an annual report on 23 the impact of HIV/AIDS in the African-American 24 community. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 455 •S 2474 IS (2) CONTENTS.—The report under subsection 1 (a) shall include information on the— 2 (A) progress that has been made in reduc- 3 ing the impact of HIV/AIDS in such commu- 4 nity; 5 (B) opportunities that exist to make addi- 6 tional progress in reducing the impact of HIV/ 7 AIDS in such community; 8 (C) challenges that may impede such addi- 9 tional progress; and 10 (D) Federal funding necessary to achieve 11 substantial reductions in HIV/AIDS in the Afri- 12 can-American community. 13 SEC. 749. REDUCING THE SPREAD OF SEXUALLY TRANS- 14 MITTED INFECTIONS IN CORRECTIONAL FA- 15 CILITIES. 16 (a) SHORT TITLE.—This section may be cited as the 17 ‘‘Justice for the Unprotected Against Sexually Trans- 18 mitted Infections among the Confined and Exposed Act’’ 19 or the ‘‘JUSTICE Act’’. 20 (b) FINDINGS.—The Congress makes the following 21 findings: 22 (1) According to the Bureau of Justice Statis- 23 tics (BJS), 2,292,133 persons were incarcerated in 24 the United States as of the end of 2009. Between 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 456 •S 2474 IS 1998 and 2008, the number of persons incarcerated 1 in Federal or State correctional facilities increased 2 by an average of 2.4 percent per year. One in every 3 32 United States residents was on probation, in jail 4 or prison, or on parole at the end of 2009. 5 (2) As of 2009, 66.8 percent of incarcerated 6 persons were racial or ethnic minorities. Based on 7 current incarceration rates, BJS estimates that Afri- 8 can-American males are 6 times more likely to be 9 held in custody than White males, while Hispanic 10 males are a little more than 2 times more likely to 11 be held in custody. Across all age categories, Afri- 12 can-American males were incarcerated at higher 13 rates than Hispanic or White males. 14 (3) There is a disproportionately high rate of 15 HIV/AIDS among incarcerated persons, especially 16 among minorities. Approximately 25 percent of the 17 HIV-positive population of the United States passes 18 through correctional facilities each year. BJS has 19 determined that the rate of confirmed AIDS cases is 20 2.4 times higher among incarcerated persons than in 21 the general population. Minorities account for the 22 majority of AIDS-related deaths among incarcerated 23 persons, with African-American incarcerated persons 24 2.8 times more likely than White incarcerated per- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 457 •S 2474 IS sons and 1.4 times more likely than Hispanic incar- 1 cerated persons to die from AIDS-related causes. 2 Nearly two-thirds of AIDS-related deaths are among 3 Black, non-Hispanic males. 4 (4) Studies suggest that other sexually trans- 5 mitted infections (STIs), such as gonorrhea, 6 chlamydia, syphilis, genital herpes, viral hepatitis, 7 and human papillomavirus, also exist at a higher 8 rate among incarcerated persons than in the general 9 population. For instance, researchers have estimated 10 that the rate of hepatitis C (HCV) infection among 11 incarcerated persons is somewhere between 8 and 20 12 times higher than that of the general population. 13 (5) Correctional facilities lack a uniform system 14 of STI testing and reporting. Establishing a uniform 15 data collection system would assist in developing and 16 targeting counseling and treatment programs for in- 17 carcerated persons. Better developed and targeted 18 programs may reduce the spread of STIs. 19 (6) Although Congress has acted to reduce the 20 spread of sexual violence in correctional facilities by 21 enacting the National Prison Rape Elimination Act 22 (PREA) of 2003, BJS reported that approximately 23 4.4 percent of incarcerated persons in prisons and 24 3.1 percent of persons in jail reported experiencing 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 458 •S 2474 IS one or more incidents of sexual victimization by an- 1 other incarcerated person or correctional facility 2 staff in the previous year. 3 (7) Approximately 95 percent of all incarcer- 4 ated persons eventually return to society. According 5 to one study, every year approximately 100,000 per- 6 sons infected with both HIV and HCV are released 7 from correctional facilities. These individuals com- 8 prise approximately 50 percent of all persons with 9 both infections in the United States. 10 (8) According to the Centers for Disease Con- 11 trol and Prevention (CDC), latex condoms, when 12 used consistently and correctly, are highly effective 13 in preventing the transmission of HIV. Latex 14 condoms also reduce the risk of other STIs. Despite 15 the effectiveness of condoms in reducing the spread 16 of STIs, the Bureau of Prisons does not recommend 17 their use in correctional facilities. 18 (9) The distribution of condoms in correctional 19 facilities is currently legal in certain parts of the 20 United States and the world. The States of Vermont 21 and Mississippi and the District of Columbia allow 22 condom distribution programs in their correctional 23 facilities. The cities of New York, San Francisco, 24 Los Angeles, Washington DC, and Philadelphia also 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 459 •S 2474 IS allow condom distribution in their correctional facili- 1 ties. However, these States and cities operate fewer 2 than 1 percent of all correctional facilities. 3 (10) A 2007 report by the Massachusetts Gen- 4 eral Hospital Division of Infectious Diseases and the 5 University of California, San Francisco, found that 6 the proportion of European prison systems allowing 7 condoms rose from 53 percent in 1989 to 81 percent 8 in 1997. The same report also found that no prison 9 system allowing the distribution of condoms had re- 10 versed their decision, and no prison system reported 11 an increase in sexual activity among incarcerated 12 persons as a result of a decision to allow condom 13 distribution. 14 (11) In 2000 and 2001, researchers surveyed 15 300 incarcerated persons and 100 correctional offi- 16 cers at the Central Detention Facility, a correctional 17 facility operated by the District of Columbia at 18 which condoms are available. Researchers found that 19 both incarcerated persons and correctional officers 20 generally supported the condom distribution pro- 21 gram and considered it to be important. Further- 22 more, the researchers determined that the program 23 had not caused any major security infractions. In 24 Canada, the Expert Committee on AIDS and Pris- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 460 •S 2474 IS ons surveyed more than 400 correctional officers in 1 the Federal prison system of Canada in 1995 and 2 reported that 82 percent of those responding indi- 3 cated that the availability of condoms had created no 4 problems at their facility. 5 (12) The American Public Health Association, 6 the United Nations Joint Program on HIV/AIDS, 7 and the World Health Organization have endorsed 8 the effectiveness of condom distribution programs in 9 correctional facilities. 10 (13) Many correctional facilities in the United 11 States do not provide comprehensive testing and 12 treatment programs to reduce the spread of STIs. 13 According to BJS surveys from 2005, only 996 of 14 the 1,821 Federal and State correctional facilities 15 (i.e. 54.7 percent) provided HIV/AIDS counseling 16 programs. 17 (14) Individuals who are enrolled in Medicaid 18 prior to incarceration face a suspension of their ben- 19 efits upon incarceration, and in some States a termi- 20 nation of their Medicaid eligibility. The Federal Gov- 21 ernment encourages States to automatically re-enroll 22 incarcerated persons on Medicaid upon their release 23 from a correctional facility, unless the State reaches 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 461 •S 2474 IS a determination that the individual is no longer eligi- 1 ble for reasons other than their prior incarceration. 2 (15) Formerly incarcerated individuals who are 3 newly released from correctional facilities often face 4 delays in the resumption of their Medicaid benefits 5 which may exacerbate any health issues which they 6 face. 7 (16) Incarcerated individuals living with HIV/ 8 AIDS who are eligible for Medicaid would benefit 9 from prompt and automatic enrollment upon their 10 release in order to ensure their continued ability to 11 access health services, including antiretroviral treat- 12 ment. 13 (c) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 14 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 15 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 16 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 17 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 18 later than 30 days after the date of enactment of 19 this Act, the Attorney General shall direct the Bu- 20 reau of Prisons to allow community organizations to 21 distribute sexual barrier protection devices and to 22 engage in STI counseling and STI prevention edu- 23 cation in Federal correctional facilities. These activi- 24 ties shall be subject to all relevant Federal laws and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 462 •S 2474 IS regulations which govern visitation in correctional 1 facilities. 2 (2) INFORMATION REQUIREMENT.—Any com- 3 munity organization permitted to distribute sexual 4 barrier protection devices under paragraph (1) must 5 ensure that the persons to whom the devices are dis- 6 tributed are informed about the proper use and dis- 7 posal of sexual barrier protection devices in accord- 8 ance with established public health practices. Any 9 community organization conducting STI counseling 10 or STI prevention education under paragraph (1) 11 must offer comprehensive sexuality education. 12 (3) POSSESSION OF DEVICE PROTECTED.—No 13 Federal correctional facility may, because of the pos- 14 session or use of a sexual barrier protection device— 15 (A) take adverse action against an incar- 16 cerated person; or 17 (B) consider possession or use as evidence 18 of prohibited activity for the purpose of any 19 Federal correctional facility administrative pro- 20 ceeding. 21 (4) IMPLEMENTATION.—The Attorney General 22 and Bureau of Prisons shall implement this section 23 according to established public health practices in a 24 manner that protects the health, safety, and privacy 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 463 •S 2474 IS of incarcerated persons and of correctional facility 1 staff. 2 (d) SENSE OF CONGRESS REGARDING DISTRIBUTION 3 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 4 PRISON SYSTEMS.—It is the sense of Congress that States 5 should allow for the legal distribution of sexual barrier 6 protection devices in State correctional facilities to reduce 7 the prevalence and spread of STIs in those facilities. 8 (e) AUTOMATIC REINSTATEMENT OF MEDICAID BEN- 9 EFITS.— 10 (1) IN GENERAL.—Section 1902(e) of the So- 11 cial Security Act (42 U.S.C. 1396a(e)) is amended 12 by adding at the end the following: 13 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 14 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 15 STATEMENT.— 16 ‘‘(i) IN GENERAL.—The State plan 17 shall provide for the automatic enrollment 18 or reinstatement of enrollment of an eligi- 19 ble individual if— 20 ‘‘(I) such individual is scheduled 21 to be released from a public institu- 22 tion due to the completion of sen- 23 tence, not less than 30 days prior to 24 the scheduled date of the release; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 464 •S 2474 IS ‘‘(II) such individual is to be re- 1 leased from a public institution on pa- 2 role or on probation, as soon as pos- 3 sible after the date on which the de- 4 termination to release such individual 5 was made, and before the date such 6 individual is released. 7 ‘‘(ii) EXCEPTION.—If a State makes a 8 determination that an individual is not eli- 9 gible to be enrolled under the State plan— 10 ‘‘(I) on or before the date by 11 which the individual would be enrolled 12 under clause (i), such clause shall not 13 apply to such individual; or 14 ‘‘(II) after such date, the State 15 may terminate the enrollment of such 16 individual. 17 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 18 PAYMENT FOR SERVICES.— 19 ‘‘(i) IN GENERAL.—Subject to sub- 20 paragraph (A)(ii), an eligible individual 21 who is enrolled, or whose enrollment is re- 22 instated under subparagraph (A), shall be 23 eligible for medical assistance that is pro- 24 vided after the date that the eligible indi- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 465 •S 2474 IS vidual is released from the public institu- 1 tion 2 ‘‘(ii) RELATIONSHIP TO PAYMENT 3 PROHIBITION FOR INMATES.—No provision 4 of this paragraph may be construed to per- 5 mit payment for care or services for which 6 payment is excluded under the subpara- 7 graph (A), following paragraph (29), of 8 section 1905(a). 9 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 10 BILITY.— 11 ‘‘(i) SUSPENSION FOR INMATES.—Any 12 period of continuous eligibility under this 13 title shall be suspended on the date an in- 14 dividual enrolled under this title becomes 15 an inmate of a public institution (except as 16 a patient of a medical institution). 17 ‘‘(ii) DETERMINATION OF REMAINING 18 PERIOD.—Notwithstanding any changes to 19 State law related to continuous eligibility 20 during the time that an individual is an in- 21 mate of a public institution (except as a 22 patient of a medical institution), subject to 23 clause (iii), with respect to an eligible indi- 24 vidual who was subject to a suspension 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 466 •S 2474 IS under subclause (I), on the date that such 1 individual is released from a public institu- 2 tion the suspension of continuous eligibility 3 under such subclause shall be lifted for a 4 period that is equal to the time remaining 5 in the period of continuous eligibility for 6 such individual on the date that such pe- 7 riod was suspended under such subclause. 8 ‘‘(iii) EXCEPTION.—If a State makes 9 a determination that an individual is not 10 eligible to be enrolled under the State 11 plan— 12 ‘‘(I) on or before the date that 13 the suspension of continuous eligibility 14 is lifted under clause (ii), such clause 15 shall not apply to such individual; or 16 ‘‘(II) after such date, the State 17 may terminate the enrollment of such 18 individual. 19 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 20 STATEMENT OF ENROLLMENT DEFINED.—For 21 purposes of this paragraph, the term ‘automatic 22 enrollment or reinstatement of enrollment’ 23 means that the State determines eligibility for 24 medical assistance under the State plan without 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 467 •S 2474 IS a program application from, or on behalf of, the 1 eligible individual, but an individual can only be 2 automatically enrolled in the State Medicaid 3 plan if the individual affirmatively consents to 4 being enrolled through affirmation in writing, 5 by telephone, orally, through electronic signa- 6 ture, or through any other means specified by 7 the Secretary. 8 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 9 For purposes of this paragraph, the term ‘eligi- 10 ble individual’ means an individual who is an 11 inmate of a public institution (except as a pa- 12 tient in a medical institution)— 13 ‘‘(i) who was enrolled under the State 14 plan for medical assistance immediately be- 15 fore becoming an inmate of such an insti- 16 tution; or 17 ‘‘(ii) is diagnosed with human im- 18 munodeficiency virus.’’. 19 (2) SUPPLEMENTAL FUNDING FOR STATE IM- 20 PLEMENTATION OF AUTOMATIC REINSTATEMENT OF 21 MEDICAID BENEFITS.— 22 (A) IN GENERAL.—Subject to paragraph 23 (6), for each State for which the Secretary of 24 Health and Human Services has approved an 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 468 •S 2474 IS application under paragraph (3), the Federal 1 matching payments (including payments based 2 on the Federal medical assistance percentage) 3 made to such State under section 1903 of the 4 Social Security Act (42 U.S.C. 1396b) shall be 5 increased by 5.0 percentage points for pay- 6 ments to the State for the activities permitted 7 under paragraph (2) for a period of one year. 8 (B) USE OF FUNDS.—A State may only 9 use increased matching payments authorized 10 under paragraph (1)— 11 (i) to strengthen the State’s enroll- 12 ment and administrative resources for the 13 purpose of improving processes for enroll- 14 ing (or reinstating the enrollment of) eligi- 15 ble individuals (as such term is defined in 16 section 1902(e)(15)(E) of the Social Secu- 17 rity Act); and 18 (ii) for medical assistance (as such 19 term is defined in section 1905(a) of the 20 Social Security Act) provided to such eligi- 21 ble individuals. 22 (C) APPLICATION AND AGREEMENT.—The 23 Secretary may only make payments to a State 24 in the increased amount if— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 469 •S 2474 IS (i) the State has amended the State 1 plan under section 1902 of the Social Se- 2 curity Act to incorporate the requirements 3 of subsection (e)(15) of such section; 4 (ii) the State has submitted an appli- 5 cation to the Secretary that includes a plan 6 for implementing the requirements of sec- 7 tion 1902(e)(15) of the Social Security Act 8 under the State’s amended State plan be- 9 fore the end of the 90-day period begin- 10 ning on the date that the State receives in- 11 creased matching payments under para- 12 graph (1); 13 (iii) the State’s application meets the 14 satisfaction of the Secretary; and 15 (iv) the State enters an agreement 16 with the Secretary that states that— 17 (I) the State will only use the in- 18 creased matching funds for the uses 19 permitted under paragraph (2); and 20 (II) at the end of the period 21 under paragraph (1), the State will 22 submit to the Secretary, and make 23 publicly available, a report that con- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 470 •S 2474 IS tains the information required under 1 paragraph (4). 2 (D) REQUIRED REPORT INFORMATION.— 3 The information that is required in the report 4 under paragraph (3)(D)(ii) includes— 5 (i) the results of an evaluation of the 6 impact of the implementation of the re- 7 quirements of section 1902(e)(15) of the 8 Social Security Act on improving the 9 State’s processes for enrolling of individ- 10 uals who are released for public institu- 11 tions into the Medicaid program; 12 (ii) the number of individuals who 13 were automatically enrolled (or whose en- 14 rollment is reinstated) under such section 15 1902(e)(15) during the period under para- 16 graph (1); and 17 (iii) any other information that is re- 18 quired by the Secretary. 19 (E) INCREASE IN CAP ON MEDICAID PAY- 20 MENTS TO TERRITORIES.—Subject to para- 21 graph (6), the amounts otherwise determined 22 for Puerto Rico, the United States Virgin Is- 23 lands, Guam, the Commonwealth of the North- 24 ern Mariana Islands, and American Samoa 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 471 •S 2474 IS under subsections (f) and (g) of section 1108 of 1 the Social Security Act (42 U.S.C. 1308) shall 2 each be increased by the necessary amount to 3 allow for the increase in the Federal matching 4 payments under paragraph (1), but only for the 5 period under such paragraph for such State. In 6 the case of such an increase for a territory, sub- 7 section (a)(1) of such section 1108 shall be ap- 8 plied without regard to any increase in payment 9 made to the territory under part E of title IV 10 of such Act that is attributable to the increase 11 in Federal medical assistance percentage ef- 12 fected under paragraph (1) for the territory. 13 (F) LIMITATIONS.— 14 (i) TIMING.—With respect to a State, 15 at the end of the period under paragraph 16 (1), no increased matching payments may 17 be made to such State under this sub- 18 section. 19 (ii) MAINTENANCE OF ELIGIBILITY.— 20 (I) IN GENERAL.—Subject to 21 clause (ii), a State is not eligible for 22 an increase in its Federal matching 23 payments under paragraph (1), or an 24 increase in a cap amount under para- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 472 •S 2474 IS graph (5), if eligibility standards, 1 methodologies, or procedures under its 2 State plan under title XIX of the So- 3 cial Security Act (including any waiv- 4 er under such title or under section 5 1115 of such Act (42 U.S.C. 1315)) 6 are more restrictive than the eligibility 7 standards, methodologies, or proce- 8 dures, respectively, under such plan 9 (or waiver) as in effect on the date of 10 enactment of this Act. 11 (II) STATE REINSTATEMENT OF 12 ELIGIBILITY PERMITTED.—A State 13 that has restricted eligibility stand- 14 ards, methodologies, or procedures 15 under its State plan under title XIX 16 of the Social Security Act (including 17 any waiver under such title or under 18 section 1115 of such Act (42 U.S.C. 19 1315)) after the date of enactment of 20 this Act, is no longer ineligible under 21 clause (i) beginning with the first cal- 22 endar quarter in which the State has 23 reinstated eligibility standards, meth- 24 odologies, or procedures that are no 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 473 •S 2474 IS more restrictive than the eligibility 1 standards, methodologies, or proce- 2 dures, respectively, under such plan 3 (or waiver) as in effect on such date. 4 (iii) NO WAIVER AUTHORITY.—The 5 Secretary may not waive the application of 6 this subsection under section 1115 of the 7 Social Security Act or otherwise. 8 (iv) LIMITATION OF MATCHING PAY- 9 MENTS TO 100 PERCENT.—In no case shall 10 an increase in Federal matching payments 11 under this subsection result in Federal 12 matching payments that exceed 100 per- 13 cent. 14 (3) EFFECTIVE DATE.— 15 (A) IN GENERAL.—Except as provided in 16 paragraph (2), the amendments made by sub- 17 section (a) shall take effect 180 days after the 18 date of the enactment of this Act and shall 19 apply to services furnished on or after such 20 date. 21 (B) RULE FOR CHANGES REQUIRING 22 STATE LEGISLATION.—In the case of a State 23 plan for medical assistance under title XIX of 24 the Social Security Act which the Secretary of 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 474 •S 2474 IS Health and Human Services determines re- 1 quires State legislation (other than legislation 2 appropriating funds) in order for the plan to 3 meet the additional requirement imposed by the 4 amendments made by this subsection, the State 5 plan shall not be regarded as failing to comply 6 with the requirements of such title solely on the 7 basis of its failure to meet this additional re- 8 quirement before the first day of the first cal- 9 endar quarter beginning after the close of the 10 first regular session of the State legislature that 11 begins after the date of the enactment of this 12 Act. For purposes of the previous sentence, in 13 the case of a State that has a 2-year legislative 14 session, each year of such session shall be 15 deemed to be a separate regular session of the 16 State legislature. 17 (f) SURVEY OF AND REPORT ON CORRECTIONAL FA- 18 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 19 STIS.— 20 (1) SURVEY.—The Attorney General, after con- 21 sulting with the Secretary of Health and Human 22 Services, State officials, and community organiza- 23 tions, shall, to the maximum extent practicable, con- 24 duct a survey of all Federal and State correctional 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 475 •S 2474 IS facilities, no later than 180 days after the date of 1 enactment of this Act and annually thereafter for 5 2 years, to determine the following: 3 (A) PREVENTION EDUCATION OFFERED.— 4 The type of prevention education, information, 5 or training offered to incarcerated persons and 6 correctional facility staff regarding sexual vio- 7 lence and the spread of STIs, including whether 8 such education, information, or training— 9 (i) constitutes comprehensive sexuality 10 education; 11 (ii) is compulsory for new incarcerated 12 persons and for new staff; and 13 (iii) is offered on an ongoing basis. 14 (B) ACCESS TO SEXUAL BARRIER PROTEC- 15 TION DEVICES.—Whether incarcerated persons 16 can— 17 (i) possess sexual barrier protection 18 devices; 19 (ii) purchase sexual barrier protection 20 devices; 21 (iii) purchase sexual barrier protection 22 devices at a reduced cost; and 23 (iv) obtain sexual barrier protection 24 devices without cost. