Text of US SB 3660 (2018)

II 115TH CONGRESS 2D SESSION S. 3660 To improve the health of minority individuals, and for other purposes. IN THE SENATE OF THE UNITED STATES NOVEMBER 27, 2018 Ms. HIRONO (for herself, Ms. DUCKWORTH, Mr. CARDIN, Ms. HARRIS, Mr. BOOKER, Mr. MERKLEY, Mr. KAINE, Mr. BLUMENTHAL, Mrs. GILLI- BRAND, and Mr. BROWN) introduced the following bill; which was read twice and referred to the Committee on Finance 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 2018’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 2 •S 3660 IS Sec. 101. Amendment to the Public Health Service Act. Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of race and ethnicity data by the Social Security Adminis- tration. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Disparities data collected by the Federal Government. Sec. 107. Data collection and analysis grants to minority-serving institutions. Sec. 108. Standards for measuring sexual orientation, gender identity, and so- cioeconomic status in collection of health data. Sec. 109. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 110. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 111. Clarification of simplified administrative reporting requirement. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH CARE Sec. 201. Definitions; findings. Sec. 202. Improving access to services for individuals with limited-English pro- ficiency. Sec. 203. National standards for culturally and linguistically appropriate serv- ices in health care. Sec. 204. Culturally and linguistically appropriate health care in the Public Health Service Act. Sec. 205. Pilot program for improvement and development of State medical in- terpreting services. Sec. 206. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. Sec. 207. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 208. Increasing understanding of and improving health literacy. Sec. 209. Requirements for health programs or activities receiving Federal funds. Sec. 210. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 211. English for speakers of other languages. Sec. 212. Implementation. Sec. 213. Language access services. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving institutions, historically black colleges and univer- sities, and tribal colleges. Sec. 303. Loan repayment program of Centers for Disease Control and Preven- tion. Sec. 304. Cooperative agreements for online degree programs at schools of pub- lic health and schools of allied health. Sec. 305. Sense of Congress on the mission of the National Health Care Work- force Commission. Sec. 306. Scholarship and fellowship programs. Sec. 307. McNair Postbaccalaureate Achievement Program. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 3 •S 3660 IS Sec. 308. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 309. Developing and implementing strategies for local health equity. Sec. 310. Loan forgiveness for mental and behavioral health social workers. Sec. 311. Health Professions Workforce Fund. Sec. 312. Findings; sense of Congress relating to graduate medical education. Sec. 313. Career support for skilled, internationally educated health profes- sionals. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Subtitle A—Expansion of Coverage Sec. 401. Amendment to the Public Health Service Act. Sec. 402. Removing citizenship and immigration barriers to access to affordable health care under ACA. Sec. 403. Study on the uninsured. Sec. 404. Medicaid in the territories. Sec. 405. Extension of Medicare secondary payer. Sec. 406. Border health grants. Sec. 407. Removing Medicare barrier to health care. Sec. 408. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 409. 100 percent FMAP for medical assistance provided to a Native Ha- waiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program. Subtitle B—Expansion of Access Sec. 410. Protecting sensitive locations. Sec. 411. Grants for racial and ethnic approaches to community health. Sec. 412. Critical access hospital improvements. Sec. 413. Establishment of Rural Community Hospital (RCH) Program. Sec. 414. Medicare remote monitoring pilot projects. Sec. 415. Rural health quality advisory commission and demonstration projects. Sec. 416. Rural health care services. Sec. 417. Community health center collaborative access expansion. Sec. 418. Facilitating the provision of telehealth services across State lines. Sec. 419. Scoring of preventive health savings. Sec. 420. Sense of Congress on Maintenance of Effort Provisions Regarding Children’s Health. Sec. 421. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 422. Protection of the HHS Offices of Minority Health. Sec. 423. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 424. Indian defined in title I of PPACA. Sec. 425. Study of DSH payments to ensure hospital access for low-income pa- tients. Sec. 426. Assistant Secretary of the Indian Health Service. Sec. 427. Reauthorization of the Native Hawaiian Health Care Improvement Act. Sec. 428. Availability of non-English language speaking providers. Sec. 429. Access to essential community providers. Sec. 430. Provider network adequacy in communities of color. Sec. 431. Improving access to dental care. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 4 •S 3660 IS Subtitle C—Advancing Health Equity Through Payment and Delivery Reform Sec. 441. Sense of Congress. Sec. 442. Centers for Medicare & Medicaid Services quality payment program. Sec. 443. Development and testing of disparity reducing delivery and payment models. Sec. 444. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle D—Health Empowerment Zones Sec. 451. Short title. Sec. 452. Findings. Sec. 453. Designation of health empowerment zones. Sec. 454. Assistance to those seeking designation. Sec. 455. Benefits of designation. Sec. 456. Definition of Secretary. Sec. 457. Authorization of appropriations. Subtitle E—At-Risk Community Coverage Sec. 461. Medicaid coverage for citizens of Freely Associated States. Sec. 462. At-risk youth Medicaid protection. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Subtitle A—In General Sec. 501. Grants to promote health for underserved communities. Sec. 502. Removing barriers to health care and nutrition assistance for chil- dren, pregnant persons, and lawfully present individuals. Sec. 503. Repeal of denial of benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. Preventing maternal deaths. Sec. 506. Eliminating disparities in maternity health outcomes. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing unintended teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Comprehensive sex education programs. Sec. 512. Compassionate assistance for rape emergencies. Sec. 513. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 514. Additional focus area for the Office on Women’s Health. Sec. 515. Interagency coordinating committee on the promotion of optimal ma- ternity outcomes. Sec. 516. Consumer education campaign. Sec. 517. Bibliographic database of systematic reviews for care of childbearing individuals and newborns. Sec. 518. Maternity care health professional shortage areas. Sec. 519. Expansion of CDC prevention research centers program to include centers on optimal maternity outcomes. Sec. 520. Expanding models allowed to be tested by Center for Medicare & Medicaid Innovation to include maternity care models. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 5 •S 3660 IS Sec. 521. Development of interprofessional maternity care educational models and tools. Sec. 522. Including services furnished by certain students, interns, and resi- dents supervised by certified nurse midwives within inpatient hospital services under Medicare. Sec. 523. Grants to professional organizations to increase diversity in maternal, reproductive, and sexual health professionals. Sec. 524. Interagency update to the quality family planning guidelines. Sec. 525. Dissemination of the quality family planning guidelines. Subtitle B—Pregnancy Screening Sec. 531. Pregnancy intention screening initiative demonstration program. TITLE VI—MENTAL HEALTH Sec. 601. Mental health findings. Sec. 602. Coverage of marriage and family therapist services, mental health counselor services, and substance abuse counselor services under part B of the Medicare program. Sec. 603. Integrated Health Care Demonstration Program. Sec. 604. Addressing racial and ethnic minority mental health disparities re- search gaps. Sec. 605. Health professions competencies to address racial and ethnic minority mental health disparities. Sec. 606. Geoaccess study. Sec. 607. Asian American, Native Hawaiian, and Pacific Islander behavioral and mental health outreach and education strategies. Sec. 608. Mental health in schools. TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 701. Lung cancer mortality reduction. Sec. 702. Expanding prostate cancer research, outreach, screening, testing, ac- cess, and treatment effectiveness. Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer pa- tients in the territories. Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 705. Reducing cancer disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 711. Viral hepatitis and liver cancer control and prevention. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 721. Acquired bone marrow failure diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease Issues Sec. 731. Guidelines for disease screening for minority patients. Sec. 732. CDC Wisewoman Screening Program. Sec. 733. Report on cardiovascular care for women and minorities. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 6 •S 3660 IS Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid and private health insurance. Sec. 735. Clinical research funding for oral health. Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. Subtitle E—HIV/AIDS Sec. 741. Statement of policy. Sec. 742. Findings. Sec. 743. Additional funding for AIDS drug assistance program treatments. Sec. 744. Enhancing the national HIV surveillance system. Sec. 745. Evidence-based strategies for improving linkage to and retention in appropriate care. Sec. 746. Improving entry into and retention in care and antiretroviral adher- ence for persons with HIV. Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 748. Minority AIDS initiative. Sec. 749. Health care professionals treating individuals with HIV/AIDS. Sec. 750. HIV/AIDS provider loan repayment program. Sec. 751. Dental education loan repayment program. Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Report on impact of HIV/AIDS in vulnerable populations. Sec. 754. National HIV/AIDS observance days. Sec. 755. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. Sec. 756. Expanding support for condoms in prisons. Sec. 757. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 758. Stop AIDS in prison. Sec. 759. Support data system review and indicators for monitoring HIV care. Sec. 760. Transfer of funds for implementation of national HIV/AIDS strategy. Sec. 761. Report on the implementation of goal 4 (improved coordination) of the national HIV/AIDS strategy. Subtitle F—Diabetes Sec. 771. Research, treatment, and education. Sec. 772. Research, education, and other activities. Sec. 773. Research, education, and other activities. Sec. 774. Research, education, and other activities. Sec. 775. Updated report on health disparities. Subtitle G—Lung Disease Sec. 776. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 777. Asthma-related activities of the Centers for Disease Control and Pre- vention. Sec. 778. Influenza and pneumonia vaccination campaign. Sec. 779. Chronic obstructive pulmonary disease action plan. Subtitle H—Tuberculosis Sec. 781. Elimination of all forms of tuberculosis. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 7 •S 3660 IS Sec. 782. Additional funding for States in combating and eliminating tuber- culosis. Sec. 783. Strengthening clinical research funding for tuberculosis. Subtitle I—Osteoarthritis and Musculoskeletal Diseases Sec. 785. Findings. Sec. 786. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Sec. 787. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. Subtitle J—Sleep and Circadian Rhythm Disorders Sec. 791. Short title; findings. Sec. 792. Sleep and circadian rhythm disorders research activities of the Na- tional Institutes of Health. Sec. 793. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. Sec. 794. Grants for comprehensive sleep and circadian health education within health professions schools. Sec. 795. Report on impact of sleep and circadian health disorders in vulner- able and racial/ethnic populations. Subtitle K—Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Sec. 796. Short title. Sec. 796A. Sickle cell disease research. Sec. 796B. Sickle cell disease surveillance. Sec. 796C. Sickle cell disease prevention and treatment. Sec. 796D. Collaboration with community-based entities. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Sec. 800. Definitions. Subtitle A—Reducing Health Disparities Through Health IT Sec. 801. HRSA assistance to health centers for promotion of Health IT. Sec. 802. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such com- munities. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Sec. 813. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 821. Data collection and assessments conducted in coordination with mi- nority-serving institutions. VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 8 •S 3660 IS Sec. 822. Study of health information technology in medically underserved com- munities. Subtitle D— Closing Gaps in Funding To Adopt Certified EHRs Sec. 831. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 832. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, marital status, familial status, sexual orientation, gen- der identity, or disability status. Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Subtitle A—In General Sec. 1001. Definitions. Sec. 1002. Findings. Sec. 1003. Health impact assessments. Sec. 1004. Implementation of recommendations by Environmental Protection Agency. Sec. 1005. Grant program to conduct environmental health improvement activi- ties and to improve social determinants of health. Sec. 1006. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1007. Environment and public health restoration. Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. Subtitle B—Gun Violence Sec. 1011. Findings. Sec. 1012. Reaffirming research authority of the Centers for Disease Control and Prevention. Sec. 1013. National violent death reporting system. Sec. 1014. Report on effects of gun violence on public health. Sec. 1015. Report on effects of gun violence on mental health in minority com- munities. SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 9 •S 3660 IS (1) The population of racial and ethnic minori- 1 ties is expected to increase over the next few dec- 2 ades, yet racial and ethnic minorities have the poor- 3 est health status and face substantial cultural, so- 4 cial, and economic barriers to obtaining quality 5 health care. 6 (2) Health disparities are a function of not only 7 access to health care, but also the social deter- 8 minants of health—including the environment, the 9 physical structure of communities, nutrition and 10 food options, educational attainment, employment, 11 race, ethnicity, sex, geography, language preference, 12 immigrant or citizenship status, sexual orientation, 13 gender identity, socioeconomic status, or disability 14 status—that directly and indirectly affect the health, 15 health care, and wellness of individuals and commu- 16 nities. 17 (3) By 2020, the United States will face a 18 shortage of health care providers and allied health 19 workers. This shortage will disproportionately affect 20 health professional shortage areas where many racial 21 and ethnic minority populations reside. 22 (4) All efforts to reduce health disparities and 23 barriers to quality health services require better and 24 more consistent data. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 10 •S 3660 IS (5) A full range of culturally and linguistically 1 appropriate health care and public health services 2 must be available and accessible in every community. 3 (6) Racial and ethnic minorities and under- 4 served populations must be included early and equi- 5 tably in health reform innovations. 6 (7) Efforts to improve minority health have 7 been limited by inadequate resources in funding, 8 staffing, stewardship, and accountability. Targeted 9 investments that are focused on disparities elimi- 10 nation must be made in providing care and services 11 that are community-based, including prevention and 12 policies addressing social determinants of health. 13 (8) In 2011, the Department of Health and 14 Human Services developed the HHS Action Plan to 15 Reduce Racial and Ethnic Health Disparities and 16 the National Stakeholder Strategy for Achieving 17 Health Equity, which are 2 strategic plans that rep- 18 resent the first coordinated roadmap in the United 19 States to reducing health disparities. These com- 20 prehensive plans, along with the National Prevention 21 Strategy issued by the National Prevention Council 22 of the Department of Health and Human Services, 23 Healthy People 2020, and the National Quality 24 Strategy of the Agency for Healthcare Research and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 11 •S 3660 IS Quality, as well as critical resources such as the 1 2012 National Healthcare Quality and Disparities 2 Reports, will work to increase the number of people 3 in the United States who are healthy at every stage 4 of life. 5 (9) The Secretary of Health and Human Serv- 6 ices has also reviewed and advanced updated clinical 7 guidelines and developed other strategic planning 8 documents to combat health disparities with a high 9 impact on minority populations and to provide high- 10 quality family planning services. Such guidelines and 11 documents include the National HIV/AIDS Strategy, 12 the Action Plan for the Prevention, Care, and Treat- 13 ment of Viral Hepatitis, and recommendations of the 14 Centers for Disease Control and Prevention and the 15 Office of Population Affairs. 