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 476 •S 2474 IS (C) INCIDENCE OF SEXUAL VIOLENCE.— 1 The incidence of sexual violence and assault 2 committed by incarcerated persons and by cor- 3 rectional facility staff. 4 (D) COUNSELING, TREATMENT, AND SUP- 5 PORTIVE SERVICES.—Whether the correctional 6 facility requires incarcerated persons to partici- 7 pate in counseling, treatment, and supportive 8 services related to STIs, or whether it offers 9 such programs to incarcerated persons. 10 (E) STI TESTING.—Whether the correc- 11 tional facility tests incarcerated persons for 12 STIs or gives them the option to undergo such 13 testing— 14 (i) at intake; 15 (ii) on a regular basis; and 16 (iii) prior to release. 17 (F) STI TEST RESULTS.—The number of 18 incarcerated persons who are tested for STIs 19 and the outcome of such tests at each correc- 20 tional facility, disaggregated to include results 21 for— 22 (i) the type of sexually transmitted in- 23 fection tested for; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 477 •S 2474 IS (ii) the race and/or ethnicity of indi- 1 viduals tested; 2 (iii) the age of individuals tested; and 3 (iv) the gender of individuals tested. 4 (G) PRE-RELEASE REFERRAL POLICY.— 5 Whether incarcerated persons are informed 6 prior to release about STI-related services or 7 other health services in their communities, in- 8 cluding free and low-cost counseling and treat- 9 ment options. 10 (H) PRE-RELEASE REFERRALS MADE.— 11 The number of referrals to community-based 12 organizations or public health facilities offering 13 STI-related or other health services provided to 14 incarcerated persons prior to release, and the 15 type of counseling or treatment for which the 16 referral was made. 17 (I) REINSTATEMENT OF MEDICAID BENE- 18 FITS.—Whether the correctional facility assists 19 incarcerated persons that were enrolled in the 20 State Medicaid program prior to their incarcer- 21 ation, in reinstating their enrollment upon re- 22 lease and whether such individuals receive refer- 23 rals as provided by paragraph (8) to entities 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 478 •S 2474 IS that accept the State Medicaid program, includ- 1 ing if applicable— 2 (i) the number of such individuals, in- 3 cluding those diagnosed with the human 4 immunodeficiency virus, that have been re- 5 instated; 6 (ii) a list of obstacles to reinstating 7 enrollment or to making determinations of 8 eligibility for reinstatement, if any; and 9 (iii) the number of individuals denied 10 enrollment. 11 (J) OTHER ACTIONS TAKEN.—Whether the 12 correctional facility has taken any other action, 13 in conjunction with community organizations or 14 otherwise, to reduce the prevalence and spread 15 of STIs in that facility. 16 (2) PRIVACY.—In conducting the survey, the 17 Attorney General shall not request or retain the 18 identity of any person who has sought or been of- 19 fered counseling, treatment, testing, or prevention 20 education information regarding an STI (including 21 information about sexual barrier protection devices), 22 or who has tested positive for an STI. 23 (3) REPORT.—The Attorney General shall 24 transmit to Congress and make publicly available 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 479 •S 2474 IS the results of the survey required under paragraph 1 (1), both for the Nation as a whole and 2 disaggregated as to each State and each correctional 3 facility. To the maximum extent possible, the Attor- 4 ney General shall issue the first report no later than 5 1 year after the date of enactment of this Act and 6 shall issue reports annually thereafter for 5 years. 7 (g) STRATEGY.— 8 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 9 Attorney General, in consultation with the Secretary 10 of Health and Human Services, State officials, and 11 community organizations, shall develop and imple- 12 ment a 5-year strategy to reduce the prevalence and 13 spread of STIs in Federal and State correctional fa- 14 cilities. To the maximum extent possible, the strat- 15 egy shall be developed, transmitted to Congress, and 16 made publicly available no later than 180 days after 17 the transmission of the first report required under 18 subsection (h)(3). 19 (2) CONTENTS OF STRATEGY.—The strategy 20 shall include the following: 21 (A) PREVENTION EDUCATION.—A plan for 22 improving prevention education, information, 23 and training offered to incarcerated persons 24 and correctional facility staff, including infor- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 480 •S 2474 IS mation and training on sexual violence and the 1 spread of STIs, and comprehensive sexuality 2 education. 3 (B) SEXUAL BARRIER PROTECTION DEVICE 4 ACCESS.—A plan for expanding access to sexual 5 barrier protection devices in correctional facili- 6 ties. 7 (C) SEXUAL VIOLENCE REDUCTION.—A 8 plan for reducing the incidence of sexual vio- 9 lence among incarcerated persons and correc- 10 tional facility staff, developed in consultation 11 with the National Prison Rape Elimination 12 Commission. 13 (D) COUNSELING AND SUPPORTIVE SERV- 14 ICES.—A plan for expanding access to coun- 15 seling and supportive services related to STIs in 16 correctional facilities. 17 (E) TESTING.—A plan for testing incarcer- 18 ated persons for STIs during intake, during 19 regular health exams, and prior to release, and 20 that— 21 (i) is conducted in accordance with 22 guidelines established by the Centers for 23 Disease Control and Prevention; 24 (ii) includes pre-test counseling; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 481 •S 2474 IS (iii) requires that incarcerated persons 1 are notified of their option to decline test- 2 ing at any time; 3 (iv) requires that incarcerated persons 4 are confidentially notified of their test re- 5 sults in a timely manner; and 6 (v) ensures that incarcerated persons 7 testing positive for STIs receive post-test 8 counseling, care, treatment, and supportive 9 services. 10 (F) TREATMENT.—A plan for ensuring 11 that correctional facilities have the necessary 12 medicine and equipment to treat and monitor 13 STIs and for ensuring that incarcerated per- 14 sons living with or testing positive for STIs re- 15 ceive and have access to care and treatment 16 services. 17 (G) STRATEGIES FOR DEMOGRAPHIC 18 GROUPS.—A plan for developing and imple- 19 menting culturally appropriate, sensitive, and 20 specific strategies to reduce the spread of STIs 21 among demographic groups heavily impacted by 22 STIs. 23 (H) LINKAGES WITH COMMUNITIES AND 24 FACILITIES.—A plan for establishing and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 482 •S 2474 IS strengthening linkages to local communities and 1 health facilities that— 2 (i) provide counseling, testing, care, 3 and treatment services; 4 (ii) may receive persons recently re- 5 leased from incarceration who are living 6 with STIs; and 7 (iii) accept payment through the State 8 Medicaid program. 9 (I) ENROLLMENT IN STATE MEDICAID 10 PROGRAMS.—Plans to ensure that incarcerated 11 persons who were— 12 (i) enrolled in their State Medicaid 13 program prior to incarceration in a correc- 14 tional facility are automatically re-enrolled 15 in such program upon their release; and 16 (ii) not enrolled in their State Med- 17 icaid program prior to incarceration, but 18 who are diagnosed with the human im- 19 munodeficiency virus while incarcerated in 20 a correctional facility, are automatically 21 enrolled in such program upon their re- 22 lease. 23 (J) OTHER PLANS.—Any other plans de- 24 veloped by the Attorney General for reducing 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 483 •S 2474 IS the spread of STIs or improving the quality of 1 health care in correctional facilities. 2 (K) MONITORING SYSTEM.—A monitoring 3 system that establishes performance goals re- 4 lated to reducing the prevalence and spread of 5 STIs in correctional facilities and which, where 6 feasible, expresses such goals in quantifiable 7 form. 8 (L) MONITORING SYSTEM PERFORMANCE 9 INDICATORS.—Performance indicators that 10 measure or assess the achievement of the per- 11 formance goals described in subparagraph (I). 12 (M) COST ESTIMATE.—A detailed estimate 13 of the funding necessary to implement the 14 strategy at the Federal and State levels for all 15 5 years, including the amount of funds required 16 by community organizations to implement the 17 parts of the strategy in which they take part. 18 (3) REPORT.—The Attorney General shall 19 transmit to Congress and make publicly available an 20 annual progress report regarding the implementation 21 and effectiveness of the strategy described in sub- 22 section (a). The progress report shall include an 23 evaluation of the implementation of the strategy 24 using the monitoring system and performance indi- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 484 •S 2474 IS cators provided for in subparagraphs (I) and (J) of 1 paragraph (2). 2 (h) DEFINITIONS.—For the purposes of this section: 3 (1) COMMUNITY ORGANIZATION.—The term 4 ‘‘community organization’’ means a public health 5 care facility or a nonprofit organization which pro- 6 vides health- or STI-related services according to es- 7 tablished public health standards. 8 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 9 The term ‘‘comprehensive sexuality education’’ 10 means sexuality education that includes information 11 about abstinence and about the proper use and dis- 12 posal of sexual barrier protection devices and which 13 is— 14 (A) evidence-based; 15 (B) medically accurate; 16 (C) age and developmentally appropriate; 17 (D) gender and identity sensitive; 18 (E) culturally and linguistically appro- 19 priate; and 20 (F) structured to promote critical thinking, 21 self-esteem, respect for others, and the develop- 22 ment of healthy attitudes and relationships. 23 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 24 rectional facility’’ means any prison, penitentiary, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 485 •S 2474 IS adult detention facility, juvenile detention facility, 1 jail, or other facility to which persons may be sent 2 after conviction of a crime or act of juvenile delin- 3 quency within the United States. 4 (4) INCARCERATED PERSON.—The term ‘‘incar- 5 cerated person’’ means any person who is serving a 6 sentence in a correctional facility after conviction of 7 a crime. 8 (5) SEXUALLY TRANSMITTED INFECTION.—The 9 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 10 means any disease or infection that is commonly 11 transmitted through sexual activity, including HIV/ 12 AIDS, gonorrhea, chlamydia, syphilis, genital her- 13 pes, viral hepatitis, and human papillomavirus. 14 (6) SEXUAL BARRIER PROTECTION DEVICE.— 15 The term ‘‘sexual barrier protection device’’ means 16 any FDA-approved physical device which has not 17 been tampered with and which reduces the prob- 18 ability of STI transmission or infection between sex- 19 ual partners, including female condoms, male 20 condoms, and dental dams. 21 (7) STATE.—The term ‘‘State’’ includes the 22 District of Columbia, American Samoa, the Com- 23 monwealth of the Northern Mariana Islands, Guam, 24 Puerto Rico, and the United States Virgin Islands. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 486 •S 2474 IS SEC. 750. STOP AIDS IN PRISON. 1 (a) SHORT TITLE.—This section may be cited as the 2 ‘‘Stop AIDS in Prison Act of 2012’’. 3 (b) COMPREHENSIVE HIV/AIDS POLICY.— 4 (1) IN GENERAL.—The Bureau of Prisons 5 (hereinafter in this section referred to as the ‘‘Bu- 6 reau’’) shall develop a comprehensive policy to pro- 7 vide HIV testing, treatment, and prevention for in- 8 mates within the correctional setting and upon re- 9 entry. 10 (2) PURPOSE.—The purposes of such policy are 11 the following: 12 (A) To stop the spread of HIV/AIDS 13 among inmates. 14 (B) To protect prison guards and other 15 personnel from HIV/AIDS infection. 16 (C) To provide comprehensive medical 17 treatment to inmates who are living with HIV/ 18 AIDS. 19 (D) To promote HIV/AIDS awareness and 20 prevention among inmates. 21 (E) To encourage inmates to take personal 22 responsibility for their health. 23 (F) To reduce the risk that inmates will 24 transmit HIV/AIDS to other persons in the 25 community following their release from prison. 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 487 •S 2474 IS (3) CONSULTATION.—The Bureau shall consult 1 with appropriate officials of the Department of 2 Health and Human Services, the Office of National 3 Drug Control Policy, the Office of National AIDS 4 Policy, and the Centers for Disease Control regard- 5 ing the development of such policy. 6 (4) TIME LIMIT.—The Bureau shall draft ap- 7 propriate regulations to implement such policy not 8 later than 1 year after the date of the enactment of 9 this Act. 10 (c) REQUIREMENTS FOR POLICY.—The policy cre- 11 ated under subsection (b) shall provide for the following: 12 (1) TESTING AND COUNSELING UPON IN- 13 TAKE.— 14 (A)(i) Subject to clause (ii), health care 15 personnel shall provide routine HIV testing to 16 all inmates as a part of a comprehensive med- 17 ical examination immediately following admis- 18 sion to a facility. 19 (ii) Health care personnel shall not be re- 20 quired to provide routine HIV testing to an in- 21 mate who is transferred to a facility from an- 22 other facility if the inmate’s medical records are 23 transferred with the inmate and indicate that 24 the inmate has been tested previously. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 488 •S 2474 IS (B) To all inmates admitted to a facility 1 prior to the effective date of this policy, health 2 care personnel shall provide routine HIV testing 3 within no more than 6 months. HIV testing for 4 these inmates may be performed in conjunction 5 with other health services provided to these in- 6 mates by health care personnel. 7 (C) All HIV tests under this paragraph 8 shall comply with paragraph (9). 9 (2) PRE-TEST AND POST-TEST COUNSELING.— 10 Health care personnel shall provide confidential pre- 11 test and post-test counseling to all inmates who are 12 tested for HIV. Counseling may be included with 13 other general health counseling provided to inmates 14 by health care personnel. 15 (3) HIV/AIDS PREVENTION EDUCATION.— 16 (A) Health care personnel shall improve 17 HIV/AIDS awareness through frequent edu- 18 cational programs for all inmates. HIV/AIDS 19 educational programs may be provided by com- 20 munity based organizations, local health depart- 21 ments, and inmate peer educators. Such HIV/ 22 AIDS educational programs shall include infor- 23 mation on modes of transmission, including 24 transmission through tattooing, sexual contact, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 489 •S 2474 IS and intravenous drug use; prevention methods; 1 treatment; and disease progression. HIV/AIDS 2 educational programs shall be culturally sen- 3 sitive, conducted in a variety of languages, and 4 present scientifically accurate information in a 5 clear and understandable manner. 6 (B) HIV/AIDS educational materials shall 7 be made available to all inmates at orientation, 8 at health care clinics, at regular educational 9 programs, and prior to release. Both written 10 and audio-visual materials shall be made avail- 11 able to all inmates. These materials shall be 12 culturally sensitive, written for low literacy lev- 13 els, and available in a variety of languages. 14 (4) HIV TESTING UPON REQUEST.— 15 (A) Health care personnel shall allow in- 16 mates to obtain HIV tests upon request once 17 per year or whenever an inmate has a reason to 18 believe the inmate may have been exposed to 19 HIV. Health care personnel shall, both orally 20 and in writing, inform inmates, during orienta- 21 tion and periodically throughout incarceration, 22 of their right to obtain HIV tests. 23 (B) Health care personnel shall encourage 24 inmates to request HIV tests if the inmate is 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 490 •S 2474 IS sexually active, has been raped, uses intra- 1 venous drugs, receives a tattoo, or if the inmate 2 is concerned that the inmate may have been ex- 3 posed to HIV/AIDS. 4 (C) An inmate’s request for an HIV test 5 shall not be considered an indication that the 6 inmate has put himself or herself at risk of in- 7 fection or committed a violation of prison rules. 8 (5) HIV TESTING OF PREGNANT WOMAN.— 9 (A) Health care personnel shall provide 10 routine HIV testing to all inmates who become 11 pregnant. 12 (B) All HIV tests under this paragraph 13 shall comply with paragraph (9). 14 (6) COMPREHENSIVE TREATMENT.— 15 (A) Health care personnel shall provide all 16 inmates who test positive for HIV— 17 (i) timely, comprehensive medical 18 treatment; 19 (ii) confidential counseling on man- 20 aging their medical condition and pre- 21 venting its transmission to other persons; 22 and 23 (iii) voluntary partner notification 24 services. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 491 •S 2474 IS (B) Medical care provided under this para- 1 graph shall be consistent with current Depart- 2 ment of Health and Human Services guidelines 3 and standard medical practice. Health care per- 4 sonnel shall discuss treatment options, the im- 5 portance of adherence to antiretroviral therapy, 6 and the side effects of medications with inmates 7 receiving treatment. 8 (C) Health care personnel and pharmacy 9 personnel shall ensure that the facility for- 10 mulary contains all Food and Drug Administra- 11 tion-approved medications necessary to provide 12 comprehensive treatment for inmates living with 13 HIV/AIDS, and that the facility maintains ade- 14 quate supplies of such medications to meet in- 15 mates’ medical needs. Health care personnel 16 and pharmacy personnel shall also develop and 17 implement automatic renewal systems for these 18 medications to prevent interruptions in care. 19 (D) Correctional staff, health care per- 20 sonnel, and pharmacy personnel shall develop 21 and implement distribution procedures to en- 22 sure timely and confidential access to medica- 23 tions. 24 (7) PROTECTION OF CONFIDENTIALITY.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 492 •S 2474 IS (A) Health care personnel shall develop 1 and implement procedures to ensure the con- 2 fidentiality of inmate tests, diagnoses, and 3 treatment. Health care personnel and correc- 4 tional staff shall receive regular training on the 5 implementation of these procedures. Penalties 6 for violations of inmate confidentiality by health 7 care personnel or correctional staff shall be 8 specified and strictly enforced. 9 (B) HIV testing, counseling, and treat- 10 ment shall be provided in a confidential setting 11 where other routine health services are provided 12 and in a manner that allows the inmate to re- 13 quest and obtain these services as routine med- 14 ical services. 15 (8) TESTING, COUNSELING, AND REFERRAL 16 PRIOR TO REENTRY.— 17 (A)(i) Subject to clauses (ii) and (iii), 18 health care personnel shall provide routine HIV 19 testing to all inmates no more than 3 months 20 prior to their release and reentry into the com- 21 munity. 22 (ii) Inmates who are already known to be 23 infected shall not be required to be tested 24 again. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 493 •S 2474 IS (iii) The requirement under clause (i) may 1 be waived if an inmate’s release occurs without 2 sufficient notice to the Bureau to allow health 3 care personnel to perform a routine HIV test 4 and notify the inmate of the results. 5 (B) All HIV tests under this paragraph 6 shall comply with paragraph (9). 7 (C) To all inmates who test positive for 8 HIV and all inmates who already are known to 9 have HIV/AIDS, health care personnel shall 10 provide— 11 (i) confidential prerelease counseling 12 on managing their medical condition in the 13 community, accessing appropriate treat- 14 ment and services in the community, and 15 preventing the transmission of their condi- 16 tion to family members and other persons 17 in the community; 18 (ii) referrals to appropriate health 19 care providers and social service agencies 20 in the community that meet the inmate’s 21 individual needs, including voluntary part- 22 ner notification services and prevention 23 counseling services for people living with 24 HIV/AIDS; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 494 •S 2474 IS (iii) a 30-day supply of any medically 1 necessary medications the inmate is cur- 2 rently receiving. 3 (9) OPT-OUT PROVISION.—Inmates shall have 4 the right to refuse routine HIV testing. Inmates 5 shall be informed both orally and in writing of this 6 right. Oral and written disclosure of this right may 7 be included with other general health information 8 and counseling provided to inmates by health care 9 personnel. If an inmate refuses a routine test for 10 HIV, health care personnel shall make a note of the 11 inmate’s refusal in the inmate’s confidential medical 12 records. However, the inmate’s refusal shall not be 13 considered a violation of prison rules or result in dis- 14 ciplinary action. 15 (10) EXCLUSION OF TESTS PERFORMED UNDER 16 SECTION 4014(b) FROM THE DEFINITION OF ROU- 17 TINE HIV TESTING.—HIV testing of an inmate 18 under section 4014(b) of title 18, United States 19 Code, is not routine HIV testing for the purposes of 20 paragraph (9). Health care personnel shall document 21 the reason for testing under section 4014(b) of title 22 18, United States Code, in the inmate’s confidential 23 medical records. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 495 •S 2474 IS (11) TIMELY NOTIFICATION OF TEST RE- 1 SULTS.—Health care personnel shall provide timely 2 notification to inmates of the results of HIV tests. 3 (d) CHANGES IN EXISTING LAW.— 4 (1) SCREENING IN GENERAL.—Section 4014(a) 5 of title 18, United States Code, is amended— 6 (A) by striking ‘‘for a period of 6 months 7 or more’’; 8 (B) by striking ‘‘, as appropriate,’’; and 9 (C) by striking ‘‘if such individual is deter- 10 mined to be at risk for infection with such virus 11 in accordance with the guidelines issued by the 12 Bureau of Prisons relating to infectious disease 13 management’’ and inserting ‘‘unless the indi- 14 vidual declines. The Attorney General shall also 15 cause such individual to be so tested before re- 16 lease unless the individual declines.’’. 17 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 18 CIVIL AND CRIMINAL PROCEEDINGS.—Section 19 4014(d) of title 18, United States Code, is amended 20 by inserting ‘‘or under the Stop AIDS in Prison Act 21 of 2012’’ after ‘‘under this section’’. 22 (3) SCREENING AS PART OF ROUTINE SCREEN- 23 ING.—Section 4014(e) of title 18, United States 24 Code, is amended by adding at the end the fol- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 496 •S 2474 IS lowing: ‘‘Such rules shall also provide that the initial 1 test under this section be performed as part of the 2 routine health screening conducted at intake.’’. 3 (e) REPORTING REQUIREMENTS.— 4 (1) REPORT ON HEPATITIS AND OTHER DIS- 5 EASES.—Not later than 1 year after the date of the 6 enactment of this Act, the Bureau shall provide a re- 7 port to the Congress on Bureau policies and proce- 8 dures to provide testing, treatment, and prevention 9 education programs for hepatitis and other diseases 10 transmitted through sexual activity and intravenous 11 drug use. The Bureau shall consult with appropriate 12 officials of the Department of Health and Human 13 Services, the Office of National Drug Control Policy, 14 the Office of National AIDS Policy, and the Centers 15 for Disease Control and Prevention regarding the 16 development of this report. 17 (2) ANNUAL REPORTS.— 18 (A) GENERALLY.—Not later than 2 years 19 after the date of the enactment of this Act, and 20 then annually thereafter, the Bureau shall re- 21 port to Congress on the incidence among in- 22 mates of diseases transmitted through sexual 23 activity and intravenous drug use. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 497 •S 2474 IS (B) MATTERS PERTAINING TO VARIOUS 1 DISEASES.—Reports under subparagraph (A) 2 shall discuss— 3 (i) the incidence among inmates of 4 HIV/AIDS, hepatitis, and other diseases 5 transmitted through sexual activity and in- 6 travenous drug use; and 7 (ii) updates on Bureau testing, treat- 8 ment, and prevention education programs 9 for these diseases. 10 (C) MATTERS PERTAINING TO HIV/AIDS 11 ONLY.—Reports under subparagraph (A) shall 12 also include— 13 (i) the number of inmates who tested 14 positive for HIV upon intake; 15 (ii) the number of inmates who tested 16 positive prior to reentry; 17 (iii) the number of inmates who were 18 not tested prior to reentry because they 19 were released without sufficient notice; 20 (iv) the number of inmates who opted- 21 out of taking the test; 22 (v) the number of inmates who were 23 tested under section 4014(b) of title 18, 24 United States Code; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 498 •S 2474 IS (vi) the number of inmates under 1 treatment for HIV/AIDS. 2 (D) CONSULTATION.—The Bureau shall 3 consult with appropriate officials of the Depart- 4 ment of Health and Human Services, the Office 5 of National Drug Control Policy, the Office of 6 National AIDS Policy, and the Centers for Dis- 7 ease Control and Prevention regarding the de- 8 velopment of reports under subparagraph (A). 9 SEC. 751. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 10 ETHNIC MINORITY COMMUNITIES. 11 For the purpose of reducing HIV/AIDS in racial and 12 ethnic minority communities, the Secretary, acting 13 through the Deputy Assistant Secretary for Minority 14 Health, may make grants to public health agencies and 15 faith-based organizations to conduct— 16 (1) outreach activities related to HIV/AIDS 17 prevention and testing activities; 18 (2) HIV/AIDS prevention activities; and 19 (3) HIV/AIDS testing activities. 20 SEC. 752. HEALTH CARE PROFESSIONALS TREATING INDI- 21 VIDUALS WITH HIV/AIDS. 22 Part E of title VII of the Public Health Service Act 23 (42 U.S.C. 294n et seq.) is amended by adding at the end 24 the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 499 •S 2474 IS ‘‘Subpart 5—Health Care Professionals Treating 1 Individuals With HIV/AIDS 2 ‘‘SEC. 785. HEALTH CARE PROFESSIONALS TREATING INDI- 3 VIDUALS WITH HIV/AIDS. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Administrator of the Health Resources and Services 6 Administration and in consultation with racial and ethnic 7 minority community organizations, may award grants for 8 any of the following: 9 ‘‘(1) Development of curricula for training pri- 10 mary care providers in HIV/AIDS prevention and 11 care. 12 ‘‘(2) Training health care professionals with ex- 13 pertise in HIV/AIDS to provide care to individuals 14 with HIV/AIDS. 15 ‘‘(3) Development by grant recipients under 16 title XXVI and other persons of policies for pro- 17 viding culturally relevant and sensitive treatment to 18 individuals with HIV/AIDS, with particular empha- 19 sis on treatment to racial and ethnic minorities, men 20 who have sex with men, and women and children 21 with HIV/AIDS. 22 ‘‘(4) Development and implementation of pro- 23 grams to increase the use of telemedicine to respond 24 to HIV/AIDS-specific health care needs in rural and 25 minority communities, with particular emphasis 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 500 •S 2474 IS given to medically underserved communities and in- 1 sular areas. 2 ‘‘(5) Creation of faith- and community-based 3 certification programs for providers in HIV/AIDS 4 care and support services. 5 ‘‘(6) Establishment of comfort care centers that 6 provide mental, emotional, and psychosocial coun- 7 seling for people with HIV/AIDS and implement ad- 8 ditional protocols to be carried out in the centers 9 that address the needs of children and young adults 10 who are infected with the disease and are 11 transitioning from childhood to adulthood. 12 ‘‘(7) Incentive payments to health care pro- 13 viders supported by the Health Resources and Serv- 14 ices Administration to implement HIV/AIDS testing 15 consistent with the guidelines issued in 2006 by the 16 Centers for Disease Control and Prevention entitled 17 ‘Revised Recommendations for HIV Testing of 18 Adults, Adolescents, and Pregnant Women in 19 Health-Care Settings’. 20 ‘‘(b) DEFINITIONS.—In this section— 21 ‘‘(1) the term ‘HIV/AIDS’ has the meaning 22 given to such term in section 2689; and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 501 •S 2474 IS ‘‘(2) the term ‘primary care’ includes obstetrical 1 and gynecological care and psychiatric and mental 2 health care.’’. 3 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN RACIAL AND 4 ETHNIC MINORITY COMMUNITIES. 5 (a) IN GENERAL.—The Secretary shall submit to the 6 Congress and the President an annual report on the im- 7 pact of HIV/AIDS in racial and ethnic minority commu- 8 nities. 9 (b) CONTENTS.—The report under subsection (a) 10 shall include information on the— 11 (1) progress that has been made in reducing 12 the impact of HIV/AIDS in such communities; 13 (2) opportunities that exist to make additional 14 progress in reducing the impact of HIV/AIDS in 15 such communities; 16 (3) challenges that may impede such additional 17 progress; and 18 (4) Federal funding necessary to achieve sub- 19 stantial reductions in HIV/AIDS in racial and ethnic 20 minority communities. 21 SEC. 754. STUDY ON STATUS OF HIV/AIDS EPIDEMIC AMONG 22 AFRICAN-AMERICANS. 23 The Secretary shall— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 502 •S 2474 IS (1) seek to enter into an agreement with the In- 1 stitute of Medicine to document, in collaboration 2 with an academic organization which specializes in 3 the identification and reduction of health disparities 4 within the African-American community, all aspects 5 of the HIV/AIDS epidemic among African-Ameri- 6 cans, including the role that historical racial or eth- 7 nic barriers play in sustaining the epidemic among 8 African-Americans; 9 (2) submit a report to the President, the Direc- 10 tor of the Office of National AIDS Policy Coordina- 11 tion, the Director of the White House Domestic Pol- 12 icy Council, the Director of White House Office of 13 Faith-Based and Neighborhood Partnerships, key 14 Federal agencies, and the relevant committees of the 15 Congress on the status of the HIV/AIDS epidemic 16 among African-Americans in the United States; and 17 (3) include in such report— 18 (A) specific recommendations on the imple- 19 mentation of Federal policies to reduce the bur- 20 den of HIV/AIDS in the African-American com- 21 munity; and 22 (B) a special focus on the Black clergy and 23 the church as a unique resource in the African- 24 American community. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 503 •S 2474 IS Subtitle F—Diabetes 1 SEC. 755. TREATMENT OF DIABETES IN MINORITY COMMU- 2 NITIES. 3 (a) SHORT TITLE.—This subtitle may be cited as the 4 ‘‘Minority Diabetes Initiative Act’’. 5 (b) GRANTS REGARDING TREATMENT OF DIABETES 6 IN MINORITY COMMUNITIES.—Part D of title III of the 7 Public Health Service Act (42 U.S.C. 254b et seq.) is 8 amended by inserting after section 330L the following: 9 ‘‘SEC. 330M. GRANTS REGARDING TREATMENT OF DIABE- 10 TES IN MINORITY COMMUNITIES. 11 ‘‘(a) IN GENERAL.—The Secretary may make grants 12 to public and nonprofit private health care providers for 13 the purpose of providing treatment for diabetes in minor- 14 ity communities. 15 ‘‘(b) RECIPIENTS OF GRANTS.—The public and non- 16 profit private health care providers to whom grants may 17 be made under subsection (a) include physicians, podia- 18 trists, community-based organizations, health care organi- 19 zations, community health centers, and State, local, and 20 tribal health departments. 21 ‘‘(c) SCOPE OF TREATMENT ACTIVITIES.—The Sec- 22 retary shall ensure that grants under subsection (a) cover 23 a variety of diabetes-related health care services, including 24 routine care for diabetic patients, public education on dia- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 504 •S 2474 IS betes prevention and control, eye care, foot care, and 1 treatment for kidney disease and other complications of 2 diabetes. 3 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—A condi- 4 tion for the receipt of a grant under subsection (a) is that 5 the applicant involved agrees that, in the program carried 6 out with the grant, services will be provided in the lan- 7 guages most appropriate for, and with consideration for 8 the cultural backgrounds of, the individuals for whom the 9 services are provided. 10 ‘‘(e) OUTREACH SERVICES.—A condition for the re- 11 ceipt of a grant under subsection (a) is that the applicant 12 involved agrees to provide outreach activities to inform the 13 public of the services of the program, and to provide offsite 14 information on diabetes. 15 ‘‘(f) REPORTING OF DATA.—A condition for the re- 16 ceipt of a grant under subsection (a) is that the applicant 17 involved agrees— 18 ‘‘(1) to collect and report data, on a time basis 19 determined appropriate by the Secretary, on race, 20 ethnicity, sex, gender, primary language, disability 21 status, and socioeconomic status; and 22 ‘‘(2) to develop research methodologies that en- 23 sure reporting of data stratified as described in 24 paragraph (1). 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 505 •S 2474 IS ‘‘(g) APPLICATION FOR GRANT.—A grant may be 1 made under subsection (a) only if an application for the 2 grant is submitted to the Secretary and the application 3 is in such form, is made in such manner, and contains 4 such agreements, assurances, and information as the Sec- 5 retary determines to be necessary to carry out this sec- 6 tion.’’. 7 SEC. 756. ELIMINATING DISPARITIES IN DIABETES PREVEN- 8 TION ACCESS AND CARE. 9 (a) RESEARCH, TREATMENT, AND EDUCATION.— 10 (1) IN GENERAL.—Subpart 3 of part C of title 11 IV of the Public Health Service Act (42 U.S.C. 285c 12 et seq.) is amended by adding at the end the fol- 13 lowing new section: 14 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 15 ‘‘(a) IN GENERAL.—The Director of the National In- 16 stitutes of Health shall expand, intensify, and support on- 17 going research and other activities with respect to pre-dia- 18 betes and diabetes, particularly type 2, in minority popu- 19 lations, including research to identify clinical, socio- 20 economic, geographical, cultural, and organizational fac- 21 tors that contribute to type 2 diabetes in such populations. 22 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub- 23 section (a) regarding type 2 diabetes in minority popu- 24 lations shall include the following: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 506 •S 2474 IS ‘‘(1) Continuing research on behavior and obe- 1 sity, including through the obesity research center 2 that is sponsored by the National Institutes of 3 Health. 4 ‘‘(2) Research on environmental factors that 5 may contribute to the increase in type 2 diabetes. 6 ‘‘(3) Support for new methods to identify envi- 7 ronmental triggers and genetic interactions that lead 8 to the development of type 2 diabetes in minority 9 newborns. Such research should follow the newborns 10 through puberty, an increasingly high-risk period for 11 developing type 2 diabetes. 12 ‘‘(4) Research to identify genes that predispose 13 individuals to the onset of developing type 1 and 14 type 2 diabetes and to the development of complica- 15 tions. 16 ‘‘(5) Research to prevent complications in indi- 17 viduals who have already developed diabetes, such as 18 research that attempts to identify the genes that 19 predispose individuals with diabetes to the develop- 20 ment of complications. 21 ‘‘(6) Research methods and alternative thera- 22 pies to control blood glucose. 23 ‘‘(7) Support of ongoing research efforts exam- 24 ining the level of glycemia at which adverse out- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 507 •S 2474 IS comes develop during pregnancy and to address the 1 many clinical issues associated with minority moth- 2 ers and fetuses during diabetic and gestational dia- 3 betic pregnancies. 4 ‘‘(c) EDUCATION.—The Director of the National In- 5 stitutes of Health shall— 6 ‘‘(1) through the National Institute on Minority 7 Health and Health Disparities and the National Di- 8 abetes Education Program— 9 ‘‘(A) make grants to programs funded 10 under section 485F (relating to centers of ex- 11 cellence) for the purpose of establishing a men- 12 toring program for health care professionals to 13 be more involved in weight counseling, obesity 14 research, and nutrition; and 15 ‘‘(B) provide for the participation of mi- 16 nority health professionals in diabetes-focused 17 research programs; and 18 ‘‘(2) make grants for programs to establish a 19 pipeline from high school to professional school that 20 will increase minority representation in diabetes-fo- 21 cused health fields by expanding Minority Access to 22 Research Careers (MARC) program internships and 23 mentoring opportunities for recruitment. 24 ‘‘(d) COLLECTION AND REPORTING OF DATA.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 508 •S 2474 IS ‘‘(1) IN GENERAL.—The Secretary shall ensure 1 that research and other activities undertaken pursu- 2 ant to this section include the collection and report- 3 ing, on a time basis determined appropriate by the 4 Secretary, data on race, ethnicity, sex, gender, pri- 5 mary language, disability status and socioeconomic 6 status. 7 ‘‘(2) GRANTS.—To qualify for a grant under 8 this section, grantees shall develop research meth- 9 odologies that ensure annual reporting of data 10 stratified as described in paragraph (1). 11 ‘‘(e) DEFINITION.—For purposes of this section, the 12 term ‘minority population’ means a racial and ethnic mi- 13 nority group, as defined in section 1707(g).’’. 14 (2) DIABETES MELLITUS INTERAGENCY CO- 15 ORDINATING COMMITTEE.—Section 429 of the Pub- 16 lic Health Service Act (42 U.S.C. 285c–3) is amend- 17 ed by adding at the end the following new sub- 18 section: 19 ‘‘(c)(1) The Diabetes Mellitus Interagency Coordi- 20 nating Committee shall submit to the Secretary a biennial 21 report that shall include an assessment of the Federal ac- 22 tivities and programs related to diabetes in minority popu- 23 lations. Such assessment shall— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 509 •S 2474 IS ‘‘(A) compile the current activities of all current 1 Federal health programs to allow for the assessment 2 of their adequacy as a systemic method of address- 3 ing the impact of diabetes mellitus on minority pop- 4 ulations; 5 ‘‘(B) develop strategic planning activities to de- 6 velop an effective and comprehensive Federal plan to 7 address diabetes mellitus within minority popu- 8 lations which will involve all appropriate Federal 9 health programs and shall— 10 ‘‘(i) include steps to address issues includ- 11 ing type 1 and type 2 diabetes in children and 12 the disproportionate impact of diabetes mellitus 13 on minority populations; and 14 ‘‘(ii) remain consistent with the programs 15 and activities identified in section 399O, as well 16 as remaining consistent with the intent of the 17 Eliminating Disparities in Diabetes Prevention 18 Access and Care Act of 2010; and 19 ‘‘(C) assess the implementation of such a plan 20 throughout Federal health programs. 21 ‘‘(2) For the purposes of this subsection, the term 22 ‘minority population’ means a racial and ethnic minority 23 group, as defined in section 1707(g).’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 510 •S 2474 IS (b) RESEARCH, EDUCATION, AND OTHER ACTIVI- 1 TIES.—Part B of title III of the Public Health Service 2 Act (42 U.S.C. 243 et seq.) is amended by inserting after 3 section 317T the following section: 4 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 5 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 6 ‘‘(1) IN GENERAL.—The Secretary, acting 7 through the Director of the Centers for Disease 8 Control and Prevention, shall conduct and support 9 research and other activities with respect to diabetes 10 in minority populations. 11 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 12 paragraph (1) regarding diabetes in minority popu- 13 lations shall include the following: 14 ‘‘(A) Expanding the National Diabetes 15 Laboratory capacity for translational research 16 and the identification of genetic and 17 immunological risk factors associated with dia- 18 betes. 19 ‘‘(B) Improving the understanding of dia- 20 betes prevalence among Asian-American, Native 21 Hawaiian and other Pacific Islanders by en- 22 hancing data in the National Health and Nutri- 23 tion Examination Survey by oversampling these 24 populations in appropriate geographic areas, or 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 511 •S 2474 IS by another method determined appropriate to 1 collect this data. 2 ‘‘(C) Within the Division of Diabetes 3 Translation, providing for prevention research 4 to better understand how to influence health 5 care systems changes to improve quality of care 6 being delivered to such populations, and within 7 the Division of Diabetes Translation, carrying 8 out model demonstration projects to design, im- 9 plement, and evaluate effective diabetes preven- 10 tion and control intervention for such popu- 11 lations. 12 ‘‘(D) Through the Division of Diabetes 13 Translation, carrying out culturally appropriate 14 community-based interventions designed to ad- 15 dress issues and problems experienced by such 16 populations. 17 ‘‘(E) Conducting applied research within 18 the Division of Diabetes Translation to reduce 19 health disparities within such populations with 20 diabetes. 21 ‘‘(F) Conducting applied research on pri- 22 mary prevention within the Division of Diabetes 23 Translation to specifically focus on such popu- 24 lations with pre-diabetes. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 512 •S 2474 IS ‘‘(b) EDUCATION.— 1 ‘‘(1) IN GENERAL.—The Secretary, acting 2 through the Director of the Centers for Disease 3 Control and Prevention, shall direct the Division of 4 Diabetes Translation to conduct and support pro- 5 grams to educate the public on the causes and ef- 6 fects of diabetes in minority populations. 7 ‘‘(2) CERTAIN ACTIVITIES.—Programs under 8 paragraph (1) regarding education on diabetes in 9 minority populations shall include carrying out pub- 10 lic awareness campaigns directed toward such popu- 11 lations to aggressively emphasize the importance and 12 impact of physical activity and diet in regard to dia- 13 betes and diabetes-related complications through the 14 National Diabetes Education Program. 15 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 16 ACTIVITIES, AND ACCESS.— 17 ‘‘(1) IN GENERAL.—The Secretary, acting 18 through the Director of the Centers for Disease 19 Control and Prevention, shall carry out culturally 20 appropriate diabetes health promotion and preven- 21 tion programs for minority populations. 22 ‘‘(2) CERTAIN ACTIVITIES.—Activities regard- 23 ing culturally appropriate diabetes health promotion 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 513 •S 2474 IS and prevention programs for minority populations 1 shall include the following: 2 ‘‘(A) Expanding the Diabetes Prevention 3 and Control Program (currently existing in all 4 the States and territories) and providing funds 5 for education and community outreach on dia- 6 betes. 7 ‘‘(B) Providing funds for an expansion of 8 the Diabetes Prevention Program Initiative that 9 focuses on physical inactivity and diet and its 10 relation to type 2 diabetes within such popu- 11 lations. 12 ‘‘(C) Providing funds to strengthen exist- 13 ing surveillance systems to improve the quality, 14 accuracy, and timeliness of morbidity and mor- 15 tality diabetes data for such populations. 16 ‘‘(d) COLLECTION AND REPORTING OF DATA.—The 17 Secretary shall ensure that research and other activities 18 undertaken pursuant to this section include the collection 19 and reporting, on a time basis determined appropriate by 20 the Secretary, data on race, ethnicity, sex, gender, primary 21 language, disability status and socioeconomic status. 22 ‘‘(e) DEFINITION.—For purposes of this section, the 23 term ‘minority population’ means a racial and ethnic mi- 24 nority group, as defined in section 1707(g).’’. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 514 •S 2474 IS (c) RESEARCH, EDUCATION, AND OTHER ACTIVI- 1 TIES.—Part P of title III of the Public Health Service 2 Act is amended— 3 (1) by redesignating the section 399R inserted 4 by section 2 of Public Law 110–373 as section 5 399S; 6 (2) by redesignating the section 399R inserted 7 by section 3 of Public Law 110–374 as section 8 399T; and 9 (3) by adding at the end the following new sec- 10 tion: 11 ‘‘SEC. 399V–8. PROGRAMS TO EDUCATE HEALTH PRO- 12 VIDERS ON THE CAUSES AND EFFECTS OF DI- 13 ABETES IN MINORITY POPULATIONS. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Director of the Health Resources and Services Admin- 16 istration, shall conduct and support programs described 17 in subsection (b) to educate health professionals on the 18 causes and effects of diabetes in minority populations. 19 ‘‘(b) PROGRAMS.—Programs described in this sub- 20 section, with respect to education on diabetes in minority 21 populations, shall include the following: 22 ‘‘(1) Making grants for diabetes-focused edu- 23 cation classes or training programs on cultural sen- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 515 •S 2474 IS sitivity and patient care within such populations for 1 health care providers. 2 ‘‘(2) Providing funds to community health cen- 3 ters for programs that provide diabetes services and 4 screenings. 5 ‘‘(3) Providing additional funds for the Health 6 Careers Opportunity Program, Centers for Excel- 7 lence, and the Minority Faculty Fellowship Program 8 to partner with the Office of Minority Health under 9 section 1707 and the National Institutes of Health 10 to strengthen programs for career opportunities 11 within minority populations focused on diabetes 12 treatment and care. 13 ‘‘(4) Developing a diabetes focus within, and 14 providing additional funds for, the National Health 15 Service Corps Scholarship program to place individ- 16 uals in areas that are disproportionately affected by 17 diabetes and to provide health care services to such 18 areas. 19 ‘‘(5) Establishing a diabetes ambassador pro- 20 gram for recruitment efforts to increase the number 21 of underrepresented minorities currently serving in 22 student, faculty, or administrative positions in insti- 23 tutions of higher learning, hospitals, and community 24 health centers. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 516 •S 2474 IS ‘‘(6) Establishing a loan repayment program 1 that focuses on diabetes care and prevention in mi- 2 nority populations. 3 ‘‘(c) COLLECTION AND REPORTING OF DATA.— 4 ‘‘(1) IN GENERAL.—The Secretary shall ensure 5 that research and other activities undertaken pursu- 6 ant to this section include the collection and report- 7 ing, on a time basis determined appropriate by the 8 Secretary, data on race, ethnicity, sex, gender, pri- 9 mary language, disability status and socioeconomic 10 status. 11 ‘‘(2) GRANTS.—To qualify for a grant under 12 this section, grantees shall develop research meth- 13 odologies that ensure annual reporting of data 14 stratified as described in paragraph (1).’’. 15 (d) RESEARCH, EDUCATION, AND OTHER ACTIVI- 16 TIES.—Part P of title III of the Public Health Service 17 Act (42 U.S.C. 280g et seq.), as amended by subsection 18 (c), is further amended by adding at the end the following 19 section: 20 ‘‘SEC. 399V–9. RESEARCH, EDUCATION, AND OTHER ACTIVI- 21 TIES REGARDING DIABETES IN MINORITY 22 POPULATIONS. 23 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 517 •S 2474 IS ‘‘(1) IN GENERAL.—In addition to activities 1 under sections 317U and 434B, the Secretary shall 2 conduct and support research and other activities 3 with respect to diabetes within minority populations. 4 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 5 paragraph (1) regarding diabetes in minority popu- 6 lations shall include the following: 7 ‘‘(A) Through the National Center on Mi- 8 nority Health and Health Disparities, the Office 9 of Minority Health under section 1707, the 10 Health Resources and Services Administration, 11 the Centers for Disease Control and Prevention, 12 and the Indian Health Service, establishing 13 partnerships within minority populations to 14 conduct studies on cultural, familial, and social 15 factors that may influence health promotion, di- 16 abetes management, and prevention. 17 ‘‘(B) Through the Indian Health Service, 18 in collaboration with other appropriate Federal 19 agencies, coordinating the collection of data on 20 ethnic and culturally appropriate diabetes treat- 21 ment, care, prevention, and services by health 22 care professionals to the American Indian popu- 23 lation. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 518 •S 2474 IS ‘‘(3) PROGRAMS RELATING TO CLINICAL RE- 1 SEARCH.— 2 ‘‘(A) EDUCATION REGARDING CLINICAL 3 TRIALS.—The Secretary shall carry out edu- 4 cation and awareness programs designed to in- 5 crease participation of minority populations in 6 clinical trials. 7 ‘‘(B) MINORITY RESEARCHERS.—The Sec- 8 retary shall carry out mentorship programs for 9 minority researchers who are conducting or in- 10 tend to conduct research on diabetes in minor- 11 ity populations. 12 ‘‘(C) SUPPLEMENTING CLINICAL RE- 13 SEARCH REGARDING CHILDREN.—The Sec- 14 retary shall make grants to supplement clinical 15 research programs to assist such programs in 16 obtaining the services of health professionals 17 and other resources to provide specialized care 18 for children with type 1 and type 2 diabetes. 19 ‘‘(4) ADDITIONAL PROGRAMS.—Activities under 20 paragraph (1) regarding education on diabetes shall 21 include providing funds for new and existing diabe- 22 tes-focused education grants and programs for 23 present and future students and clinicians in the 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 519 •S 2474 IS medical field from minority populations, including 1 for the following: 2 ‘‘(A) For Federal and State loan repay- 3 ment programs for health profession students 4 within communities of color. 5 ‘‘(B) For the Office of Minority Health 6 under section 1707 for training health profes- 7 sion students to focus on diabetes within such 8 populations. 9 ‘‘(b) COLLECTION AND REPORTING OF DATA.— 10 ‘‘(1) IN GENERAL.—The Secretary shall ensure 11 that research and other activities undertaken pursu- 12 ant to this section include the collection and report- 13 ing, on a time basis determined appropriate by the 14 Secretary, data on race, ethnicity, sex, gender, pri- 15 mary language, disability status and socioeconomic 16 status. 17 ‘‘(2) GRANTS.—To qualify for a grant under 18 this section, grantees shall develop research meth- 19 odologies that ensure annual reporting of data 20 stratified as described in paragraph (1). 21 ‘‘(c) DEFINITION.—For purposes of this section, the 22 term ‘minority population’ means a racial and ethnic mi- 23 nority group as defined in section 1707(g).’’. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 520 •S 2474 IS (e) SENSE OF THE CONGRESS.—It is the sense of the 1 Congress that States and localities are encourage to recog- 2 nize established times of diabetes awareness, such as 3 American Diabetes Month (November), American Diabe- 4 tes Alert Day (annually on the 4th Tuesday of March), 5 and World Diabetes Day (November 14th). 6 Subtitle G—Lung Disease 7 SEC. 761. EXPANSION OF THE NATIONAL ASTHMA EDU- 8 CATION AND PREVENTION PROGRAM. 9 (a) IN GENERAL.—Not later than 2 years after the 10 date of the enactment of this Act, the Secretary of Health 11 and Human Services shall convene a working group com- 12 prised of patient groups, nonprofit organizations, medical 13 societies, and other relevant governmental and nongovern- 14 mental entities, including those that participate in the Na- 15 tional Asthma Education and Prevention Program, to de- 16 velop a report to Congress that— 17 (1) catalogs, with respect to asthma prevention, 18 management, and surveillance— 19 (A) the activities of the Federal Govern- 20 ment, including identifying all Federal pro- 21 grams that carry out asthma-related activities, 22 as well as assessment of the progress of the 23 Federal Government and States, with respect to 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 521 •S 2474 IS achieving the goals of the Healthy People 2020 1 initiative; and 2 (B) the activities of other entities that par- 3 ticipate in the program, including nonprofit or- 4 ganizations, patient advocacy groups, and med- 5 ical societies; and 6 (2) makes recommendations for the future di- 7 rection of asthma activities, in consultation with re- 8 searchers from the National Institutes of Health and 9 other member bodies of the National Asthma Edu- 10 cation and Prevention Program who are qualified to 11 review and analyze data and evaluate interventions, 12 including— 13 (A) description of how the Federal Govern- 14 ment may better coordinate and improve its re- 15 sponse to asthma including identifying any bar- 16 riers that may exist; 17 (B) description of how the Federal Govern- 18 ment may continue, expand, and improve its 19 private-public partnerships with respect to asth- 20 ma including identifying any barriers that may 21 exist; 22 (C) identification of steps that may be 23 taken to reduce the— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 522 •S 2474 IS (i) morbidity, mortality, and overall 1 prevalence of asthma; 2 (ii) financial burden of asthma on so- 3 ciety; 4 (iii) burden of asthma on dispropor- 5 tionately affected areas, particularly those 6 in medically underserved populations (as 7 defined in section 330(b)(3) of the Public 8 Health Service Act (42 U.S.C. 9 254b(b)(3)); and 10 (iv) burden of asthma as a chronic 11 disease; 12 (D) identification of programs and policies 13 that have achieved the steps described in sub- 14 paragraph (C), and steps that may be taken to 15 expand such programs and policies to benefit 16 larger populations; and 17 (E) recommendations for future research 18 and interventions. 19 (b) REPORT TO CONGRESS.—At the end of the 5-year 20 period following the submission of the report under sub- 21 section (a), the National Asthma Education and Preven- 22 tion Program shall evaluate the analyses and rec- 23 ommendations under such report and determine whether 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 523 •S 2474 IS a new report to the Congress is necessary, and make ap- 1 propriate recommendations to the Congress. 2 SEC. 762. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 3 FOR DISEASE CONTROL AND PREVENTION. 4 Section 317I of the Public Health Service Act (42 5 U.S.C. 247b–10) is amended to read as follows: 6 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 7 FOR DISEASE CONTROL AND PREVENTION. 8 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 9 EDUCATION TO THE PUBLIC.—The Secretary, acting 10 through the Director of the Centers for Disease Control 11 and Prevention, shall collaborate with State and local 12 health departments to conduct activities, including the 13 provision of information and education to the public re- 14 garding asthma including— 15 ‘‘(1) deterring the harmful consequences of un- 16 controlled asthma; and 17 ‘‘(2) disseminating health education and infor- 18 mation regarding prevention of asthma episodes and 19 strategies for managing asthma. 20 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 21 The Secretary, acting through the Director of the Centers 22 for Disease Control and Prevention, shall collaborate with 23 State and local health departments to develop State plans 24 incorporating public health responses to reduce the burden 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 524 •S 2474 IS of asthma, particularly regarding disproportionately af- 1 fected populations. 2 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 3 through the Director of the Centers for Disease Control 4 and Prevention, shall, in cooperation with State and local 5 public health officials— 6 ‘‘(1) conduct asthma surveillance activities to 7 collect data on the prevalence and severity of asth- 8 ma, the effectiveness of public health asthma inter- 9 ventions, and the quality of asthma management, in- 10 cluding— 11 ‘‘(A) collection of household data on the 12 local burden of asthma; 13 ‘‘(B) surveillance of health care facilities; 14 and 15 ‘‘(C) collection of data not containing indi- 16 vidually identifiable information from electronic 17 health records or other electronic communica- 18 tions; 19 ‘‘(2) compile and annually publish data regard- 20 ing the prevalence and incidence of childhood asth- 21 ma, the child mortality rate, and the number of hos- 22 pital admissions and emergency department visits by 23 children associated with asthma nationally and in 24 each State and at the county level by age, sex, race, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 525 •S 2474 IS and ethnicity, as well as lifetime and current preva- 1 lence; and 2 ‘‘(3) compile and annually publish data regard- 3 ing the prevalence and incidence of adult asthma, 4 the adult mortality rate, and the number of hospital 5 admissions and emergency department visits by 6 adults associated with asthma nationally and in each 7 State and at the county level by age, sex, race, eth- 8 nicity, industry, and occupation, as well as lifetime 9 and current prevalence. 10 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 11 Director of the Centers for Disease Control and Preven- 12 tion, in conjunction with State and local health depart- 13 ments, shall coordinate data collection activities under 14 subsection (c)(2) so as to maximize comparability of re- 15 sults. 16 ‘‘(e) COLLABORATION.—The Centers for Disease 17 Control and Prevention are encouraged to collaborate with 18 national, State, and local nonprofit organizations to pro- 19 vide information and education about asthma, and to 20 strengthen such collaborations when possible.’’. 21 SEC. 763. INFLUENZA AND PNEUMONIA VACCINATION CAM- 22 PAIGN. 23 (a) IN GENERAL.—The Secretary of Health and 24 Human Services shall— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 526 •S 2474 IS (1) enhance the annual campaign by the De- 1 partment of Health and Human Services to increase 2 the number of people vaccinated each year for influ- 3 enza and pneumonia; and 4 (2) include in such campaign the use of written 5 educational materials, public service announcements, 6 physician education, and any other means which the 7 Secretary deems effective. 8 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 9 out the annual campaign described in subsection (a), the 10 Secretary of Health and Human Services shall ensure 11 that— 12 (1) educational materials and public service an- 13 nouncements are readily and widely available in 14 communities experiencing disparities in the incidence 15 and mortality rates of influenza and pneumonia; and 16 (2) the campaign uses targeted, culturally ap- 17 propriate messages and messengers to reach under- 18 served communities. 19 SEC. 764. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 20 ACTION PLAN. 21 (a) IN GENERAL.—The Director of the Centers for 22 Disease Control and Prevention shall conduct, support, 23 and expand public health strategies, prevention, diagnosis, 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 527 •S 2474 IS surveillance, and public and professional awareness activi- 1 ties regarding chronic obstructive pulmonary disease. 2 (b) NATIONAL ACTION PLAN.— 3 (1) DEVELOPMENT.—Not later than 2 years 4 after the date of the enactment of this Act, the Di- 5 rector of the National Heart, Lung, and Blood Insti- 6 tute, in consultation with the Director of the Centers 7 for Disease Control and Prevention, shall develop a 8 national action plan to address chronic obstructive 9 pulmonary disease in the United States with partici- 10 pation from patients, caregivers, health profes- 11 sionals, patient advocacy organizations, researchers, 12 providers, public health professionals, and other 13 stakeholders. 14 (2) CONTENTS.—At a minimum, such plan 15 shall include recommendations for— 16 (A) public health interventions for the pur- 17 pose of implementation of the national plan; 18 (B) biomedical, health services, and public 19 health research on chronic obstructive pul- 20 monary disease; and 21 (C) inclusion of chronic obstructive pul- 22 monary disease in the health data collections of 23 all Federal agencies. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 528 •S 2474 IS (3) CONSIDERATION.—In developing such plan, 1 the Director of the National Heart, Lung, and Blood 2 Institute shall consider the recommendations and 3 findings of the Institute of Medicine in the report 4 entitled ‘‘A Nationwide Framework for Surveillance 5 of Cardiovascular and Chronic Lung Diseases’’ (July 6 22, 2011). 7 (c) CHRONIC DISEASE PREVENTION PROGRAMS.— 8 The Director of the National Heart, Lung, and Blood In- 9 stitute shall carry out the following: 10 (1) Conduct public education and awareness ac- 11 tivities with patient and professional organizations 12 to stimulate earlier diagnosis and improve patient 13 outcomes from treatment of chronic obstructive pul- 14 monary disease. To the extent known and relevant, 15 such public education and awareness activities shall 16 reflect differences in chronic obstructive pulmonary 17 disease by cause (tobacco, environmental, occupa- 18 tional, biological, and genetic) and include a focus 19 on outreach to undiagnosed and, as appropriate, mi- 20 nority populations. 21 (2) Supplement and expand upon the activities 22 of the National Heart, Lung, and Blood Institute by 23 making grants to nonprofit organizations, State and 24 local jurisdictions, and Indian tribes for the purpose 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 529 •S 2474 IS of reducing the burden of chronic obstructive pul- 1 monary disease, especially in disproportionately im- 2 pacted communities, through public health interven- 3 tions and related activities. 4 (3) Coordinate with the Centers for Disease 5 Control and Prevention, the Indian Health Service, 6 the Health Resources and Services Administration, 7 and the Department of Veterans Affairs to develop 8 pilot programs to demonstrate best practices for the 9 diagnosis and management of chronic obstructive 10 pulmonary disease. 11 (4) Develop improved techniques and identify 12 best practices, in coordination with the Secretary of 13 Veterans Affairs, for assisting chronic obstructive 14 pulmonary disease patients to successfully stop 15 smoking, including identification of subpopulations 16 with different needs. Initiatives under this para- 17 graph may include research to determine whether 18 successful smoking cessation strategies are different 19 for chronic obstructive pulmonary disease patients 20 compared to such strategies for patients with other 21 chronic diseases. 22 (d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 23 PROGRAMS.—The Director of the Centers for Disease 24 Control and Prevention shall— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 530 •S 2474 IS (1) support research into the environmental and 1 occupational causes and biological mechanisms that 2 contribute to chronic obstructive pulmonary disease; 3 and 4 (2) develop and disseminate public health inter- 5 ventions that will lessen the impact of environmental 6 and occupational causes of chronic obstructive pul- 7 monary disease. 8 (e) DATA COLLECTION.—Not later than 180 days 9 after the enactment of this Act, the Director of the Na- 10 tional Heart, Lung, and Blood Institute and the Director 11 of the Centers for Disease Control and Prevention, acting 12 jointly, shall assess the depth and quality of information 13 on chronic obstructive pulmonary disease that is collected 14 in surveys and population studies conducted by the Cen- 15 ters for Disease Control and Prevention, including wheth- 16 er there are additional opportunities for information to be 17 collected in the National Health and Nutrition Examina- 18 tion Survey, the National Health Interview Survey, and 19 the Behavioral Risk Factors Surveillance System surveys. 20 The Director of the National Heart, Lung, and Blood In- 21 stitute shall include the results of such assessment in the 22 national action plan under subsection (b). 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 531 •S 2474 IS TITLE VIII—HEALTH 1 INFORMATION TECHNOLOGY 2 Subtitle A—Reducing Health 3 Disparities Through Health IT 4 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 5 PROMOTION OF HEALTH IT. 6 The Secretary of Health and Human Services, acting 7 through the Administrator of the Health Resources and 8 Services Administration, shall expand and intensify the 9 programs and activities of the Administration (directly or 10 through grants or contracts) to provide technical assist- 11 ance and resources to health centers (as defined in section 12 330(a) of the Public Health Service Act (42 U.S.C. 13 254b(a)) to adopt and meaningfully use certified EHR 14 technology (as defined in section 3000(1) of such Act (42 15 U.S.C. 300jj(1)) for the management of chronic diseases 16 and health conditions. 17 SEC. 802. ASSESSMENT OF USE OF HEALTH IT IN RACIAL 18 AND ETHNIC MINORITY COMMUNITIES. 19 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 20 MATION TECHNOLOGY.— 21 (1) IN GENERAL.—The National Coordinator 22 for Health Information Technology shall conduct an 23 evaluation of the level of use and accessibility of 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 532 •S 2474 IS electronic health records in racial and ethnic minor- 1 ity communities. 2 (2) CONTENT.—In conducting the evaluation 3 under paragraph (1), the National Coordinator shall 4 publish the results of a study regarding the 100,000 5 providers recruited by the Regional Extension Cen- 6 ter established under section 3012 of the Public 7 Health Service Act (42 U.S.C. 300jj–32), including 8 the race and ethnicity of such providers and the pop- 9 ulations served by such providers. 10 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 11 As soon as practicable after the date of enactment of this 12 Act, the Director of the National Center for Health Statis- 13 tics shall provide to Congress a more detailed analysis of 14 the data presented in the Data Brief 79 published by such 15 Center in November 2011 (entitled ‘‘Electronic Health 16 Record Systems and Intent to Apply for Meaningful Use 17 Incentives Among Office-Based Physician Practices’’). 18 (c) INSTITUTE OF MEDICINE.—The Secretary of 19 Health and Human Services may enter into an agreement 20 with the Institute of Medicine of the National Academies 21 that provides such Institute will evaluate the impact of 22 health information technology in racial and ethnic minor- 23 ity communities and publish a report regarding such eval- 24 uation. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 533 •S 2474 IS Subtitle B—Modifications to 1 Achieve Parity in Existing Pro- 2 grams 3 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 4 HEALTH IT INFRASTRUCTURE IN RACIAL 5 AND ETHNIC MINORITY COMMUNITIES. 6 Section 3011 of the Public Health Service Act (42 7 U.S.C. 300jj–31) is amended— 8 (1) in subsection (a), by adding at the end the 9 following new paragraph: 10 ‘‘(8) Activities described in the previous para- 11 graphs of this subsection with respect to commu- 12 nities with a high proportion of individuals from ra- 13 cial and ethnic minority groups (as defined in sec- 14 tion 1707(g)).’’; and 15 (2) by adding at the end the following new sub- 16 section: 17 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 18 National Coordinator shall report annually to the Con- 19 gress on activities and expenditures under this section.’’. 20 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS- 21 SISTANCE TO RACIAL AND ETHNIC MINORITY 22 GROUPS. 23 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub- 24 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 534 •S 2474 IS amended by inserting ‘‘or individuals from racial and eth- 1 nic minority groups (as defined in section 1707(g))’’ after 2 ‘‘medically underserved individuals’’. 3 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 4 such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 5 (1) by inserting: ‘‘Each evaluation panel shall 6 include at least one consumer advocate from a racial 7 and ethnic minority community served by the center 8 involved and at least one representative of a minor- 9 ity-serving institution.’’ after ‘‘ ‘and of Federal offi- 10 cials.’’; and 11 (2) by inserting ‘‘and shall determine the de- 12 gree to which such center provides outreach and as- 13 sistance to providers predominantly serving racial 14 and ethnic minority groups (as defined in section 15 1707(g))’’ after ‘‘specified in paragraph (3)’’. 16 SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE- 17 VELOPMENT OF LOAN PROGRAMS TO FACILI- 18 TATE ADOPTION OF CERTIFIED EHR TECH- 19 NOLOGY BY PROVIDERS SERVING RACIAL 20 AND ETHNIC MINORITY GROUPS. 21 Section 3014(e) of the Public Health Service Act (42 22 U.S.C. 300jj–34(e)) is amended— 23 (1) in paragraph (3), by striking at the end 24 ‘‘or’’; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 535 •S 2474 IS (2) in paragraph (4), by striking the period at 1 the end and inserting ‘‘; or’’; and 2 (3) by adding at the end the following new 3 paragraph: 4 ‘‘(5) carry out any of the activities described in 5 a previous paragraph of this subsection with respect 6 to communities with a high proportion of individuals 7 from racial and ethnic minority groups (as defined 8 in section 1707(g)).’’. 9 Subtitle C—Additional Research 10 and Studies 11 SEC. 821. DATA COLLECTION AND ASSESSMENTS CON- 12 DUCTED IN COORDINATION WITH MINORITY- 13 SERVING INSTITUTIONS. 14 Section 3001(c)(6) of the Public Health Service Act 15 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 16 end the following new subparagraph: 17 ‘‘(F) DATA COLLECTION AND ASSESS- 18 MENTS CONDUCTED IN COORDINATION WITH 19 MINORITY-SERVING INSTITUTIONS.— 20 ‘‘(i) IN GENERAL.—In carrying out 21 subparagraph (C) with respect to commu- 22 nities with a high proportion of individuals 23 from racial and ethnic minority groups (as 24 defined in section 1707(g)), the National 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 536 •S 2474 IS Coordinator shall, to the greatest extent 1 possible, coordinate with an entity de- 2 scribed in clause (ii). 3 ‘‘(ii) MINORITY-SERVING INSTITU- 4 TIONS.—For purposes of clause (i), an en- 5 tity described in this clause is a historically 6 Black college or university, an Hispanic- 7 serving institution, a tribal college or uni- 8 versity, or an Asian-American-, Native 9 American-, and Pacific Islander-serving in- 10 stitution with an accredited public health, 11 health policy, or health services research 12 program.’’. 13 SEC. 822. IOM STUDY AND REPORT ON PRIVACY CONCERNS 14 OF CERTAIN MINORITY POPULATIONS. 15 (a) IN GENERAL.—The Secretary of Health and 16 Human Services shall seek to enter into an agreement 17 with the Institute of Medicine of the National Academies 18 to— 19 (1) complete a study— 20 (A) on the privacy concerns, relating to the 21 exchange of health information, of individuals 22 described in subsection (b); 23 (B) on how such concerns may create bar- 24 riers for such individuals to access health care 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 537 •S 2474 IS or participate in the exchange of health infor- 1 mation; and 2 (C) including recommendations for over- 3 coming such barriers for such individuals; and 4 (2) not later than 24 months after the date of 5 the enactment of this Act, submit to Congress a re- 6 port on the results of such study. 7 If such Institute declines to conduct the study and submit 8 the report, the Secretary shall enter into an agreement 9 with another appropriate public or nonprofit private entity 10 to conduct the study and submit the report. 11 (b) INDIVIDUALS DESCRIBED.—For purposes of sub- 12 section (a), the individuals described in this subsection are 13 individuals from racial and ethnic minority groups (as de- 14 fined in section 1707(g)), including such individuals 15 who— 16 (1) are immigrants, as well as citizens living 17 within immigrant households (‘‘mixed-status’’ house- 18 holds) in the United States; 19 (2) are lesbian, gay, bisexual, or transgender; or 20 (3) have a mental health disability or a record 21 of a mental health disability or treatment for a men- 22 tal health disability. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 538 •S 2474 IS SEC. 823. STUDY OF HEALTH INFORMATION TECHNOLOGY 1 IN MEDICALLY UNDERSERVED AREAS. 2 (a) IN GENERAL.—Not later than 24 months after 3 the date of enactment of this Act, the Secretary of Health 4 and Human Services shall— 5 (1) enter into an agreement with the Institute 6 of Medicine of the National Academies (or, if the In- 7 stitute of Medicine declines, another appropriate 8 public or nonprofit private entity) to conduct a study 9 on the development, implementation, and effective- 10 ness of health information technology within medi- 11 cally underserved areas (as described in subsection 12 (c)); and 13 (2) submit a report to Congress describing the 14 results of such study, including any recommenda- 15 tions for legislative or administrative action. 