16 (10) The Patient Protection and Affordable 17 Care Act (Public Law 111–148), as amended by the 18 Health Care and Education Reconciliation Act (Pub- 19 lic Law 111–152), represents the biggest advance- 20 ment for minority health in the 40 years imme- 21 diately preceding the enactment of this Act. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 12 •S 3660 IS TITLE I—DATA COLLECTION 1 AND REPORTING 2 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 3 ACT. 4 (a) PURPOSE.—It is the purpose of the amendment 5 made by this section to promote data collection, analysis, 6 and reporting by race, ethnicity, sex, primary language, 7 sexual orientation, disability status, gender identity, and 8 socioeconomic status among federally supported health 9 programs. 10 (b) AMENDMENT.—Title XXXIV of the Public 11 Health Service Act, as added by titles II and III of this 12 Act, is further amended by inserting after subtitle B the 13 following: 14 ‘‘Subtitle C—Strengthening Data 15 Collection, Improving Data 16 Analysis, and Expanding Data 17 Reporting 18 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 19 ‘‘(a) REQUIREMENTS.— 20 ‘‘(1) IN GENERAL.—Each health-related pro- 21 gram shall— 22 ‘‘(A) require the collection, by the agency 23 or program involved, of data on the race, eth- 24 nicity, sex, primary language, sexual orienta- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 13 •S 3660 IS tion, disability status, gender identity, and so- 1 cioeconomic status of each applicant for and re- 2 cipient of health-related assistance under such 3 program, including— 4 ‘‘(i) using, at a minimum, standards 5 for data collection on race, ethnicity, sex, 6 primary language, sexual orientation, gen- 7 der identity, socioeconomic status, and dis- 8 ability status as each are developed under 9 section 3101; 10 ‘‘(ii) collecting data for additional 11 population groups if such groups can be 12 aggregated into the race and ethnicity cat- 13 egories outlined by standards developed 14 under section 3101; 15 ‘‘(iii) using, where practicable, the 16 standards developed by the Health and 17 Medicine Division of the National Acad- 18 emies of Sciences, Engineering, and Medi- 19 cine (formerly known as the ‘Institute of 20 Medicine’) in the 2009 publication, entitled 21 ‘Race, Ethnicity, and Language Data: 22 Standardization for Health Care Quality 23 Improvement’; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 14 •S 3660 IS ‘‘(iv) where practicable, collecting 1 such data through self-reporting; 2 ‘‘(B) with respect to the collection of the 3 data described in subparagraph (A), for appli- 4 cants and recipients who are minors, require 5 communication assistance in speech or writing, 6 and for applicants and recipients who are other- 7 wise legally incapacitated, require that— 8 ‘‘(i) such data be collected from the 9 parent or legal guardian of such an appli- 10 cant or recipient; and 11 ‘‘(ii) the primary language of the par- 12 ent or legal guardian of such an applicant 13 or recipient be collected; 14 ‘‘(C) systematically analyze such data 15 using the smallest appropriate units of analysis 16 feasible to detect racial and ethnic disparities, 17 as well as disparities along the lines of primary 18 language, sex, disability status, sexual orienta- 19 tion, gender identity, and socioeconomic status 20 in health and health care, and report the results 21 of such analysis to the Secretary, the Director 22 of the Office for Civil Rights, each agency listed 23 in section 3101(c)(1), the Committee on 24 Health, Education, Labor, and Pensions and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 15 •S 3660 IS the Committee on Finance of the Senate, and 1 the Committee on Energy and Commerce and 2 the Committee on Ways and Means of the 3 House of Representatives; 4 ‘‘(D) provide such data to the Secretary on 5 at least an annual basis; and 6 ‘‘(E) ensure that the provision of assist- 7 ance to an applicant or recipient of assistance 8 is not denied or otherwise adversely affected be- 9 cause of the failure of the applicant or recipient 10 to provide race, ethnicity, primary language, 11 sex, sexual orientation, disability status, gender 12 identity, and socioeconomic status data. 13 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 14 this subsection shall be construed to— 15 ‘‘(A) permit the use of information col- 16 lected under this subsection in a manner that 17 would adversely affect any individual providing 18 any such information; or 19 ‘‘(B) diminish any requirements, including 20 such requirements in effect on or after the date 21 of enactment of this section, on health care pro- 22 viders to collect data. 23 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 24 This title does not authorize any health care pro- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 16 •S 3660 IS vider, Federal official, or other entity to compel the 1 disclosure of any data collected under this title. The 2 disclosure of any such data by an individual pursu- 3 ant to this title shall be strictly voluntary. 4 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 5 ensure (through the promulgation of regulations or other- 6 wise) that all data collected pursuant to subsection (a) are 7 protected— 8 ‘‘(1) under the same privacy protections as the 9 Secretary applies to other health data under the reg- 10 ulations promulgated under section 264(c) of the 11 Health Insurance Portability and Accountability Act 12 of 1996 relating to the privacy of individually identi- 13 fiable health information and other protections; and 14 ‘‘(2) from all inappropriate internal use by any 15 entity that collects, stores, or receives the data, in- 16 cluding use of such data in determinations of eligi- 17 bility (or continued eligibility) in health plans, and 18 from other inappropriate uses, as defined by the 19 Secretary. 