16 (b) STUDY.—The study described in subsection 17 (a)(1) shall— 18 (1) identify barriers to successful implementa- 19 tion of health information technology in medically 20 underserved areas; 21 (2) examine the impact of health information 22 technology on providing quality care and reducing 23 the cost of care to individuals in such areas, includ- 24 ing the impact of such technology on improved 25 health outcomes for individuals; 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 539 •S 2474 IS (3) examine the impact of health information 1 technology on improving health care-related deci- 2 sions by both patients and providers in such areas; 3 (4) identify specific best practices for using 4 health information technology to foster the con- 5 sistent provision of physical accessibility and reason- 6 able policy accommodations in health care to individ- 7 uals with disabilities in such areas; 8 (5) assess the feasibility and costs associated 9 with the use of health information technology in 10 such areas; 11 (6) evaluate whether the adoption and use of 12 qualified electronic health records (as described in 13 section 3000(13) of the Public Health Service Act 14 (42 U.S.C. 300jj(13)) is effective in reducing health 15 disparities, including analysis of clinical quality 16 measures reported by Medicare and Medicaid pro- 17 viders pursuant to programs to encourage the adop- 18 tion and use of certified EHR technology; 19 (7) identify providers in medically underserved 20 areas that are not electing to adopt and use elec- 21 tronic health records and determine what barriers 22 are preventing those providers from adopting and 23 using such records; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 540 •S 2474 IS (8) examine urban and rural community health 1 systems and determine the impact that health infor- 2 mation technology may have on the capacity of pri- 3 mary health providers in those systems. 4 (c) MEDICALLY UNDERSERVED AREA.—The term 5 ‘‘medically underserved area’’ means— 6 (1) a population that has been designated as a 7 medically underserved population under section 8 330(b)(3) of the Public Health Service Act (42 9 U.S.C. 254b(b)(3)); 10 (2) an area that has been designated as a 11 health professional shortage area under section 332 12 of the Public Health Service Act (42 U.S.C. 254e); 13 (3) an area or population that has been des- 14 ignated as a medically underserved community under 15 section 799B(6) of the Public Health Service Act 16 (42 U.S.C. 295p(6)); or 17 (4) an area or population that— 18 (A) is not described in paragraphs (1) 19 through (3) of this subsection; 20 (B) experiences significant barriers to ac- 21 cessing quality health services; and 22 (C) has a high prevalence of diseases or 23 conditions described in title VII of this Act, 24 with such diseases or conditions having a dis- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 541 •S 2474 IS proportionate impact on racial and ethnic mi- 1 nority groups (as defined in section 1707(g) of 2 the Public Health Service Act (42 U.S.C. 300u- 3 6(g))) or a subgroup of people with disabilities 4 who have specific functional impairments. 5 Subtitle D—Closing Gaps in 6 Funding To Adopt Certified EHRs 7 SEC. 831. APPLICATION OF MEDICARE HITECH PAYMENTS 8 TO HOSPITALS IN PUERTO RICO. 9 (a) IN GENERAL.—Subsection (n)(6)(B) of section 10 1886 of the Social Security Act (42 U.S.C. 1395ww) is 11 amended by striking ‘‘subsection (d) hospital’’ and insert- 12 ing ‘‘hospital that is a subsection (d) hospital or a sub- 13 section (d) Puerto Rico hospital’’. 14 (b) OFFSETTING REDUCTION.—Subsection (n)(2) of 15 such section is amended by adding at the end the following 16 new subparagraph: 17 ‘‘(H) BUDGET NEUTRALITY ADJUST- 18 MENT.—The Secretary shall reduce the applica- 19 ble amounts that would otherwise be deter- 20 mined under this subsection with respect to— 21 ‘‘(i) the first fiscal year to which this 22 subparagraph applies by an amount that 23 the Secretary estimates would ensure that 24 estimated aggregate payments under this 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 542 •S 2474 IS subsection for such fiscal year are not in- 1 creased as a result of the amendments 2 made by subsection (a) of section 831 of 3 the Health Equity and Accountability Act 4 of 2012; or 5 ‘‘(ii) a succeeding fiscal year by an 6 amount that the Secretary estimates would 7 ensure that estimated aggregate payments 8 under this subsection for such fiscal year 9 are not increased as a result of the amend- 10 ments made by subsections (a) and (c) of 11 such section.’’. 12 (c) CONFORMING AMENDMENTS.—(1) Subsection 13 (b)(3)(B)(ix) of such section is amended— 14 (A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 15 and inserting ‘‘(n)(6)(B)’’; and 16 (B) in subclause (II), by striking ‘‘subsection 17 (d) hospital’’ and inserting ‘‘an eligible hospital’’. 18 (2) Paragraphs (2) and (4)(A) of section 1853(m) of 19 the Social Security Act (42 U.S.C. 1395w–23(m)) are 20 each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 21 ‘‘1886(n)(6)(B)’’. 22 (d) IMPLEMENTATION.—Notwithstanding any other 23 provision of law, the Secretary of Health and Human 24 Services may implement the amendments made by sub- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 543 •S 2474 IS sections (a), (b) and (c) by program instruction or other- 1 wise. 2 (e) EFFECTIVE DATE.—The amendments made by 3 this section shall apply to payments for payment years for 4 fiscal years beginning after the date of the enactment of 5 this Act. 6 SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 7 FOR MEDICAID ELECTRONIC HEALTH 8 RECORD INCENTIVE PAYMENTS. 9 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 10 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 11 amended by striking ‘‘insofar as the assistant is prac- 12 ticing’’ and all that follows through ‘‘so led’’. 13 (b) EFFECTIVE DATE.—The amendment made by 14 subsection (a) shall apply with respect to amounts ex- 15 pended under 1903(a)(3)(F) of the Social Security Act 16 (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters begin- 17 ning on or after the date of the enactment of this Act. 18 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 544 •S 2474 IS TITLE IX—ACCOUNTABILITY 1 AND EVALUATION 2 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 3 ASSISTED HEALTH CARE SERVICES AND RE- 4 SEARCH PROGRAMS ON THE BASIS OF SEX, 5 RACE, COLOR, NATIONAL ORIGIN, SEXUAL 6 ORIENTATION, GENDER IDENTITY, OR DIS- 7 ABILITY STATUS. 8 No person in the United States shall, on the basis 9 of sex, race, color, national origin, sexual orientation, gen- 10 der identity, or disability status, be excluded from partici- 11 pation in, be denied the benefits of, or be subjected to dis- 12 crimination under any health care service or research pro- 13 gram or activity receiving Federal financial assistance. 14 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 15 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 16 A payment to a provider of services, physician, or 17 other supplier under part B, C, or D of title XVIII of 18 the Social Security Act shall be deemed a grant, and not 19 a contract of insurance or guaranty, for the purposes of 20 title VI of the Civil Rights Act of 1964. 21 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 545 •S 2474 IS SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 1 THE DEPARTMENT OF HEALTH AND HUMAN 2 SERVICES. 3 Title XXXIV of the Public Health Service Act, as 4 amended by titles I, II, and III of this Act, is further 5 amended by inserting after subtitle B the following: 6 ‘‘Subtitle C—Strengthening 7 Accountability 8 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 9 ‘‘(a) IN GENERAL.—The Secretary shall establish 10 within the Office for Civil Rights an Office of Health Dis- 11 parities, which shall be headed by a director to be ap- 12 pointed by the Secretary. 13 ‘‘(b) PURPOSE.—The Office of Health Disparities 14 shall ensure that the health programs, activities, and oper- 15 ations of health entities which receive Federal financial as- 16 sistance are in compliance with title VI of the Civil Rights 17 Act, which prohibits discrimination on the basis of race, 18 color, or national origin. The activities of the Office shall 19 include the following: 20 ‘‘(1) The development and implementation of 21 an action plan to address racial and ethnic health 22 care disparities, which shall address concerns relat- 23 ing to the Office for Civil Rights as released by the 24 United States Commission on Civil Rights in the re- 25 port entitled ‘Health Care Challenge: Acknowledging 26 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 546 •S 2474 IS Disparity, Confronting Discrimination, and Ensur- 1 ing Equity’ (September 1999) in conjunction with 2 the reports by the Institute of Medicine entitled ‘Un- 3 equal Treatment: Confronting Racial and Ethnic 4 Disparities in Health Care’, ‘Crossing the Quality 5 Chasm: A New Health System for the 21st Cen- 6 tury’, and ‘In the Nation’s Compelling Interest: En- 7 suring Diversity in the Health Care Workforce’, and 8 ‘The National Partnership for Action to End Health 9 Disparities’, and other related reports by the Insti- 10 tute of Medicine. This plan shall be publicly dis- 11 closed for review and comment and the final plan 12 shall address any comments or concerns that are re- 13 ceived by the Office. 14 ‘‘(2) Investigative and enforcement actions 15 against intentional discrimination and policies and 16 practices that have a disparate impact on minorities. 17 ‘‘(3) The review of racial, ethnic, and primary 18 language health data collected by Federal health 19 agencies to assess health care disparities related to 20 intentional discrimination and policies and practices 21 that have a disparate impact on minorities. 22 ‘‘(4) Outreach and education activities relating 23 to compliance with title VI of the Civil Rights Act. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 547 •S 2474 IS ‘‘(5) The provision of technical assistance for 1 health entities to facilitate compliance with title VI 2 of the Civil Rights Act. 3 ‘‘(6) Coordination and oversight of activities of 4 the civil rights compliance offices established under 5 section 3442. 6 ‘‘(7) Ensuring compliance with the 1997 Office 7 of Management and Budget Standards for Maintain- 8 ing, Collecting, and Presenting Federal Data on 9 Race, Ethnicity and the available language stand- 10 ards. 11 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 12 sure the effectiveness of the Office of Health Disparities 13 by ensuring that the Office is provided with— 14 ‘‘(1) adequate funding to enable the Office to 15 carry out its duties under this section; and 16 ‘‘(2) staff with expertise in— 17 ‘‘(A) epidemiology; 18 ‘‘(B) statistics; 19 ‘‘(C) health quality assurance; 20 ‘‘(D) minority health and health dispari- 21 ties; 22 ‘‘(E) cultural and linguistic competency; 23 and 24 ‘‘(F) civil rights. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 548 •S 2474 IS ‘‘(d) REPORT.—Not later than December 31, 2012, 1 and annually thereafter, the Secretary, in collaboration 2 with the Director of the Office for Civil Rights and the 3 Deputy Assistant Secretary for Minority Health, shall 4 submit a report to the Committee on Health, Education, 5 Labor, and Pensions of the Senate and the Committee on 6 Energy and Commerce of the House of Representatives 7 that includes— 8 ‘‘(1) the number of cases filed, broken down by 9 category; 10 ‘‘(2) the number of cases investigated and 11 closed by the office; 12 ‘‘(3) the outcomes of cases investigated; 13 ‘‘(4) the staffing levels of the office including 14 staff credentials; 15 ‘‘(5) the number of other lingering and emerg- 16 ing cases in which civil rights inequities can be dem- 17 onstrated; and 18 ‘‘(6) the number of cases remaining open and 19 an explanation for their open status. 20 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 21 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 22 HEALTH AND HUMAN SERVICES AGENCIES. 23 ‘‘(a) IN GENERAL.—The Secretary shall establish 24 civil rights compliance offices in each agency within the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 549 •S 2474 IS Department of Health and Human Services that admin- 1 isters health programs. 2 ‘‘(b) PURPOSE OF OFFICES.—Each office established 3 under subsection (a) shall ensure that recipients of Fed- 4 eral financial assistance under Federal health programs 5 administer their programs, services, and activities in a 6 manner that— 7 ‘‘(1) does not discriminate, either intentionally 8 or in effect, on the basis of race, national origin, lan- 9 guage, ethnicity, sex, age, disability, sexual orienta- 10 tion, and gender identity; and 11 ‘‘(2) promotes the reduction and elimination of 12 disparities in health and health care based on race, 13 national origin, language, ethnicity, sex, age, dis- 14 ability, sexual orientation, and gender identity. 15 ‘‘(c) POWERS AND DUTIES.—The offices established 16 in subsection (a) shall have the following powers and du- 17 ties: 18 ‘‘(1) The establishment of compliance and pro- 19 gram participation standards for recipients of Fed- 20 eral financial assistance under each program admin- 21 istered by an agency within the Department of 22 Health and Human Services including the establish- 23 ment of disparity reduction standards to encompass 24 disparities in health and health care related to race, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 550 •S 2474 IS national origin, language, ethnicity, sex, age, dis- 1 ability, sexual orientation, and gender identity. 2 ‘‘(2) The development and implementation of 3 program-specific guidelines that interpret and apply 4 Department of Health and Human Services guid- 5 ance under title VI of the Civil Rights Act of 1964 6 and section 1557 of the Patient Protection and Af- 7 fordable Care Act to each Federal health program 8 administered by the agency. 9 ‘‘(3) The development of a disparity-reduction 10 impact analysis methodology that shall be applied to 11 every rule issued by the agency and published as 12 part of the formal rulemaking process under sections 13 555, 556, and 557 of title 5, United States Code. 14 ‘‘(4) Oversight of data collection, analysis, and 15 publication requirements for all recipients of Federal 16 financial assistance under each Federal health pro- 17 gram administered by the agency, and compliance 18 with the 1997 Office of Management and Budget 19 Standards for Maintaining, Collecting, and Pre- 20 senting Federal Data on Race and Ethnicity and the 21 available language standards. 22 ‘‘(5) The conduct of publicly available studies 23 regarding discrimination within Federal health pro- 24 grams administered by the agency as well as dis- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 551 •S 2474 IS parity reduction initiatives by recipients of Federal 1 financial assistance under Federal health programs. 2 ‘‘(6) Annual reports to the Committee on 3 Health, Education, Labor, and Pensions and the 4 Committee on Finance of the Senate and the Com- 5 mittee on Energy and Commerce and the Committee 6 on Ways and Means of the House of Representatives 7 on the progress in reducing disparities in health and 8 health care through the Federal programs adminis- 9 tered by the agency. 10 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 11 IN THE DEPARTMENT OF JUSTICE.— 12 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 13 SERVICES.—The Office for Civil Rights in the De- 14 partment of Health and Human Services shall pro- 15 vide standard-setting and compliance review inves- 16 tigation support services to the Civil Rights Compli- 17 ance Office for each agency. 18 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 19 for Civil Rights in the Department of Justice shall 20 continue to maintain the power to institute formal 21 proceedings when an agency Office for Civil Rights 22 determines that a recipient of Federal financial as- 23 sistance is not in compliance with the disparity re- 24 duction standards of the agency. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 552 •S 2474 IS ‘‘(e) DEFINITION.—In this section, the term ‘Federal 1 health programs’ mean programs— 2 ‘‘(1) under the Social Security Act (42 U.S.C. 3 301 et seq.) that pay for health care and services; 4 and 5 ‘‘(2) under this Act that provide Federal finan- 6 cial assistance for health care, biomedical research, 7 health services research, and programs designed to 8 improve the public’s health.’’. 9 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 10 Section 3 of the Civil Rights Commission Act of 1983 11 (42 U.S.C. 1975a) is amended— 12 (1) in paragraph (1), by striking ‘‘and’’ at the 13 end; 14 (2) in paragraph (2), by striking the period at 15 the end and inserting ‘‘; and’’; and 16 (3) by adding at the end the following: 17 ‘‘(3) shall, with respect to activities carried out 18 in health care and correctional facilities toward the 19 goal of eliminating health disparities between the 20 general population and members of racial or ethnic 21 minority groups, coordinate such activities of— 22 ‘‘(A) the Office for Civil Rights within the 23 Department of Justice; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 553 •S 2474 IS ‘‘(B) the Office of Justice Programs within 1 the Department of Justice; 2 ‘‘(C) the Office for Civil Rights within the 3 Department of Health and Human Services; 4 and 5 ‘‘(D) the Office of Minority Health within 6 the Department of Health and Human Services 7 (headed by the Deputy Assistant Secretary for 8 Minority Health).’’. 9 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 10 ING OF ACTIVITIES TO ELIMINATE RACIAL 11 AND ETHNIC HEALTH DISPARITIES. 12 (a) FINDINGS.—Congress makes the following find- 13 ings: 14 (1) The health status of the American populace 15 is declining and the United States currently ranks 16 below most industrialized nations in health status 17 measured by longevity, sickness, and mortality. 18 (2) Racial and ethnic minority populations tend 19 have the poorest health status and face substantial 20 cultural, social, and economic barriers to obtaining 21 quality health care. 22 (3) Efforts to improve minority health have 23 been limited by inadequate resources (funding, staff- 24 ing, and stewardship) and accountability. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 554 •S 2474 IS (b) SENSE OF CONGRESS.—It is the sense of Con- 1 gress that— 2 (1) funding should be doubled by fiscal year 3 2013 for the National Institute for Minority Health 4 Disparities, the Office of Civil Rights in the Depart- 5 ment of Health and Human Services, the National 6 Institute of Nursing Research, and the Office of Mi- 7 nority Health; 8 (2) adequate funding by fiscal year 2013, and 9 subsequent funding increases, should be provided for 10 health professions training programs, the Racial and 11 Ethnic Approaches to Community Health (REACH) 12 at the Centers for Disease Control and Prevention, 13 the Minority HIV/AIDS Initiative, and the Excel- 14 lence Centers to Eliminate Ethnic/Racial Disparities 15 (EXCEED) Program at the Agency for Healthcare 16 Research and Quality; 17 (3) funding should be restored to the Racial 18 and Ethnic Approaches to Community Health 19 (REACH) program at the Centers for Disease Con- 20 trol and Prevention, which has been a successful 21 program at the community health level; 22 (4) current and newly created health disparity 23 elimination incentives, programs, agencies, and de- 24 partments under this Act (and the amendments 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 555 •S 2474 IS made by this Act) should receive adequate staffing 1 and funding by fiscal year 2013; and 2 (5) stewardship and accountability should be 3 provided to the Congress and the President for 4 measurable and sustainable progress toward health 5 disparity elimination. 6 SEC. 906. GAO AND NIH REPORTS. 7 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 8 NIC DIVERSITY.— 9 (1) IN GENERAL.—The Comptroller General of 10 the United States shall conduct a study on the racial 11 and ethnic diversity among the following groups: 12 (A) All applicants for grants, contracts, 13 and cooperative agreements awarded by the Na- 14 tional Institutes of Health during the period be- 15 ginning January 1, 1990, and ending December 16 31, 2011. 17 (B) All recipients of such grants, con- 18 tracts, and cooperative agreements. 19 (C) All members of the peer review panels 20 of such applicants and recipients, respectively. 21 (2) REPORT.—Not later than six months after 22 the date of the enactment of this Act, the Comp- 23 troller General shall complete the study under para- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 556 •S 2474 IS graph (1) and submit to Congress a report con- 1 taining the results of such study. 2 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 3 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 4 DISPARITIES.—Not later than six months after the date 5 of the enactment of this Act, and biennially thereafter, the 6 Director of the National Institutes of Health, in collabora- 7 tion with the Director of the National Institute on Minor- 8 ity Health and Health Disparities, shall submit to Con- 9 gress a report that details and evaluates— 10 (1) the steps taken during the applicable report 11 period by the Director of the National Institutes of 12 Health to enforce the expanded planning, coordina- 13 tion, review, and evaluation authority provided the 14 National Institute on Minority Health and Health 15 Disparities under section 464z–3(h) of the Public 16 Health Service Act (42 U.S.C. 285(h)), as added by 17 section 10334(c) of the Patient Protection and Af- 18 fordable Care Act, over all minority health and 19 health disparity research that is conducted or sup- 20 ported by the Institutes and Centers at the National 21 Institutes of Health; and 22 (2) the outcomes of such steps. 23 (c) GAO REPORT RELATED TO RECIPIENTS OF 24 PPACA FUNDING.—Not later than one year after the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 557 •S 2474 IS date of the enactment of this Act and biennially thereafter 1 until 2020, the Comptroller General of the United States 2 shall submit to Congress a report that identifies, with re- 3 spect to minority community-based organizations that ap- 4 plied during the applicable report period for Federal fund- 5 ing provided pursuant to the provisions of (and amend- 6 ments made by) the Patient Protection and Affordable 7 Care Act for purposes of achieving health equity and elimi- 8 nating health disparities, the percentage of such organiza- 9 tions that were awarded such funding. 10 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 11 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 12 PARITIES.—The Director of the National Institute on Mi- 13 nority Health and Health Disparities shall prepare an an- 14 nual report on the activities carried out or to be carried 15 out by the Institute, and shall submit each such report 16 to the Committee on Health, Education, Labor, and Pen- 17 sions of the Senate, the Committee on Energy and Com- 18 merce of the House of Representatives, the Secretary of 19 Health and Human Services, and the Director of the Na- 20 tional Institutes of Health. With respect to the fiscal year 21 involved, the report shall— 22 (1) describe and evaluate the progress made in 23 health disparities research conducted or supported 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 558 •S 2474 IS by institutes and centers of the National Institutes 1 of Health; 2 (2) summarize and analyze expenditures made 3 for activities with respect to health disparities re- 4 search conducted or supported by the National Insti- 5 tutes of Health; 6 (3) include a separate statement applying the 7 requirements of paragraphs (1) and (2) specifically 8 to minority health disparities research; and 9 (4) contain such recommendations as the Direc- 10 tor of the Institute considers appropriate. 11 TITLE X—ADDRESSING SOCIAL 12 DETERMINANTS AND IM- 13 PROVING ENVIRONMENTAL 14 JUSTICE 15 SEC. 1001. CODIFICATION OF EXECUTIVE ORDER 12898. 16 (a) IN GENERAL.—The President of the United 17 States is authorized and directed to execute, administer, 18 and enforce as a matter of Federal law the provisions of 19 Executive Order 12898, dated February 11, 1994 (‘‘Fed- 20 eral Actions To Address Environmental Justice In Minor- 21 ity Populations and Low-Income Populations’’), with such 22 modifications as are provided in this section. 