20 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 21 Secretary shall develop and implement a national plan to 22 ensure the collection of data in a culturally and linguis- 23 tically appropriate manner, to improve the collection, anal- 24 ysis, and reporting of racial, ethnic, sex, primary lan- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 17 •S 3660 IS guage, sexual orientation, disability status, gender iden- 1 tity, and socioeconomic status data at the Federal, State, 2 territorial, Tribal, and local levels, including data to be 3 collected under subsection (a), and to ensure that data col- 4 lection activities carried out under this section are in com- 5 pliance with standards developed under section 3101. The 6 Data Council of the Department of Health and Human 7 Services, in consultation with the National Committee on 8 Vital Health Statistics, the Office of Minority Health, Of- 9 fice on Women’s Health, and other appropriate public and 10 private entities, shall make recommendations to the Sec- 11 retary concerning the development, implementation, and 12 revision of the national plan. Such plan shall include rec- 13 ommendations on how to— 14 ‘‘(1) implement subsection (a) while minimizing 15 the cost and administrative burdens of data collec- 16 tion and reporting; 17 ‘‘(2) expand knowledge among Federal agen- 18 cies, States, territories, Indian Tribes, counties, mu- 19 nicipalities, health providers, health plans, and the 20 general public that data collection, analysis, and re- 21 porting by race, ethnicity, sex, primary language, 22 sexual orientation, gender identity, socioeconomic 23 status, and disability status is legal and necessary to 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 18 •S 3660 IS assure equity and nondiscrimination in the quality of 1 health care services; 2 ‘‘(3) ensure that future patient record systems 3 follow Federal standards promulgated under the 4 Health Information Technology for Economic and 5 Clinical Health Act for the collection and meaningful 6 use of electronic health data on race, ethnicity, sex, 7 primary language, sexual orientation, gender iden- 8 tity, socioeconomic status, and disability status; 9 ‘‘(4) improve health and health care data collec- 10 tion and analysis for more population groups if such 11 groups can be aggregated into the minimum race 12 and ethnicity categories, including exploring the fea- 13 sibility of enhancing collection efforts in States, 14 counties, and municipalities for racial and ethnic 15 groups that comprise a significant proportion of the 16 population of the State, county, or municipality; 17 ‘‘(5) provide researchers with greater access to 18 racial, ethnic, primary language, sex, sexual orienta- 19 tion, gender identity, socioeconomic status data, and 20 disability status data, subject to all applicable pri- 21 vacy and confidentiality requirements, including 22 HIPAA privacy and security law as defined in sec- 23 tion 3009; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 19 •S 3660 IS ‘‘(6) safeguard and prevent the misuse of data 1 collected under subsection (a). 2 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 3 lected under subsection (a) shall be obtained, maintained, 4 and presented (including for reporting purposes) in ac- 5 cordance with standards developed under section 3101. 6 ‘‘(e) 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 Assistant Secretary for Planning and Evaluation, the 10 Administrator of the Centers for Medicare & Medicaid 11 Services, the Director of the National Center for Health 12 Statistics, and the Director of the National Institutes of 13 Health, shall provide technical assistance to agencies of 14 the Department of Health and Human Services in meeting 15 Federal standards for health disparity data collection and 16 for analysis of racial, ethnic, and other disparities in 17 health and health care in programs conducted or sup- 18 ported by such agencies by— 19 ‘‘(1) identifying appropriate quality assurance 20 mechanisms to monitor for health disparities; 21 ‘‘(2) specifying the clinical, diagnostic, or thera- 22 peutic measures which should be monitored; 23 ‘‘(3) developing new quality measures relating 24 to racial and ethnic disparities and their overlap 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 20 •S 3660 IS with other disparity factors in health and health 1 care; 2 ‘‘(4) identifying the level at which data analysis 3 should be conducted; and 4 ‘‘(5) sharing data with external organizations 5 for research and quality improvement purposes. 6 ‘‘(f) DEFINITIONS.—In this section— 7 ‘‘(1) the term ‘health-related program’ means a 8 program that is operated by the Secretary, or that 9 receives funding or reimbursement, in whole or in 10 part, either directly or indirectly from the Sec- 11 retary— 12 ‘‘(A) for activities under the Social Secu- 13 rity Act for health care services; or 14 ‘‘(B) for providing federal financial assist- 15 ance for health care, biomedical research, or 16 health services research or for otherwise im- 17 proving the health of the public; 18 ‘‘(2) the term ‘primary language data’ includes 19 spoken and written primary language data; and 20 ‘‘(3) the term ‘primary language data collection 21 activities’ includes identifying, collecting, storing, 22 tracking, and analyzing primary language data and 23 information on the methods used to meet the lan- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 21 •S 3660 IS guage access needs of individuals with limited- 1 English proficiency. 2 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section 4 such sums as may be necessary for each of fiscal years 5 2019 through 2024. 6 ‘‘SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION 7 IMPROVEMENT ACTIVITIES. 8 ‘‘(a) IN GENERAL.—The Secretary, acting through 9 the Director of the Agency for Healthcare Research and 10 Quality and in consultation with the Deputy Assistant 11 Secretary for Minority Health, the Director of the Na- 12 tional Institutes of Health, the Assistant Secretary for 13 Planning and Evaluation, and the Director of the National 14 Center for Health Statistics, shall establish a technical as- 15 sistance program under which the Secretary provides 16 grants to eligible entities to assist such entities in com- 17 plying with section 3431. 