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 559 •S 2474 IS (b) DEFINITION OF ENVIRONMENTAL JUSTICE.—For 1 purposes of carrying out the provisions of Executive Order 2 12898, the following definitions shall apply: 3 (1) The term ‘‘environmental justice’’ means 4 the fair treatment and meaningful involvement of all 5 people regardless of race, color, national origin, edu- 6 cational level, or income with respect to the develop- 7 ment, implementation, and enforcement of environ- 8 mental laws and regulations in order to ensure 9 that— 10 (A) minority and low-income communities 11 have access to public information relating to 12 human health and environmental planning, reg- 13 ulations, and enforcement; and 14 (B) no minority or low-income population 15 is forced to shoulder a disproportionate burden 16 of the negative human health and environ- 17 mental impacts of pollution or other environ- 18 mental hazard. 19 (2) The term ‘‘fair treatment’’ means policies 20 and practices that ensure that no group of people, 21 including racial, ethnic, or socioeconomic groups 22 bear disproportionately high and adverse human 23 health or environmental effects resulting from Fed- 24 eral agency programs, policies, and activities. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 560 •S 2474 IS (c) JUDICIAL REVIEW AND RIGHTS OF ACTION.— 1 The provisions of section 6–609 of Executive Order 12898 2 shall not apply for purposes of this Act. 3 SEC. 1002. IMPLEMENTATION OF RECOMMENDATIONS BY 4 ENVIRONMENTAL PROTECTION AGENCY. 5 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 6 Administrator of the Environmental Protection Agency 7 shall, as promptly as practicable, carry out each of the 8 following recommendations of the Inspector General of the 9 agency as set forth in Report No. 2006–P–00034 entitled 10 ‘‘EPA needs to conduct environmental justice reviews of 11 its programs, policies and activities’’: 12 (1) The recommendation that the Agency’s pro- 13 gram and regional offices identify which programs, 14 policies, and activities need environmental justice re- 15 views and require these offices to establish a plan to 16 complete the necessary reviews. 17 (2) The recommendation that the Administrator 18 of the Agency ensure that these reviews determine 19 whether the programs, policies, and activities may 20 have a disproportionately high and adverse health or 21 environmental impact on minority and low-income 22 populations. 23 (3) The recommendation that each program 24 and regional office develop specific environmental 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 561 •S 2474 IS justice review guidance for conducting environmental 1 justice reviews. 2 (4) The recommendation that the Administrator 3 designate a responsible office to compile results of 4 environmental justice reviews and recommend appro- 5 priate actions. 6 (b) GAO RECOMMENDATIONS.—In developing rules 7 under laws administered by the Environmental Protection 8 Agency, the Administrator of the Agency shall, as prompt- 9 ly as practicable, carry out each of the following rec- 10 ommendations of the Comptroller General of the United 11 States as set forth in GAO Report numbered GAO–05– 12 289 entitled ‘‘EPA Should Devote More Attention to En- 13 vironmental Justice when Developing Clean Air Rules’’: 14 (1) The recommendation that the Administrator 15 ensure that workgroups involved in developing a rule 16 devote attention to environmental justice while draft- 17 ing and finalizing the rule. 18 (2) The recommendation that the Administrator 19 enhance the ability of such workgroups to identify 20 potential environmental justice issues through such 21 steps as providing workgroup members with guid- 22 ance and training to helping them identify potential 23 environmental justice problems and involving envi- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 562 •S 2474 IS ronmental justice coordinators in the workgroups 1 when appropriate. 2 (3) The recommendation that the Administrator 3 improve assessments of potential environmental jus- 4 tice impacts in economic reviews by identifying the 5 data and developing the modeling techniques needed 6 to assess such impacts. 7 (4) The recommendation that the Administrator 8 direct appropriate Agency officers and employees to 9 respond fully when feasible to public comments on 10 environmental justice, including improving the Agen- 11 cy’s explanation of the basis for its conclusions, to- 12 gether with supporting data. 13 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad- 14 ministrator of the Environmental Protection Agency shall, 15 as promptly as practicable, carry out each of the following 16 recommendations of the Inspector General of the Agency 17 as set forth in the report entitled ‘‘EPA Needs to Consist- 18 ently Implement the Intent of the Executive Order on En- 19 vironmental Justice’’ (Report No. 2004–P–00007): 20 (1) The recommendation that the Agency clear- 21 ly define the mission of the Office of Environmental 22 Justice (OEJ) and provide Agency staff with an un- 23 derstanding of the roles and responsibilities of the 24 Office. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 563 •S 2474 IS (2) The recommendation that the Agency estab- 1 lish (through issuing guidance or a policy statement 2 from the Administrator) specific time frames for the 3 development of definitions, goals, and measurements 4 regarding environmental justice and provide the re- 5 gions and program offices a standard and consistent 6 definition for a minority and low-income community, 7 with instructions on how the Agency will implement 8 and operationalize environmental justice into the 9 Agency’s daily activities. 10 (3) The recommendation that the Agency en- 11 sure the comprehensive training program currently 12 under development includes standard and consistent 13 definitions of the key environmental justice concepts 14 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor- 15 tionately impacted’’) and instructions for implemen- 16 tation of those concepts. 17 The Administrator shall submit an initial report to Con- 18 gress within 6 months after the enactment of this Act re- 19 garding the Administrator’s strategy for implementing the 20 recommendations referred to in paragraphs (1), (2), and 21 (3). Thereafter, the Administrator shall provide semi- 22 annual reports to Congress regarding the Administrator’s 23 progress in implementing such recommendations and 24 modifying the Administrator’s emergency management 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 564 •S 2474 IS procedures to incorporate environmental justice in the 1 Agency’s Incident Command Structure (in accordance 2 with the December 18, 2006, letter from the Deputy Ad- 3 ministrator to the Acting Inspector General of the Agen- 4 cy). 5 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 6 PROTECTING PEOPLE AND THEIR FAMILIES FROM 7 RADON.— 8 (1) IN GENERAL.—Because radon is a naturally 9 occurring radioactive gas that is recognized as the 10 leading cause of lung cancer among nonsmokers and 11 is a particular environmental threat for low-income 12 and minority individuals because of the lack of infor- 13 mation about radon levels in their own homes, the 14 Administrator of the Environmental Protection 15 Agency shall within 6 months after the date of the 16 enactment of this Act, implement the action plan en- 17 titled ‘‘Protecting People and Families from Radon: 18 A Federal Action Plan for Saving Lives’’ (June 20, 19 2011), working with the Secretary of Health and 20 Human Services acting through the Director of the 21 Centers for Disease Control and Prevention, and 22 with the other Federal agencies mentioned in and as 23 set forth in the action plan. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 565 •S 2474 IS (2) SPECIFIC STEPS.—In carrying out para- 1 graph (1), the Administrator shall take steps to 2 achieve each of the following: 3 (A) The recommendation that the 4 workgroup comprised of the Federal agencies 5 participating in the development of the action 6 plan referred to in paragraph (1) implement 7 specific steps within the current authority and 8 activities of each Federal agency to reduce ex- 9 posure to radon. 10 (B) The recommendation that such 11 workgroup meet on the 1-year anniversary of 12 the plan to assess and recognize achievements 13 of the plan. 14 (3) REPORT.—The Administrator shall report 15 to the Congress on the 1-year assessment of the 16 plan’s implementation, including the challenges re- 17 maining and the progress in reducing radon expo- 18 sure particularly to low-income and minority fami- 19 lies. 20 SEC. 1003. GRANT PROGRAM. 21 (a) DEFINITIONS.—In this section: 22 (1) DIRECTOR.—The term ‘‘Director’’ means 23 the Director of the Centers for Disease Control and 24 Prevention, acting in collaboration with the Adminis- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 566 •S 2474 IS trator of the Environmental Protection Agency and 1 the Director of the National Institute of Environ- 2 mental Health Sciences. 3 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 4 ty’’ means a State or local community that— 5 (A) bears a disproportionate burden of ex- 6 posure to environmental health hazards; 7 (B) has established a coalition— 8 (i) with not less than 1 community- 9 based organization; and 10 (ii) with not less than 1— 11 (I) public health entity; 12 (II) health care provider organi- 13 zation; or 14 (III) academic institution, includ- 15 ing any minority-serving institution 16 (including an Hispanic-serving institu- 17 tion, a historically Black college or 18 university, and a tribal college or uni- 19 versity); 20 (C) ensures planned activities and funding 21 streams are coordinated to improve community 22 health; and 23 (D) submits an application in accordance 24 with subsection (c). 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 567 •S 2474 IS (b) ESTABLISHMENT.—The Director shall establish a 1 grant program under which eligible entities shall receive 2 grants to conduct environmental health improvement ac- 3 tivities. 4 (c) APPLICATION.—To receive a grant under this sec- 5 tion, an eligible entity shall submit an application to the 6 Director at such time, in such manner, and accompanied 7 by such information as the Director may require. 8 (d) COOPERATIVE AGREEMENTS.—An eligible entity 9 may use a grant under this section— 10 (1) to promote environmental health; and 11 (2) to address environmental health disparities. 12 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 13 (1) IN GENERAL.—The Director shall award 14 grants to eligible entities at the 2 different funding 15 levels described in this subsection. 16 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 17 (A) IN GENERAL.—An eligible entity 18 awarded a grant under this paragraph shall use 19 the funds to identify environmental health prob- 20 lems and solutions by— 21 (i) establishing a planning and 22 prioritizing council in accordance with sub- 23 paragraph (B); and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 568 •S 2474 IS (ii) conducting an environmental 1 health assessment in accordance with sub- 2 paragraph (C). 3 (B) PLANNING AND PRIORITIZING COUN- 4 CIL.— 5 (i) IN GENERAL.—A prioritizing and 6 planning council established under sub- 7 paragraph (A)(i) (referred to in this para- 8 graph as a ‘‘PPC’’) shall assist the envi- 9 ronmental health assessment process and 10 environmental health promotion activities 11 of the eligible entity. 12 (ii) MEMBERSHIP.—Membership of a 13 PPC shall consist of representatives from 14 various organizations within public health, 15 planning, development, and environmental 16 services and shall include stakeholders 17 from vulnerable groups such as children, 18 the elderly, disabled, and minority ethnic 19 groups that are often not actively involved 20 in democratic or decisionmaking processes. 21 (iii) DUTIES.—A PPC shall— 22 (I) identify key stakeholders and 23 engage and coordinate potential part- 24 ners in the planning process; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 569 •S 2474 IS (II) establish a formal advisory 1 group to plan for the establishment of 2 services; 3 (III) conduct an in-depth review 4 of the nature and extent of the need 5 for an environmental health assess- 6 ment, including a local epidemiological 7 profile, an evaluation of the service 8 provider capacity of the community, 9 and a profile of any target popu- 10 lations; and 11 (IV) define the components of 12 care and form essential programmatic 13 linkages with related providers in the 14 community. 15 (C) ENVIRONMENTAL HEALTH ASSESS- 16 MENT.— 17 (i) IN GENERAL.—A PPC shall carry 18 out an environmental health assessment to 19 identify environmental health concerns. 20 (ii) ASSESSMENT PROCESS.—The 21 PPC shall— 22 (I) define the goals of the assess- 23 ment; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 570 •S 2474 IS (II) generate the environmental 1 health issue list; 2 (III) analyze issues with a sys- 3 tems framework; 4 (IV) develop appropriate commu- 5 nity environmental health indicators; 6 (V) rank the environmental 7 health issues; 8 (VI) set priorities for action; 9 (VII) develop an action plan; 10 (VIII) implement the plan; and 11 (IX) evaluate progress and plan- 12 ning for the future. 13 (D) EVALUATION.—Each eligible entity 14 that receives a grant under this paragraph shall 15 evaluate, report, and disseminate program find- 16 ings and outcomes. 17 (E) TECHNICAL ASSISTANCE.—The Direc- 18 tor may provide such technical and other non- 19 financial assistance to eligible entities as the 20 Director determines to be necessary. 21 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 22 (A) ELIGIBILITY.— 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 571 •S 2474 IS (i) IN GENERAL.—The Director shall 1 award grants under this paragraph to eli- 2 gible entities that have already— 3 (I) established broad-based col- 4 laborative partnerships; and 5 (II) completed environmental as- 6 sessments. 7 (ii) NO LEVEL 1 REQUIREMENT.—To 8 be eligible to receive a grant under this 9 paragraph, an eligible entity is not re- 10 quired to have successfully completed a 11 Level 1 Cooperative Agreement (as de- 12 scribed in paragraph (2)). 13 (B) USE OF GRANT FUNDS.—An eligible 14 entity awarded a grant under this paragraph 15 shall use the funds to further activities to carry 16 out environmental health improvement activi- 17 ties, including— 18 (i) addressing community environ- 19 mental health priorities in accordance with 20 paragraph (2)(C)(ii), including— 21 (I) air quality; 22 (II) water quality; 23 (III) solid waste; 24 (IV) land use; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 572 •S 2474 IS (V) housing; 1 (VI) food safety; 2 (VII) crime; 3 (VIII) injuries; and 4 (IX) health care services; 5 (ii) building partnerships between 6 planning, public health, and other sectors, 7 to address how the built environment im- 8 pacts food availability and access and 9 physical activity to promote healthy behav- 10 iors and lifestyles and reduce overweight 11 and obesity, asthma, respiratory condi- 12 tions, dental, oral and mental health condi- 13 tions, poverty, and related co-morbidities; 14 (iii) establishing programs to ad- 15 dress— 16 (I) how environmental and social 17 conditions of work and living choices 18 influence physical activity and dietary 19 intake; or 20 (II) how those conditions influ- 21 ence the concerns and needs of people 22 who have impaired mobility and use 23 assistance devices, including wheel- 24 chairs and lower limb prostheses; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 573 •S 2474 IS (iv) convening intervention programs 1 that examine the role of the social environ- 2 ment in connection with the physical and 3 chemical environment in— 4 (I) determining access to nutri- 5 tional food; and 6 (II) improving physical activity to 7 reduce morbidity and increase quality 8 of life. 9 SEC. 1004. ADDITIONAL RESEARCH ON THE RELATIONSHIP 10 BETWEEN THE BUILT ENVIRONMENT AND 11 THE HEALTH OF COMMUNITY RESIDENTS. 12 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 13 section, the term ‘‘eligible institution’’ means a public or 14 private nonprofit institution that submits to the Secretary 15 of Health and Human Services (in this section referred 16 to as the ‘‘Secretary’’) and the Administrator of the Envi- 17 ronmental Protection Agency (in this section referred to 18 as the ‘‘Administrator’’) an application for a grant under 19 the grant program authorized under subsection (b)(2) at 20 such time, in such manner, and containing such agree- 21 ments, assurances, and information as the Secretary and 22 Administrator may require. 23 (b) RESEARCH GRANT PROGRAM.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 574 •S 2474 IS (1) DEFINITION OF HEALTH.—In this section, 1 the term ‘‘health’’ includes— 2 (A) levels of physical activity; 3 (B) consumption of nutritional foods; 4 (C) rates of crime; 5 (D) air, water, and soil quality; 6 (E) risk of injury; 7 (F) accessibility to health care services; 8 and 9 (G) other indicators as determined appro- 10 priate by the Secretary. 11 (2) GRANTS.—The Secretary, in collaboration 12 with the Administrator, shall provide grants to eligi- 13 ble institutions to conduct and coordinate research 14 on the built environment and its influence on indi- 15 vidual and population-based health. 16 (3) RESEARCH.—The Secretary shall support 17 research that— 18 (A) investigates and defines the causal 19 links between all aspects of the built environ- 20 ment and the health of residents; 21 (B) examines— 22 (i) the extent of the impact of the 23 built environment (including the various 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 575 •S 2474 IS characteristics of the built environment) on 1 the health of residents; 2 (ii) the variance in the health of resi- 3 dents by— 4 (I) location (such as inner cities, 5 inner suburbs, and outer suburbs); 6 and 7 (II) population subgroup (such as 8 children, the elderly, the disadvan- 9 taged); or 10 (iii) the importance of the built envi- 11 ronment to the total health of residents, 12 which is the primary variable of interest 13 from a public health perspective; 14 (C) is used to develop— 15 (i) measures to address health and the 16 connection of health to the built environ- 17 ment; and 18 (ii) efforts to link the measures to 19 travel and health databases; and 20 (D) distinguishes carefully between per- 21 sonal attitudes and choices and external influ- 22 ences on observed behavior to determine how 23 much an observed association between the built 24 environment and the health of residents, versus 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 576 •S 2474 IS the lifestyle preferences of the people that 1 choose to live in the neighborhood, reflects the 2 physical characteristics of the neighborhood; 3 and 4 (E)(i) identifies or develops effective inter- 5 vention strategies to promote better health 6 among residents with a focus on behavioral 7 interventions and enhancements of the built en- 8 vironment that promote increased use by resi- 9 dents; and 10 (ii) in developing the intervention strate- 11 gies under clause (i), ensures that the interven- 12 tion strategies will reach out to high-risk popu- 13 lations, including racial and ethnic minorities 14 and low-income urban and rural communities. 15 (4) PRIORITY.—In providing assistance under 16 the grant program authorized under paragraph (2), 17 the Secretary and the Administrator shall give pri- 18 ority to research that incorporates— 19 (A) minority-serving institutions as grant- 20 ees; 21 (B) interdisciplinary approaches; or 22 (C) the expertise of the public health, 23 physical activity, urban planning, and transpor- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 577 •S 2474 IS tation research communities in the United 1 States and abroad. 2 SEC. 1005. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 3 TION. 4 (a) FINDINGS.— 5 (1) GENERAL FINDINGS.—The Congress finds 6 as follows: 7 (A) As human beings, we share our envi- 8 ronment with a wide variety of habitats and 9 ecosystems that nurture and sustain a diversity 10 of species. 11 (B) The abundance of natural resources in 12 our environment forms the basis for our econ- 13 omy and has greatly contributed to human de- 14 velopment throughout history. 15 (C) The accelerated pace of human devel- 16 opment over the last several hundred years has 17 significantly impacted our natural environment 18 and its resources, the health and diversity of 19 plant and animal wildlife, the availability of 20 critical habitats, the quality of our air and our 21 water, and our global climate. 22 (D) The intervention of the Federal Gov- 23 ernment is necessary to minimize and mitigate 24 human impact on the environment for the ben- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 578 •S 2474 IS efit of public health, to maintain air quality and 1 water quality, to sustain the diversity of plants 2 and animals, to combat global climate change, 3 and to protect the environment. 4 (E) Laws and regulations in the United 5 States have been created and promulgated to 6 minimize and mitigate human impact on the en- 7 vironment for the benefit of public health, to 8 maintain air quality and water quality, to sus- 9 tain wildlife, and to protect the environment. 10 (F) Such laws include the Antiquities Act 11 of 1906 (16 U.S.C. 431 et seq.) initiated by 12 President Theodore Roosevelt to create the na- 13 tional park system, the National Environmental 14 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 15 the Clean Air Act (42 U.S.C. 7401 et seq.), the 16 Federal Water Pollution Control Act (33 U.S.C. 17 1251 et seq.), the Comprehensive Environ- 18 mental Response, Compensation, and Liability 19 Act of 1980 (Public Law 96–510), the Endan- 20 gered Species Act of 1973 (Public Law 93– 21 205), and the National Forest Management Act 22 of 1976 (Public Law 94–588). 23 (G) Attempts to repeal or weaken key envi- 24 ronmental safeguards pose dangers to the pub- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 579 •S 2474 IS lic health, air quality, water quality, wildlife, 1 and the environment. 2 (2) FINDINGS ON CHANGES AND PROPOSED 3 CHANGES IN LAW.—The Congress finds that, since 4 2001, the following changes and proposed changes 5 to existing law or regulations have negatively im- 6 pacted or will negatively impact the environment and 7 public health: 8 (A) CLEAN WATER.— 9 (i) On May 9, 2002, the Environ- 10 mental Protection Agency (EPA) and the 11 Army Corps of Engineers put forth a final 12 rule that reconciled regulations imple- 13 menting section 404 of the Federal Water 14 Pollution Control Act by redefining the 15 term ‘‘fill material’’ and amending the def- 16 inition of the term ‘‘discharge of fill mate- 17 rial’’, reversing a 25-year-old regulation. 18 The new rule fails to restrict the dumping 19 of hardrock mining waste, construction de- 20 bris, and other industrial wastes into riv- 21 ers, streams, lakes, and wetlands. The rule 22 further allows destructive mountaintop re- 23 moval coal mining companies to dump 24 waste into streams and lakes, polluting the 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 580 •S 2474 IS surrounding natural habitat and poisoning 1 plants and animals that depend on those 2 water sources. 3 (ii) On February 12, 2003, the Envi- 4 ronmental Protection Agency published the 5 rule ‘‘National Pollutant Discharge Elimi- 6 nation System Permit Regulation and Ef- 7 fluent Limitation Guidelines and Stand- 8 ards for Concentrated Animal Feeding Op- 9 erations’’, new livestock waste regulations 10 that aimed to control factory farm pollu- 11 tion but which would severely undermine 12 existing protections under the Federal 13 Water Pollution Control Act. This regula- 14 tion allows large-scale animal factories to 15 foul the Nation’s waters with animal 16 waste, allows livestock owners to draft 17 their own pollution-management plans and 18 avoid ground water monitoring, legalizes 19 the discharge of contaminated runoff water 20 rich in nitrogen, phosphorus, bacteria, and 21 metals, and ensures that large factory 22 farms are not held liable for the environ- 23 mental damage they cause. In a 2005 Fed- 24 eral court decision (‘‘Waterkeeper Alliance, 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 581 •S 2474 IS et al. v. Environmental Protection Agen- 1 cy’’, 399 F.3d 486 (2nd Cir. 2005)), major 2 parts of the rule were upheld, others va- 3 cated, and still others remanded back to 4 the EPA. On November 20, 2008, the En- 5 vironmental Protection Agency published a 6 revised final rule which undermines envi- 7 ronmental protection provisions by remov- 8 ing mandatory permitting requirements 9 and allowing large animal farms to self- 10 certify the absence of pollutant discharge 11 activity. 