18 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 19 under this section may be used to— 20 ‘‘(1) enhance or upgrade computer technology 21 that will facilitate collection, analysis, and reporting 22 of racial, ethnic, primary language, sexual orienta- 23 tion, sex, gender identity, socioeconomic status, and 24 disability status data; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 22 •S 3660 IS ‘‘(2) improve methods for health data collection 1 and analysis, including additional population groups 2 if such groups can be aggregated into the race and 3 ethnicity categories outlined by standards developed 4 under section 3101; 5 ‘‘(3) develop mechanisms for submitting col- 6 lected data subject to any applicable privacy and 7 confidentiality regulations; and 8 ‘‘(4) develop educational programs to inform 9 health plans, health providers, health-related agen- 10 cies, and the general public that data collection and 11 reporting by race, ethnicity, primary language, sex- 12 ual orientation, sex, gender identity, disability sta- 13 tus, and socioeconomic status are legal and essential 14 for eliminating health and health care disparities. 15 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 16 under this section, an entity shall be a State, territory, 17 Indian Tribe, municipality, county, health provider, health 18 care organization, or health plan making a demonstrated 19 effort to bring data collections into compliance with sec- 20 tion 3431. 21 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2019 through 2024. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 23 •S 3660 IS ‘‘SEC. 3433. OVERSAMPLING OF UNDERREPRESENTED 1 GROUPS IN FEDERAL HEALTH SURVEYS. 2 ‘‘(a) NATIONAL STRATEGY.— 3 ‘‘(1) IN GENERAL.—The Secretary, acting 4 through the Director of the National Center for 5 Health Statistics of the Centers for Disease Control 6 and Prevention, and other agencies within the De- 7 partment of Health and Human Services as the Sec- 8 retary determines appropriate, shall develop and im- 9 plement an ongoing and sustainable national strat- 10 egy for oversampling underrepresented populations 11 within the categories of race, ethnicity, sex, primary 12 language, sexual orientation, disability status, gen- 13 der identity, and socioeconomic status as determined 14 appropriate by the Secretary in Federal health sur- 15 veys and program data collections. Such national 16 strategy shall include a strategy for oversampling of 17 Asian Americans, Native Hawaiians, and Pacific Is- 18 landers. 19 ‘‘(2) CONSULTATION.—In developing and imple- 20 menting a national strategy, as described in para- 21 graph (1), not later than 180 days after the date of 22 the enactment of this section, the Secretary shall— 23 ‘‘(A) consult with representatives of com- 24 munity groups, nonprofit organizations, non- 25 governmental organizations, and government 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 24 •S 3660 IS agencies working with underrepresented popu- 1 lations; 2 ‘‘(B) solicit the participation of representa- 3 tives from other Federal departments and agen- 4 cies, including subagencies of the Department 5 of Health and Human Services; and 6 ‘‘(C) consult on, and use as models, the 7 2014 National Health Interview Survey over- 8 sample of Native Hawaiian and Pacific Islander 9 populations and the 2017 Behavioral Risk Fac- 10 tor Surveillance System oversample of American 11 Indian and Alaska Native communities. 12 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 13 after the date of the enactment of this section, the Sec- 14 retary shall submit to the Congress a progress report, 15 which shall include the national strategy described in sub- 16 section (a)(1). 17 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 18 carry out this section, there are authorized to be appro- 19 priated such sums as may be necessary for fiscal years 20 2019 through 2024.’’. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 25 •S 3660 IS SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP- 1 PROPRIATIONS FOR DATA COLLECTION AND 2 ANALYSIS. 3 Section 3101 of the Public Health Service Act (42 4 U.S.C. 300kk) is amended— 5 (1) by striking subsection (h); and 6 (2) by redesignating subsection (i) as subsection 7 (h). 8 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 9 THE SOCIAL SECURITY ADMINISTRATION. 10 Part A of title XI of the Social Security Act (42 11 U.S.C. 1301 et seq.) is amended by adding at the end 12 the following: 13 ‘‘COLLECTION OF RACE AND ETHNICITY DATA BY THE 14 SOCIAL SECURITY ADMINISTRATION 15 ‘‘SEC. 1150C. (a) REQUIREMENT.— 16 ‘‘(1) IN GENERAL.—The Commissioner of So- 17 cial Security, in consultation with the Administrator 18 of the Centers for Medicare & Medicaid Services, 19 shall collect data on the race, ethnicity, primary lan- 20 guage, and disability status of all applicants for So- 21 cial Security account numbers or benefits under title 22 II or part A of title XVIII and all individuals with 23 respect to whom the Commissioner maintains 24 records of wages and self-employment income. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 26 •S 3660 IS ‘‘(2) DATA COLLECTION STANDARDS.—In col- 1 lecting data under paragraph (1), the Commissioner 2 of Social Security shall use standards for data col- 3 lection on race, ethnicity, primary language, and dis- 4 ability status developed under section 3101 of the 5 Public Health Service Act and, where practicable, 6 the standards developed by the Institute of Medicine 7 in ‘Race, Ethnicity, and Language Data: Standard- 8 ization for Health Care Quality Improvement’ (re- 9 leased August 31, 2009). 10 ‘‘(3) DATA FOR ADDITIONAL POPULATION 11 GROUPS.—Where practicable, the information col- 12 lected by the Commissioner of Social Security under 13 paragraph (1) shall include data for additional popu- 14 lation groups if such groups can be aggregated into 15 the race and ethnicity categories outlined by the 16 data collection standards described in paragraph (2). 17 ‘‘(4) COLLECTION OF DATA FOR MINORS AND 18 LEGALLY INCAPACITATED INDIVIDUALS.—With re- 19 spect to the collection of the data described in para- 20 graph (1) of applicants who are under 18 years of 21 age or otherwise legally incapacitated, the Commis- 22 sioner of Social Security shall require that— 23 ‘‘(A) such data be collected from the par- 24 ent or legal guardian of such an applicant; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 27 •S 3660 IS ‘‘(B) the primary language of the parent 1 or legal guardian of such an applicant or recipi- 2 ent be used in collecting the data. 3 ‘‘(5) ADDITIONAL REQUIREMENTS.—With re- 4 spect to data collected under paragraph (1), the 5 Commissioner of Social Security shall— 6 ‘‘(A) require that such data be uniformly 7 analyzed and that such analysis be reported at 8 least annually to the Commissioner; 9 ‘‘(B) be responsible for storing the data re- 10 ported under subparagraph (A); 11 ‘‘(C) ensure transmission to the Centers 12 for Medicare & Medicaid Services and other 13 agencies within the Department of Health and 14 Human Services, as determined appropriate by 15 the Secretary; 16 ‘‘(D) provide such data to the Secretary on 17 at least an annual basis; and 18 ‘‘(E) ensure that the provision of assist- 19 ance or benefits to an applicant is not denied 20 or otherwise adversely affected because of the 21 failure of the applicant to provide race, eth- 22 nicity, primary language, and disability status 23 data. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 28 •S 3660 IS ‘‘(b) PROTECTION OF DATA.—The Commissioner of 1 Social Security shall ensure (through the promulgation of 2 regulations or otherwise) that all data collected pursuant 3 to subsection (a) is protected— 4 ‘‘(1) under the same privacy protections as the 5 Secretary applies to health data under the regula- 6 tions promulgated under section 264(c) of the 7 Health Insurance Portability and Accountability Act 8 of 1996 (relating to the privacy of individually iden- 9 tifiable health information and other protections); 10 and 11 ‘‘(2) from all inappropriate internal use by any 12 entity that collects, stores, or receives the data, in- 13 cluding use of such data in determinations of eligi- 14 bility (or continued eligibility) in health plans, and 15 from other inappropriate uses, as defined by the 16 Secretary. 17 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec- 18 tion shall be construed to permit the use of information 19 collected under this section in a manner that would ad- 20 versely affect any individual providing any such informa- 21 tion. 22 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 23 either directly or by grant or contract, provide technical 24 assistance to enable any entity to comply with the require- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 29 •S 3660 IS ments of this section or with regulations implementing this 1 section. 2 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section 4 such sums as may be necessary for each of fiscal years 5 2019 through 2024.’’. 6 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 7 (a) IN GENERAL.—Not later than 1 year after the 8 date of enactment of this Act, the Secretary of Health and 9 Human Services shall revise the regulations promulgated 10 under part C of title XI of the Social Security Act (42 11 U.S.C. 1320d et seq.), relating to the collection of data 12 on race, ethnicity, and primary language in a health-re- 13 lated transaction, to require— 14 (1) the use, at a minimum, of standards for 15 data collection on race, ethnicity, primary language, 16 disability, sex, sexual orientation, gender identity, 17 and socioeconomic status developed under section 18 3101 of the Public Health Service Act (42 U.S.C. 19 300kk); and 20 (2) in consultation with the Office of the Na- 21 tional Coordinator for Health Information Tech- 22 nology, the designation of the appropriate racial, 23 ethnic, primary language, disability, sex, and other 24 code sets as required for claims and enrollment data. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 30 •S 3660 IS (b) DISSEMINATION.—The Secretary of Health and 1 Human Services shall disseminate the new standards de- 2 veloped under subsection (a) to all entities that are subject 3 to the regulations described in such subsection and provide 4 technical assistance with respect to the collection of the 5 data involved. 6 (c) COMPLIANCE.—The Secretary of Health and 7 Human Services shall require that entities comply with the 8 new standards developed under subsection (a) not later 9 than 2 years after the final promulgation of such stand- 10 ards. 11 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 12 Section 306(n) of the Public Health Service Act (42 13 U.S.C. 242k(n)) is amended— 14 (1) in paragraph (1), by striking ‘‘2003’’ and 15 inserting ‘‘2022’’; 16 (2) in paragraph (2), in the first sentence, by 17 striking ‘‘2003’’ and inserting ‘‘2022’’; and 18 (3) in paragraph (3), by striking ‘‘2002’’ and 19 inserting ‘‘2022’’. 20 SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL 21 GOVERNMENT. 22 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec- 23 retary of Health and Human Services, in coordination 24 with the departments, agencies, or offices described in 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 31 •S 3660 IS subsection (b), shall establish a centralized electronic re- 1 pository of Government data on factors related to the 2 health and well-being of the population of the United 3 States. 4 (b) COLLECTION; SUBMISSION.—Not later than 180 5 days after the date of the enactment of this Act, and Jan- 6 uary 31 of each year thereafter, each department, agency, 7 and office of the Federal Government that has collected 8 data on race, ethnicity, sex, primary language, sexual ori- 9 entation, disability status, gender identity, or socio- 10 economic status during the preceding calendar year shall 11 submit such data to the repository of Government data 12 established under subsection (a). 