12 (iii) On March 19, 2003, the Environ- 13 mental Protection Agency published a new 14 rule regarding the Total Maximum Daily 15 Load program of the Federal Water Pollu- 16 tion Control Act that regulates the max- 17 imum amount of a particular pollutant 18 that can be present in a body of water and 19 still meet water quality standards. The new 20 rule withdrew the existing regulation put 21 forth on July 13, 2000, and halted mo- 22 mentum in cleaning up polluted waterways 23 throughout the Nation. By abandoning the 24 existing rule, the Environmental Protection 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 582 •S 2474 IS Agency is undermining the effectiveness of 1 clean-up plans and is allowing States to 2 avoid cleaning polluted waters entirely by 3 dropping them from their clean-up lists. 4 Waterways play a crucial role in the lives 5 of the people of the United States and are 6 critical to the livelihood of fish and wildlife. 7 The result of dropping the July 2000 rule 8 is that the restoration of polluted rivers, 9 shorelines, and lakes will be delayed, harm- 10 ing more fish and wildlife and worsening 11 the quality of drinking water. 12 (iv) On December 2, 2008, the Envi- 13 ronmental Protection Agency and the 14 Army Corps of Engineers jointly issued a 15 guidance document in the form of a legal 16 memorandum, titled ‘‘Clean Water Act Ju- 17 risdiction Following the U.S. Supreme 18 Court’s Decision in Rapanos v. United 19 States & Carabell v. United States’’. This 20 new guidance dictates enforcement actions 21 under the Federal Water Pollution Control 22 Act and calls for a complicated ‘‘case-by- 23 case’’ analysis to determine jurisdiction for 24 waterways that do not flow all year. Such 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 583 •S 2474 IS actions endanger small streams and wet- 1 lands that serve as important habitats for 2 aquatic life, which play a fundamental role 3 in safeguarding sources of clean drinking 4 water and mitigate the risks and effects of 5 floods and droughts. Further, the defini- 6 tion provided therein for ‘‘waters of the 7 United States’’ is applicable to the Federal 8 Water Pollution Control Act as a whole, 9 potentially affecting programs that control 10 industrial pollution and sewage levels, pre- 11 vent oil spills, and set water quality stand- 12 ards for all waters in the United States 13 protected under the Federal Water Pollu- 14 tion Control Act. 15 (B) FORESTS AND LAND MANAGEMENT.— 16 (i) On December 3, 2003, the Presi- 17 dent signed into law the Healthy Forests 18 Restoration Act of 2003 (Public Law 108– 19 148; 16 U.S.C. 6501 et seq.). Although the 20 law attempts to reduce the risk of cata- 21 strophic forest fires, it provides a boon to 22 timber companies by accelerating the ag- 23 gressive thinning of backcountry forests 24 that are far from at-risk communities. The 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 584 •S 2474 IS law allows for increased logging of large, 1 fire-resistant trees that are not in close 2 proximity of homes and communities; it 3 undermines critical protections for endan- 4 gered species by exempting Federal land 5 management agencies from consulting with 6 the United States Fish and Wildlife Serv- 7 ice before approving any action that could 8 harm endangered plants or wildlife; and it 9 limits public participation by reducing the 10 number of environmental project reviews. 11 (ii) On April 21, 2008, the Depart- 12 ment of Agriculture issued a Final Plan- 13 ning Rule and Record of Decision for Na- 14 tional Forest System Land Management 15 Planning. Similar to rules enacted by the 16 Administration on January 5, 2005, later 17 remanded back to the agency in Federal 18 district court for violating the National 19 Environmental Policy Act of 1969, the En- 20 dangered Species Act of 1973, and the Ad- 21 ministrative Procedure Act (‘‘Citizens for 22 Better Forestry v. United States Depart- 23 ment of Agriculture’’, 481 F. Supp. 2d 24 1059 (N.D. Cal. 2007)), this revised rule 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 585 •S 2474 IS eliminates strict forest planning standards 1 established in 1982, and opens millions of 2 acres of public lands to damaging and 3 invasive logging, mining, and drilling oper- 4 ations. These regulations would reverse 5 more than 20 years of protection for wild- 6 life and national forests by removing the 7 overall goal of ensuring ecological sustain- 8 ability in managing the national forest sys- 9 tem, weakening the National Forest Man- 10 agement Act of 1976, and effectively end- 11 ing the review of forest management plans 12 under the National Environmental Policy 13 Act of 1969. 14 (iii) On September 20, 2006, the Dis- 15 trict Court for the Northern District of 16 California vacated the Protection of Inven- 17 toried Roadless Areas rule, enacted on May 18 13, 2005, which gave State Governors 18 19 months to petition the Federal Government 20 to either restore the previous rule for their 21 States, or submit a new management and 22 development plan for national forest areas 23 inventoried under the rule. Despite the 24 enjoinment of the Administration’s 2005 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 586 •S 2474 IS rule, and the subsequent restoration of the 1 original Roadless Area Conservation Rule, 2 the U.S. Forest Service has continued to 3 allow States to petition for a special rule 4 under the authority of the Administrative 5 Procedure Act, publishing a final special 6 rule for Idaho on October 16, 2008. As a 7 result, 58.5 million acres of wild national 8 forests are still vulnerable to logging, road 9 building, and other developments that may 10 fragment natural habitats and negatively 11 impact fish and wildlife. 12 (iv) On November 17, 2008, the De- 13 partment of the Interior’s Bureau of Land 14 Management (BLM) signed the Record of 15 Decision (ROD) amending 12 resource 16 management plans in Colorado, Utah, and 17 Wyoming, opening 2,000,000 acres of pub- 18 lic lands to commercial tar sands and oil 19 shale exploration and development. On No- 20 vember 18, 2008, the BLM published a 21 final rule for Oil Shale Management set- 22 ting the policies and procedures for a com- 23 mercial leasing program for the manage- 24 ment of federally owned oil shale in those 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 587 •S 2474 IS three States. Previously barred by a con- 1 gressional moratorium on the commercial 2 leasing regulations for oil shale until Sep- 3 tember 30, 2008, the development of oil 4 shale on public lands poses a serious threat 5 to land conservation, endangered and 6 threatened species, and critical habitat. 7 Domestic shale oil production allowed by 8 these regulations is highly water and en- 9 ergy intensive, the impacts of which will in- 10 tensify existing water scarcity in the arid 11 Western Region and potentially degrade 12 air and water quality for surrounding pop- 13 ulations. 14 (C) SCIENTIFIC REVIEW.—On December 15 16, 2008, the United States Fish and Wildlife 16 Service of the Department of the Interior and 17 the National Oceanic and Atmospheric Admin- 18 istration of the Department of Commerce joint- 19 ly issued a new rule amending regulations gov- 20 erning interagency cooperation under section 7 21 of the Endangered Species Act of 1973 (ESA). 22 This rule undermines the intention of the ESA 23 to protect species and the ecosystems upon 24 which they depend by allowing Federal agencies 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 588 •S 2474 IS to carry out, permit, or fund an action without 1 proper environmental review and expert third- 2 party consultation from Federal wildlife ex- 3 perts. Under this new rule, Federal agencies 4 can unilaterally circumvent the formal review 5 process, eliminating longstanding and scientif- 6 ically grounded safeguards that serve to protect 7 the biodiversity of our Nation’s ecosystems and 8 avert harm to thousands of endangered and 9 threatened species. 10 (b) STATEMENT OF POLICY.—It is the policy of the 11 United States Government to work in conjunction with 12 States, territories, tribal governments, international orga- 13 nizations, and foreign governments in order to act as a 14 steward of the environment for the benefit of public 15 health, to maintain air quality and water quality, to sus- 16 tain the diversity of plant and animal species, to combat 17 global climate change, and to protect the environment for 18 future generations to enjoy. 19 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 20 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 21 TIONS, LAWS, OR PROPOSED LAWS.— 22 (1) STUDY.—Not later than 30 days after the 23 date of enactment of this Act, the President shall 24 enter into an arrangement under which the National 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 589 •S 2474 IS Academy of Sciences will conduct a study to deter- 1 mine the impact on public health, air quality, water 2 quality, wildlife, and the environment of the fol- 3 lowing regulations, laws, and proposed laws: 4 (A) CLEAN WATER.— 5 (i) Final revisions to the Federal 6 Water Pollution Control Act regulatory 7 definitions of ‘‘fill material’’ and ‘‘dis- 8 charge of fill material’’, finalized and pub- 9 lished in the Federal Register on May 9, 10 2002 (67 FR 31129), amending part 232 11 of title 40, Code of Federal Regulations. 12 (ii) Revised National Pollutant Dis- 13 charge Elimination System Permit Regula- 14 tion and Effluent Limitation Guidelines 15 and Standards for Concentrated Animal 16 Feeding Operations in response to the 17 ‘‘Waterkeeper Alliance, et al. v. Environ- 18 mental Protection Agency’’ decision, final- 19 ized and published in the Federal Register 20 on November 20, 2008 (73 FR 225), 21 amending parts 9, 122, and 412 of title 22 40, Code of Federal Regulations. 23 (iii) A March 19, 2003, rule published 24 in the Federal Register (68 FR 13608) 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 590 •S 2474 IS withdrawing a July 13, 2000, rule revising 1 the Total Maximum Daily Load program 2 of the Federal Water Pollution Control Act 3 (65 FR 43586), amending parts 9, 122, 4 123, 124, and 130 of title 40, Code of 5 Federal Regulations. 6 (iv) Official Guidance Document, 7 ‘‘Clean Water Act Jurisdiction Following 8 the United States Supreme Court’s Deci- 9 sion in Rapanos v. United States & 10 Carabell v. United States’’, issued on De- 11 cember 2, 2008, relating to jurisdiction 12 under section 404 of the Federal Water 13 Pollution Control Act. 14 (B) FORESTS AND LAND MANAGEMENT.— 15 (i) Healthy Forests Restoration Act of 16 2003, signed into law on December 3, 17 2003 (Public Law 108–148; 16 U.S.C. 18 6501 et seq.). 19 (ii) National Forest System Land 20 Management Planning Rule, finalized and 21 published in the Federal Register on April 22 21, 2008 (73 FR 21468), replacing the 23 2005 final rule (70 FR 1022, Jan. 5, 24 2005), as amended March 3, 2006 (71 FR 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 591 •S 2474 IS 10837) and the 2000 final rule adopted on 1 November 9, 2000 (65 FR 67514) as 2 amended on September 29, 2004 (69 FR 3 58055), amending title 36, Code of Fed- 4 eral Regulations, part 219. 5 (iii) The application of the Adminis- 6 trative Procedure Act (5 U.S.C. 551 to 7 559, 701 to 706, et seq.), such that States 8 may petition for a special rule for the 9 roadless areas in all or part of said State. 10 (iv) Record of Decision, ‘‘Oil Shale 11 and Tar Sands Resources Resource Man- 12 agement Plan Amendments’’, issued on 13 November 17, 2008, along with the Final 14 Rule, Oil Shale Management-General, pub- 15 lished in the Federal Register on Novem- 16 ber 18, 2008 (73 FR 223), amending title 17 43, Code of Federal Regulations, parts 18 3900, 3910, 3920, and 3930. 19 (C) SCIENTIFIC REVIEW.—Final Rule, 20 Interagency Cooperation Under the Endangered 21 Species Act, published in the Federal Register 22 on December 16, 2008, amending title 50, Code 23 of Federal Regulations, part 402. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 592 •S 2474 IS (2) METHOD.—In conducting the study under 1 paragraph (1), the National Academy of Sciences 2 may utilize and compare existing scientific studies 3 regarding the regulations, laws, and proposed laws 4 listed in paragraph (1). 5 (3) REPORT.—Under the arrangement entered 6 into under paragraph (1), not later than 270 days 7 after the date on which such arrangement is entered 8 into, the National Academy of Sciences shall make 9 publicly available and shall submit to the Congress 10 and to the head of each department and agency of 11 the Federal Government that issued, implements, or 12 would implement a regulation, law, or proposed law 13 listed in paragraph (1), a report containing— 14 (A) a description of the impact of all such 15 regulations, laws, and proposed laws on public 16 health, air quality, water quality, wildlife, and 17 the environment, compared to the impact of 18 preexisting regulations, or laws in effect, includ- 19 ing— 20 (i) any negative impacts to air quality 21 or water quality; 22 (ii) any negative impacts to wildlife; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 593 •S 2474 IS (iii) any delays in hazardous waste 1 cleanup that are projected to be hazardous 2 to public health; and 3 (iv) any other negative impact on pub- 4 lic health or the environment; and 5 (B) any recommendations that the Na- 6 tional Academy of Sciences considers appro- 7 priate to maintain, restore, or improve in whole 8 or in part protections for public health, air 9 quality, water quality, wildlife, and the environ- 10 ment for each of the regulations, laws, and pro- 11 posed laws listed in paragraph (1), which may 12 include recommendations for the adoption of 13 any regulation or law in place or proposed prior 14 to January 1, 2001. 15 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 16 ING RULES, REGULATIONS, OR LAWS.—Not later than 17 180 days after the date on which the report is submitted 18 pursuant to subsection (c)(3), the head of each depart- 19 ment and agency that has issued or implemented a regula- 20 tion or law listed in subsection (c)(1) shall submit to the 21 Congress a plan describing the steps such department or 22 such agency will take, or has taken, to restore or improve 23 protections for public health and the environment in whole 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 594 •S 2474 IS or in part that were in existence prior to the issuance of 1 such regulation or law. 2 SEC. 1006. HEALTHY FOOD FINANCING INITIATIVE. 3 (a) IN GENERAL.—Subtitle D of the Department of 4 Agriculture Reorganization Act of 1994 (7 U.S.C. 6951) 5 is amended by adding at the end the following: 6 ‘‘SEC. 242. HEALTHY FOOD FINANCING INITIATIVE. 7 ‘‘(a) PURPOSE.—The purpose of this section is to es- 8 tablish a program to improve access to healthy foods in 9 underserved areas, to create and preserve quality jobs, and 10 to revitalize low-income communities by providing loans 11 and grants to eligible fresh, healthy food retailers to over- 12 come the higher costs and initial barriers to entry in un- 13 derserved, urban, suburban, and rural areas. 14 ‘‘(b) DEFINITIONS.—In this section: 15 ‘‘(1) COMMUNITY DEVELOPMENT FINANCIAL IN- 16 STITUTION.—The term ‘community development fi- 17 nancial institution’ has the meaning given the term 18 in section 103 of the Community Development 19 Banking and Financial Institutions Act of 1994 (12 20 U.S.C. 4702). 21 ‘‘(2) FOOD ACCESS ORGANIZATION.—The term 22 ‘food access organization’ means a nonprofit organi- 23 zation with expertise in improving access to healthy 24 food in underserved communities. 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 595 •S 2474 IS ‘‘(3) INITIATIVE.—The term ‘Initiative’ means 1 the Healthy Food Financing Initiative established in 2 the Department by subsection (c)(1). 3 ‘‘(4) LOCAL FUNDS.—The term ‘local funds’ 4 means the allocation of national funds and any other 5 forms of financial assistance (including grants, 6 loans, and equity investments) that are raised by 7 partnerships to carry out the purposes of this sec- 8 tion. 9 ‘‘(5) NATIONAL FUNDS.—The term ‘national 10 funds’ means any Federal appropriation made to 11 carry out this section and any other forms of finan- 12 cial assistance (including grants, loans, and equity 13 investments) that are raised by the national fund 14 manager to carry out the purposes of this section. 15 ‘‘(6) NATIONAL FUND MANAGER.—The term 16 ‘national fund manager’ means a community devel- 17 opment financial institution in existence as of the 18 date of enactment of this section and certified by the 19 Community Development Financial Institutions 20 Fund of the Department of the Treasury that is des- 21 ignated by the Secretary to manage the Initiative for 22 purposes of— 23 ‘‘(A) raising private capital; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 596 •S 2474 IS ‘‘(B) providing financial and technical as- 1 sistance to partnerships; and 2 ‘‘(C) funding eligible projects directly at 3 the request of partnerships to attract fresh, 4 healthy food retailers to underserved urban, 5 suburban, and rural areas, in accordance with 6 this section. 7 ‘‘(7) PARTNERSHIP.— 8 ‘‘(A) IN GENERAL.—The term ‘partner- 9 ship’ means a regional, State, or local public 10 and private partnership that is organized to im- 11 prove access to fresh, healthy foods by pro- 12 viding financial and technical assistance to eli- 13 gible projects. 14 ‘‘(B) INCLUSIONS.—The term ‘partnership’ 15 includes— 16 ‘‘(i) an unit of State, local, or tribal 17 government or a quasi-public State or local 18 government agency; 19 ‘‘(ii) a food access or community 20 health organization committed to improv- 21 ing access to healthy foods; 22 ‘‘(iii) a community development finan- 23 cial institution or other organization that 24 is capable of administering a loan and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 597 •S 2474 IS grant program in accordance with this sec- 1 tion; and 2 ‘‘(iv) other organizations interested in 3 improving access to healthy foods in under- 4 served areas. 5 ‘‘(c) ESTABLISHMENT.— 6 ‘‘(1) IN GENERAL.—There is established in the 7 Department a Healthy Food Financing Initiative. 8 ‘‘(2) MANAGEMENT.—Not later than 1 year 9 after the date of enactment of this section, the Sec- 10 retary shall select and enter into a grant agreement 11 with a national fund manager who shall be respon- 12 sible for the management of the Initiative nationally. 13 ‘‘(3) ELIGIBLE PROJECTS.— 14 ‘‘(A) IN GENERAL.—Subject to the re- 15 quirements of this paragraph, the national fund 16 manager shall establish the eligibility criteria 17 for projects to be assisted by the Initiative. 18 ‘‘(B) REQUIREMENTS.—To be eligible to 19 receive assistance through the Initiative, a 20 project shall— 21 ‘‘(i) include a supermarket, grocery 22 store, farmers market, or other fresh, 23 healthy food retailer; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 598 •S 2474 IS ‘‘(ii) consist of a for-profit business 1 enterprise, a member- or worker-owned co- 2 operative, or a nonprofit organization; 3 ‘‘(iii) meet the eligibility criteria es- 4 tablished under this section; 5 ‘‘(iv) continue to be a viable business 6 enterprise with a financial viability plan; 7 ‘‘(v) require an investment of public 8 funding to move forward and be competi- 9 tive; 10 ‘‘(vi) operate on a self-service basis; 11 ‘‘(vii) in accordance with subpara- 12 graph (C), expand or preserve the avail- 13 ability of healthy, fresh, high quality un- 14 prepared and unprocessed foods, particu- 15 larly fresh fruits and vegetables, in under- 16 served areas; and 17 ‘‘(viii) agree to accept benefits under 18 the supplemental nutrition assistance pro- 19 gram established under the Food and Nu- 20 trition Act of 2008 (7 U.S.C. 2011 et 21 seq.). 22 ‘‘(C) REQUIREMENTS.— 23 ‘‘(i) DEFINITIONS.—In this subpara- 24 graph: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 599 •S 2474 IS ‘‘(I) PERISHABLE FOOD.— 1 ‘‘(aa) IN GENERAL.—The 2 term ‘perishable food’ means food 3 that is fresh, refrigerated, or fro- 4 zen. 5 ‘‘(bb) EXCLUSION.—The 6 term ‘perishable food’ does not 7 include packaged or canned 8 goods. 9 ‘‘(II) STAPLE FOOD.— 10 ‘‘(aa) IN GENERAL.—The 11 term ‘staple food’ means food 12 that is a basic dietary item, in- 13 cluding bread, flour, fruits, vege- 14 tables, and meat. 15 ‘‘(bb) EXCLUSIONS.—The 16 term ‘staple food’ does not in- 17 clude snack or accessory food 18 (such as chips, soda, coffee, con- 19 diments, and spices) or ready-to- 20 eat, prepared food. 21 ‘‘(III) VARIETY.—The term ‘vari- 22 ety’ means an assortment of different 23 types of food items. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 600 •S 2474 IS ‘‘(ii) IN GENERAL.—For purposes of 1 subparagraph (B)(vii), to expand or pre- 2 serve the availability of fresh fruits and 3 vegetables in underserved areas shall 4 mean, with respect to a project, that the 5 project maintains a store that— 6 ‘‘(I) carries a full line of fresh 7 produce, as defined by the national 8 fund manager to reflect differences in 9 project size and overall store size; 10 ‘‘(II) sells food for home prepara- 11 tion and consumption; and 12 ‘‘(III) at a minimum— 13 ‘‘(aa) offers for sale at least 14 3 different varieties of food in 15 each of the 4 staple food groups 16 (bread and grains, dairy, fruits 17 and vegetables, and meat, poul- 18 try, and fish), with perishable 19 food in at least 2 categories, on 20 a daily basis; or 21 ‘‘(bb) has a store at which 22 at least 50 percent of the total 23 sales of the store (including food 24 and nonfood items or services) 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 601 •S 2474 IS are from the sale of eligible sta- 1 ple food. 2 ‘‘(D) INCOME CRITERIA.—Each eligible 3 project shall be located in— 4 ‘‘(i) a low- or moderate-income census 5 tract, as determined by the Bureau of the 6 Census of the Department of Commerce; 7 ‘‘(ii) a population census tract that is 8 treated as a low-income community under 9 section 45D(e) of the Internal Revenue 10 Code of 1986; or 11 ‘‘(iii) an area that significantly serves 12 an adjacent area that meets the criteria 13 described in clause (i) or (ii), as approved 14 by the national fund manager. 15 ‘‘(E) UNDERSERVED CRITERIA.— 16 ‘‘(i) IN GENERAL.—Each eligible 17 project shall be located in an underserved 18 area, as determined by the partnerships 19 according to criteria established by the na- 20 tional fund manager. 21 ‘‘(ii) FACTORS.—In determining 22 whether an area is an underserved area, 23 the following factors shall be taken into 24 consideration: 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 602 •S 2474 IS ‘‘(I) Population density. 1 ‘‘(II) Below average supermarket 2 density or sales. 3 ‘‘(III) Car ownership. 4 ‘‘(IV) Geographical or physical 5 barriers, such as highways, moun- 6 tains, major parks, or bodies of water. 7 ‘‘(iii) LOCATIONS.—On an annual 8 basis, the national fund manager shall col- 9 lect data and publish maps that show the 10 location of underserved areas. 11 ‘‘(4) PRIORITY PROJECTS.— 12 ‘‘(A) IN GENERAL.—Priority shall be given 13 to projects that— 14 ‘‘(i) are located in severely distressed 15 low-income communities, as defined by the 16 Community Development Financial Insti- 17 tutions Fund of the Department of the 18 Treasury; and 19 ‘‘(ii) include 1 or more of the fol- 20 lowing characteristics: 21 ‘‘(I) The project will create or re- 22 tain quality jobs in the community, as 23 determined in accordance with sub- 24 paragraph (B). 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 603 •S 2474 IS ‘‘(II) The project has community 1 support in terms of store quality, af- 2 fordability, site location, and coordina- 3 tion with local community plans or 4 other programs promoting community 5 and economic development. 6 ‘‘(III) The project supports re- 7 gional food systems and locally grown 8 foods, to the extent available. 9 ‘‘(IV) In major metropolitan 10 areas, the project is associated with a 11 transit-oriented development project. 12 ‘‘(V) In areas with public transit, 13 the project is accessible by public 14 transit. 15 ‘‘(VI) The project involves the 16 reuse of a building that is listed in or 17 eligible for the National Register of 18 Historic Places. 19 ‘‘(VII) The project involves a 20 brownfield or grayfield (as those 21 terms are used in the Comprehensive 22 Environmental Response, Compensa- 23 tion, and Liability Act of 1980 (42 24 U.S.C. 9601 et seq.)). 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 604 •S 2474 IS ‘‘(VIII) The estimated energy 1 consumption of the project, calculated 2 using building energy software ap- 3 proved by the Department of Energy, 4 will qualify the project for designation 5 under the Energy Star program estab- 6 lished by section 324A of the Energy 7 Policy and Conservation Act (42 8 U.S.C. 6294a). 9 ‘‘(IX) The project involves 10 women- and minority-owned busi- 11 nesses. 12 ‘‘(B) QUALITY JOBS.—For purposes of 13 subparagraph (A)(ii)(I), a quality job is a job 14 that— 15 ‘‘(i) provides wages that are com- 16 parable to or better than similar positions 17 in existing businesses of similar size in 18 similar local economies; 19 ‘‘(ii) offers benefits that are com- 20 parable to or better than what is offered 21 for similar positions in existing local busi- 22 nesses of similar size in similar local econo- 23 mies; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 605 •S 2474 IS ‘‘(iii) is targeted for residents of 1 neighborhoods with a high proportion of 2 persons of low income (as that term is de- 3 fined in section 102(a) of the Housing and 4 Community Development Act of 1974 (42 5 U.S.C. 5302(a))) through local targeted 6 hiring programs. 7 ‘‘(d) DUTIES OF THE SECRETARY.— 8 ‘‘(1) IN GENERAL.—The Secretary shall— 9 ‘‘(A) designate a national fund manager to 10 manage national funds; 11 ‘‘(B) oversee the Initiative nationally; 12 ‘‘(C) work closely with the designated na- 13 tional fund manager— 14 ‘‘(i) to ensure that funds are used ap- 15 propriately and in the most effective man- 16 ner practicable; and 17 ‘‘(ii) to develop the program strategy 18 into a detailed work plan, program, and 19 operating budget; 20 ‘‘(D) review and approve the operating 21 budget for the national fund manager to ensure 22 that the administrative costs are— 23 ‘‘(i) reasonable (not more than 5 per- 24 cent of the total budget); 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 606 •S 2474 IS ‘‘(ii) connected to the costs of oper- 1 ations; and 2 ‘‘(iii) reflect efficient operations by the 3 national fund manager; and 4 ‘‘(E) make available to the public an an- 5 nual report, using data obtained from the De- 6 partment of Agriculture, the Department of 7 Health and Human Services, and the Commu- 8 nity Development Financial Institutions, that 9 describes the impacts of the Initiative, including 10 tracking health and economic development indi- 11 cators at the local, State, and national levels to 12 determine the impacts of individual projects 13 and the collective impact in local areas and 14 statewide of funded projects and the Initiative 15 overall. 16 ‘‘(2) NATIONAL FUND MANAGER.—The Sec- 17 retary shall— 18 ‘‘(A) select the national fund manager 19 through a competitive process from among com- 20 munity development financial institutions that 21 have a proven and recent track record of suc- 22 cess and effectiveness in— 23 ‘‘(i) attracting private capital; 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 607 •S 2474 IS ‘‘(ii) developing and managing pro- 1 grams that provide grants and loans to 2 support supermarkets and other fresh, 3 healthy food retail business enterprises in 4 low- and moderate-income communities, in- 5 cluding the development of grocery stores, 6 farmers markets, and other fresh, healthy 7 food retail models; 8 ‘‘(iii) making and servicing loans that 9 are similar to loans proposed in the Initia- 10 tive or having a record of otherwise suc- 11 cessfully investing in fresh, healthy food 12 retail development projects; 13 ‘‘(iv) effectively managing multiple 14 contracts and subcontractors; 15 ‘‘(v) effectively managing large capital 16 pools, of at least $100,000,000; and 17 ‘‘(vi) providing or contracting for the 18 provision of technical assistance; and 19 ‘‘(B) administer the Initiative by approving 20 the disbursement of funds to the national fund 21 manager in a manner that facilitates the imple- 22 mentation of the overall Initiative. 23 ‘‘(3) COORDINATION.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 608 •S 2474 IS ‘‘(A) IN GENERAL.—Not later than 45 1 days after the date of receipt of an award, the 2 national fund manager shall develop, with guid- 3 ance from and in consultation with the Sec- 4 retary, and submit to the Secretary, a detailed 5 work plan. 6 ‘‘(B) APPROVAL REQUIRED.—The Sec- 7 retary shall review and approve the work plan, 8 program budget, and administrative costs under 9 subsection (e)(4)(C) prior to entering into an 10 agreement with the national fund manager to 11 administer the Initiative. 12 ‘‘(4) PERFORMANCE TARGETS.— 13 ‘‘(A) IN GENERAL.—The Secretary shall 14 conduct financial audits of, and establish per- 15 formance targets for, the national fund man- 16 ager, which shall include, at a minimum, the re- 17 quirements described in this paragraph. 18 ‘‘(B) GEOGRAPHIC SPREAD.—Partnerships 19 funded by the Initiative shall be geographically 20 diverse and representative of the underserved 21 areas across the United States. 22 ‘‘(C) FOCUS ON LOW-INCOME COMMU- 23 NITIES.—A substantial portion of the projects 24 funded by partnerships shall serve very low- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 609 •S 2474 IS and low-income communities, as defined by the 1 Bureau of the Census of the Department of 2 Commerce. 3 ‘‘(D) FINANCIAL EFFECTIVENESS OF THE 4 NATIONAL FUND MANAGER.—The national fund 5 manager and any local financial institution in- 6 volved in a partnership shall demonstrate on- 7 going capacity and timeliness in raising private 8 capital and disbursing funds as required under 9 the Initiative. 10 ‘‘(E) TECHNICAL ASSISTANCE EFFECTIVE- 11 NESS OF THE NATIONAL FUND MANAGER.—The 12 provision of technical assistance by the national 13 fund manager shall be evaluated based on— 14 ‘‘(i) the responsiveness of the national 15 fund manager to requests for assistance; 16 and 17 ‘‘(ii) the ability of the national fund 18 manager to craft programs that develop 19 needed new capacities in partnerships. 20 ‘‘(F) IMPACT.—Performance targets shall 21 address the allocation of funds by the national 22 fund manager to partnerships and the tracking 23 and reporting of the impacts of the funds in im- 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 610 •S 2474 IS proving access to fresh, healthy foods and in 1 achieving other related impacts. 2 ‘‘(e) DUTIES OF THE NATIONAL FUND MANAGER.— 3 ‘‘(1) ALLOCATION OF FUNDS.— 4 ‘‘(A) IN GENERAL.—The national fund 5 manager shall— 6 ‘‘(i) allocate at least 70 percent of any 7 Federal appropriation made to carry out 8 this section to partnerships that are se- 9 lected based on the criteria described in 10 paragraph (3); and 11 ‘‘(ii) retain not more than 30 percent 12 of any Federal appropriation made to 13 carry out this section to undertake financ- 14 ing activities described in subparagraph 15 (C), including a reasonable amount for ad- 16 ministrative costs (not to exceed 5 percent) 17 approved by the Secretary in accordance 18 with paragraph (4)(C). 19 ‘‘(B) USE OF THE NATIONAL FUNDS BY 20 PARTNERSHIP PROGRAMS.— 21 ‘‘(i) IN GENERAL.—As a condition on 22 the receipt of funds, each partnership shall 23 use— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 611 •S 2474 IS ‘‘(I) the national funds received 1 from the national fund manager under 2 subparagraph (A)(i) to create 1 or 3 more revolving loan programs or other 4 revolving pools of capital or other 5 products to facilitate financing of local 6 projects as determined by the agree- 7 ment between the partnership and the 8 national fund manager; and 9 ‘‘(II) any remaining funds for 10 grants, or, as approved, for innovative 11 financing mechanisms. 12 ‘‘(ii) LIMITATIONS.— 13 ‘‘(I) IN GENERAL.—Use of funds 14 for administrative costs and other 15 purposes shall be— 16 ‘‘(aa) limited in accordance 17 with the terms of the agreement 18 negotiated between the national 19 fund manager and partnerships; 20 ‘‘(bb) based on whether ad- 21 ministrative costs are reasonable, 22 connected to the costs of oper- 23 ation, and reflect efficient oper- 24 ations by the partnership; and 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 612 •S 2474 IS ‘‘(cc) determined using cri- 1 teria including geographic cov- 2 erage, program duration, and 3 total funding amount. 4 ‘‘(II) GOAL.—The goal of this 5 clause to limit administrative costs to 6 the maximum extent practicable, but 7 in no case may the amount used for 8 administrative costs exceed 10 percent 9 of the Federal funds allocated. 10 ‘‘(C) USE OF THE NATIONAL FUNDS BY 11 THE NATIONAL FUND MANAGER.—The national 12 fund manager shall use national funds de- 13 scribed in subparagraph (A)(ii) to undertake fi- 14 nancing and other activities to enhance and 15 maximize the effectiveness of the Initiative, as 16 determined by the agreement with the Sec- 17 retary, including— 18 ‘‘(i) attracting other forms of financial 19 assistance to match or leverage the na- 20 tional funds; 21 ‘‘(ii) awarding national funds to part- 22 nerships in accordance with paragraph (3); 23 ‘‘(iii) creating and managing pools of 24 grant or loan capital that blend or leverage 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 613 •S 2474 IS national funds with other forms of finan- 1 cial assistance, including capital in the 2 form of tax credits under section 45D of 3 the Internal Revenue Code of 1986, for the 4 benefit of partnerships; 5 ‘‘(iv) creating and managing pools of 6 grant or loan capital that blend or leverage 7 the national funds with other forms of fi- 8 nancial assistance, including capital in the 9 form of tax credits under section 45D of 10 the Internal Revenue Code of 1986, to fi- 11 nance eligible local projects identified by 12 partnerships or the national fund manager 13 that have special or unique characteristics; 14 ‘‘(v) providing loans or grants directly 15 to eligible local projects as matching funds 16 if requested by a partnership; 17 ‘‘(vi) providing credit enhancement or 18 other financial products and instruments 19 for the benefit of partnerships or eligible 20 local projects; 21 ‘‘(vii) providing technical assistance; 22 and 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 614 •S 2474 IS ‘‘(viii) funding reasonable administra- 1 tive costs approved by the Secretary in ac- 2 cordance with paragraph (4)(C). 3 ‘‘(2) RESPONSIBILITIES OF THE NATIONAL 4 FUND MANAGER.—The designated national fund 5 manager shall— 6 ‘‘(A) raise other forms of financial assist- 7 ance to match or leverage the national funds; 8 ‘‘(B) use administrative funds to develop 9 appropriate training programs and offer tech- 10 nical assistance services to— 11 ‘‘(i) partnerships; 12 ‘‘(ii) State, local, and tribal govern- 13 ments; 14 ‘‘(iii) the food retail industry; and 15 ‘‘(iv) food access and health advocacy 16 organizations to augment local capacities; 17 ‘‘(C) develop financial products such as 18 loans, grants, and credit enhancement tools 19 that can be used by partnerships to incentivize 20 and support the development and retention of 21 supermarkets and other fresh, healthy food re- 22 tail in underserved areas; 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 615 •S 2474 IS ‘‘(D) award Initiative funds to eligible 1 partnerships through an annual competitive 2 process in accordance with paragraph (3); 3 ‘‘(E) contract with a national food access 4 organization to assist in the review of applica- 5 tions from partnerships and to provide technical 6 assistance to local food access organizations in 7 the proposed partnerships; 8 ‘‘(F) award and disburse funds to partner- 9 ships or eligible local projects in a timely man- 10 ner; 11 ‘‘(G) create and meet performance bench- 12 marks and reporting guidelines, as approved by 13 the Secretary, including for— 14 ‘‘(i) the amount of capital raised and 15 leveraged from financial institutions, part- 16 nerships, and other resources; 17 ‘‘(ii) the geographic diversity of part- 18 nerships; and 19 ‘‘(iii) the proportion of projects fund- 20 ed by the partnership that are in severely 21 distressed low-income communities; 22 ‘‘(H) develop program guidelines and oper- 23 ating procedures for the Initiative, including— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 616 •S 2474 IS ‘‘(i) maximum grant and loan 1 amounts for projects; 2 ‘‘(ii) eligible uses of funds; 3 ‘‘(iii) prudent underwriting criteria; 4 ‘‘(iv) performance targets; 5 ‘‘(v) reporting guidelines; 6 ‘‘(vi) limits on administrative costs; 7 and 8 ‘‘(vii) implementation milestones; 9 ‘‘(I) monitor the performance of partner- 10 ships; and 11 ‘‘(J) collect data, compile information, and 12 conduct such research studies as the national 13 fund manager determines to be relevant to the 14 successful implementation of the Initiative, in- 15 cluding— 16 ‘‘(i) to assess national and local mar- 17 ket conditions; 18 ‘‘(ii) to determine barriers to market 19 entry; and 20 ‘‘(iii) to identify opportunities for the 21 development or retention of supermarkets 22 and other fresh, healthy food retail enter- 23 prises in underserved communities. 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 617 •S 2474 IS ‘‘(3) CRITERIA FOR AWARDING NATIONAL 1 FUNDS TO PARTNERSHIPS.— 2 ‘‘(A) IN GENERAL.—The national fund 3 manager shall award national funds to partner- 4 ships through a competitive process on an an- 5 nual basis. 6 ‘‘(B) FIRST ROUND PRIORITY.—In the 7 first round of funding, the national fund man- 8 ager shall give priority to existing partnerships 9 that have demonstrable capacity to implement 10 fresh food financing programs in underserved 11 areas quickly. 12 ‘‘(C) ADDITIONAL ROUNDS.—Additional 13 rounds shall be designed to promote geographic 14 diversity. 15 ‘‘(D) CRITERIA.—In awarding national 16 funds to partnerships, the national fund man- 17 ager shall consider— 18 ‘‘(i) the amount of funds and other 19 resources pledged by a partnership to 20 match or leverage national funds; 21 ‘‘(ii) the degree of State, local, or trib- 22 al government support of the partnership 23 as evidenced by matching grant and loan 24 funds or other types of support, such as al- 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 618 •S 2474 IS location of tax-exempt bonds, loan guaran- 1 tees, and coordination of resources from 2 other State or local economic development 3 programs; 4 ‘‘(iii) the capacity of the partnership 5 to successfully develop and manage loan 6 and grant programs; 7 ‘‘(iv) the lack of supermarkets and 8 other fresh, healthy food retail enterprises 9 in low- and moderate-income areas that 10 would be served by the partnership; 11 ‘‘(v) the experience of the food access 12 or community health organization of the 13 partnership in outreach about access to 14 healthy foods and local healthy food access 15 issues; 16 ‘‘(vi) the degree of community engage- 17 ment and support in the development and 18 retention of supermarkets and other fresh, 19 healthy food retail enterprises; and 20 ‘‘(vii) the contribution of the program 21 of the partnership to the overall geographic 22 diversity of the Initiative. 23 ‘‘(4) ADMINISTRATIVE COSTS.— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 619 •S 2474 IS ‘‘(A) IN GENERAL.—Not later than 45 1 days after the date of receipt of an award, the 2 national fund manager shall submit to the Sec- 3 retary for approval a 3-year program and oper- 4 ating budget and detailed work plan that shall 5 include— 6 ‘‘(i) costs for research and evaluation, 7 technical assistance, and training; and 8 ‘‘(ii) program and operating costs. 9 ‘‘(B) EARNED REVENUES.—Earned reve- 10 nues from loan fees and interest may be ex- 11 pended on program and operating costs in ac- 12 cordance with the budget approved by the Sec- 13 retary. 14 ‘‘(C) BASIS OF REVIEW.—The Secretary 15 shall base the review under subparagraph (A) 16 on— 17 ‘‘(i) the likelihood of the plan and ex- 18 penditures to further the purposes of this 19 section; and 20 ‘‘(ii) whether the administrative costs 21 are reasonable, connected to the costs of 22 operation, and reflect efficient operations 23 by the national fund manager. 24 ‘‘(f) PARTNERSHIPS.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 620 •S 2474 IS ‘‘(1) IN GENERAL.—Each partnership that re- 1 ceives assistance through the Initiative shall provide 2 financial and technical assistance to eligible fresh, 3 healthy food retail projects in underserved areas 4 within the defined communities of the partnership. 5 ‘‘(2) ADMINISTRATION.—Each partnership shall 6 designate a community development financial insti- 7 tution or other organization that is capable of ad- 8 ministering a loan and grant program— 9 ‘‘(A) to execute grant agreements with the 10 national fund manager; and 11 ‘‘(B) to serve as the manager of local 12 funds. 13 ‘‘(3) RESPONSIBILITIES OF PARTNERSHIPS.—A 14 partnership shall— 15 ‘‘(A) raise other forms of financial assist- 16 ance to match the national funds received by 17 the partnership; 18 ‘‘(B) provide marketing and outreach to 19 communities, the supermarket industry, other 20 fresh, healthy food retailers, State and local 21 government officials, and civic and public inter- 22 est organizations— 23 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 621 •S 2474 IS ‘‘(i) to solicit applications from under- 1 served areas from across the State or local- 2 ity to be served by the partnership; and 3 ‘‘(ii) to inform the communities and 4 other persons about the availability of 5 grants, loans, training, and technical as- 6 sistance; 7 ‘‘(C) review and underwrite projects to de- 8 termine whether— 9 ‘‘(i) a proposed project meets the cri- 10 teria for eligible projects under subsection 11 (c)(3); and 12 ‘‘(ii) a proposed project meets the cri- 13 teria for priority projects under subsection 14 (c)(4); 15 ‘‘(D) provide technical assistance services 16 to eligible fresh, healthy food retail operators 17 and developers; 18 ‘‘(E) track and report outcomes, includ- 19 ing— 20 ‘‘(i) the number of jobs created or re- 21 tained; 22 ‘‘(ii) the quantity of fresh, healthy 23 food retail space created or retained; and 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 622 •S 2474 IS ‘‘(iii) such other health and economic 1 indicators as are required by the national 2 fund manager; 3 ‘‘(F) monitor and audit funded projects to 4 ensure compliance with the Initiative, the na- 5 tional fund manager, and partnership program 6 requirements for a period of at least 3 years; 7 ‘‘(G) submit an annual report to the na- 8 tional fund manager that describes— 9 ‘‘(i) the activities of the partnership; 10 ‘‘(ii) the expenditure of local funds; 11 and 12 ‘‘(iii) success in meeting performance 13 targets and satisfying such other terms 14 and conditions as are specified in the 15 agreement between the partnership and the 16 national fund manager; and 17 ‘‘(H) coordinate with the national fund 18 manager for the smooth operation of the Initia- 19 tive. 20 ‘‘(4) ADMINISTRATIVE COSTS.— 21 ‘‘(A) IN GENERAL.—As a condition on the 22 receipt of assistance under this section, each 23 partnership shall submit to the national fund 24 manager for approval a 3-year budget and plan 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 623 •S 2474 IS for all program and operating costs, includ- 1 ing— 2 ‘‘(i) costs for research and evaluation, 3 technical assistance, and training; and 4 ‘‘(ii) administrative and operating 5 costs. 6 ‘‘(B) EARNED REVENUES.—Earned reve- 7 nues from loan fees and interest may be ex- 8 pended on program and operating costs in ac- 9 cordance with the budget approved by the na- 10 tional fund manager. 11 ‘‘(C) BASIS OF REVIEW.—The national 12 fund manager shall base the review under sub- 13 paragraph (A) on the likelihood of the budget 14 and plan to further the purposes of this section. 15 ‘‘(g) EVALUATION AND MONITORING.— 16 ‘‘(1) IN GENERAL.—Program evaluation and fi- 17 nancial audits shall occur at all levels of the Initia- 18 tive to ensure that— 19 ‘‘(A) national and local funds are used 20 properly; and 21 ‘‘(B) the objectives of the Initiative are 22 met. 23 ‘‘(2) PROGRAM EVALUATION AND FINANCIAL 24 AUDITS.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 624 •S 2474 IS ‘‘(A) IN GENERAL.—The Secretary shall— 1 ‘‘(i) conduct periodic program evalua- 2 tions and financial audits of the national 3 fund manager, partnerships, and projects 4 funded by the Initiative; and 5 ‘‘(ii) share with the national fund 6 manager the results of the evaluations and 7 audits. 8 ‘‘(B) FUNDED PROJECTS.—The Secretary 9 or the national fund manager shall evaluate 10 partnerships to assess the health and economic 11 impacts of projects funded by the Initiative. 12 ‘‘(C) OTHER IMPACTS.— 13 ‘‘(i) SECRETARY OF HEALTH AND 14 HUMAN SERVICES.—The Secretary of 15 Health and Human Services shall conduct 16 research studies and evaluate the health 17 impacts of the Initiative. 18 ‘‘(ii) COMMUNITY DEVELOPMENT FI- 19 NANCIAL INSTITUTIONS.—Representatives 20 of the Community Development Financial 21 Institutions shall conduct research studies 22 and evaluate the economic impacts of the 23 Initiative. 24 ‘‘(D) PARTNERSHIPS.— 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 625 •S 2474 IS ‘‘(i) IN GENERAL.—Each partnership 1 shall— 2 ‘‘(I) conduct periodic administra- 3 tive and financial audits of projects 4 funded by the Initiative; and 5 ‘‘(II) share with the national 6 fund manager the results of the au- 7 dits. 8 ‘‘(ii) FAILURE OF PARTNERSHIP.—In 9 a case in which a partnership fails, the na- 10 tional fund manager shall take over the 11 portfolio of the failed partnership. 12 ‘‘(h) ADMINISTRATIVE PROVISIONS.—Not later than 13 180 days after the date of enactment of this section, the 14 Secretary shall promulgate such regulations as may be 15 necessary to carry out this section, including regulations— 16 ‘‘(1) for the conduct of a performance evalua- 17 tion at the end of the initial 5-year period; 18 ‘‘(2) to terminate the contract for cause; and 19 ‘‘(3) to extend the contract for an additional 5- 20 year period.’’. 21 (b) CONFORMING AMENDMENT.—Section 296(b) of 22 the Department of Agriculture Reorganization Act of 23 1994 (7 U.S.C. 7014(b)) is amended— 24 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 626 •S 2474 IS (1) in paragraph (6)(C), by striking ‘‘or’’ at the 1 end; 2 (2) in paragraph (7), by striking the period at 3 the end and inserting ‘‘; or’’; and 4 (3) by adding at the end the following: 5 ‘‘(8) the authority of the Secretary to establish 6 in the Department the Healthy Food Financing Ini- 7 tiative in accordance with section 242.’’. 8 SEC. 1007. GAO REPORT ON HEALTH EFFECTS OF DEEP- 9 WATER HORIZON OIL RIG EXPLOSION IN THE 10 GULF COAST. 11 (a) STUDY.—The Comptroller General of the United 12 States shall conduct a study on the type and scope of 13 health care services administered through the Department 14 of Health and Human Services addressing the provision 15 of health care to racial and ethnic minorities (whether 16 residents, clean-up workers, or volunteers) affected by the 17 explosion of the mobile offshore drilling unit Deepwater 18 Horizon that occurred on April 20, 2010. 19 (b) SPECIFIC COMPONENTS; REPORTING.—In car- 20 rying out subsection (a), the Comptroller General shall— 21 (1) assess the type, size, and scope of programs 22 administered by the Department of Health and 23 Human Services that focus on provision of health 24 care to communities in the Gulf Coast; 25 VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS 627 •S 2474 IS (2) identify the merits and disadvantages asso- 1 ciated with each the programs; 2 (3) perform an analysis of the costs and bene- 3 fits of the programs; 4 (4) determine whether there is any duplication 5 of programs; and 6 (5) not later than 180 days after the date of 7 the enactment of this Act, report findings and rec- 8 ommendations for improving access to health care 9 for racial and ethnic minorities to the Congress. 10 Æ VerDate Mar 15 2010 22:28 Apr 27, 2012 Jkt 019200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6301 E:\BILLS\S2474.IS S2474 srobinson on DSK4SPTVN1PROD with BILLS