13 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 14 Not later than April 30, 2019, and April 30 of each year 15 thereafter, the Secretary of Health and Human Services, 16 acting through the Assistant Secretary for Planning and 17 Evaluation, the Assistant Secretary for Health, the Direc- 18 tor of the Agency for Healthcare Research and Quality, 19 the Director of the National Center for Health Statistics, 20 the Administrator of the Centers for Medicare & Medicaid 21 Services, the Director of the National Institute on Minor- 22 ity Health and Health Disparities, and the Deputy Assist- 23 ant Secretary for Minority Health, shall— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 32 •S 3660 IS (1) prepare and make available datasets for 1 public use that relate to disparities in health status, 2 health care access, health care quality, health out- 3 comes, public health, and other areas of health and 4 well-being by factors that include race, ethnicity, 5 sex, primary language, sexual orientation, disability 6 status, gender identity, and socioeconomic status; 7 (2) ensure that these datasets are publicly iden- 8 tified on the repository established under subsection 9 (a) as ‘‘disparities’’ data; and 10 (3) submit a report to the Congress on the 11 availability and use of such data by public stake- 12 holders. 13 SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 14 NORITY-SERVING INSTITUTIONS. 15 (a) AUTHORITY.—The Secretary of Health and 16 Human Services, acting through the Director of the Na- 17 tional Institute on Minority Health and Health Disparities 18 and the Deputy Assistant Secretary for Minority Health, 19 shall award grants to eligible entities to access and analyze 20 racial and ethnic data on disparities in health and health 21 care, and where possible other data on disparities in health 22 and health care, to monitor and report on progress to re- 23 duce and eliminate disparities in health and health care. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 33 •S 3660 IS (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 1 igible entity’’ means an entity that has an accredited pub- 2 lic health, health policy, or health services research pro- 3 gram and is any of the following: 4 (1) A part B institution, as defined in section 5 322 of the Higher Education Act of 1965 (20 6 U.S.C. 1061). 7 (2) A Hispanic-serving institution, as defined in 8 section 502 of such Act (20 U.S.C. 1101a). 9 (3) A Tribal College or University, as defined in 10 section 316 of such Act (20 U.S.C. 1059c). 11 (4) An Asian American and Native American 12 Pacific Islander-serving institution, as defined in 13 section 371(c) of such Act (20 U.S.C. 1067q(c)). 14 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated 16 such sums as may be necessary for fiscal years 2019 17 through 2024. 18 SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTA- 19 TION, GENDER IDENTITY, AND SOCIO- 20 ECONOMIC STATUS IN COLLECTION OF 21 HEALTH DATA. 22 Section 3101(a) of the Public Health Service Act (42 23 U.S.C. 300kk(a)) is amended— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 34 •S 3660 IS (1) in paragraph (1)(A), by inserting ‘‘sexual 1 orientation, gender identity, socioeconomic status,’’ 2 before ‘‘and disability status’’; 3 (2) in paragraph (1)(C), by inserting ‘‘sexual 4 orientation, gender identity, socioeconomic status,’’ 5 before ‘‘and disability status’’; and 6 (3) in paragraph (2)(B), by inserting ‘‘sexual 7 orientation, gender identity, socioeconomic status,’’ 8 before ‘‘and disability status’’. 9 SEC. 109. SAFETY AND EFFECTIVENESS OF DRUGS WITH 10 RESPECT TO RACIAL AND ETHNIC BACK- 11 GROUND. 12 (a) IN GENERAL.—Chapter V of the Federal Food, 13 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 14 ed by adding after section 505F the following: 15 ‘‘SEC. 505G. SAFETY AND EFFECTIVENESS OF DRUGS WITH 16 RESPECT TO RACIAL AND ETHNIC BACK- 17 GROUND. 18 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 19 that there may be a disparity on the basis of racial or 20 ethnic background as to the safety or effectiveness of a 21 drug or biological product, then— 22 ‘‘(1)(A) in the case of a drug, the investigations 23 required under section 505(b)(1)(A) shall include 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 35 •S 3660 IS adequate and well-controlled investigations of the 1 disparity; or 2 ‘‘(B) in the case of a biological product, the evi- 3 dence required under section 351(a) of the Public 4 Health Service Act for approval of a biologics license 5 application for the biological product shall include 6 adequate and well-controlled investigations of the 7 disparity; and 8 ‘‘(2) if the investigations described in subpara- 9 graph (A) or (B) of paragraph (1) confirm that 10 there is such a disparity, the labeling of the drug or 11 biological product shall include appropriate informa- 12 tion about the disparity. 13 ‘‘(b) POSTMARKET STUDIES.— 14 ‘‘(1) IN GENERAL.—If there is evidence that 15 there may be a disparity on the basis of racial or 16 ethnic background as to the safety or effectiveness 17 of a drug for which there is an approved application 18 under section 505 of this Act or of a biological prod- 19 uct for which there is an approved license under sec- 20 tion 351 of the Public Health Service Act, the Sec- 21 retary may by order require the holder of the ap- 22 proved application or license to conduct, by a date 23 specified by the Secretary, postmarket studies to in- 24 vestigate the disparity. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 36 •S 3660 IS ‘‘(2) LABELING.—If the Secretary determines 1 that the postmarket studies confirm that there is a 2 disparity described in paragraph (1), the labeling of 3 the drug or biological product shall include appro- 4 priate information about the disparity. 5 ‘‘(3) STUDY DESIGN.—The Secretary may, in 6 an order under paragraph (1), specify all aspects of 7 the design of the postmarket studies required under 8 such paragraph for a drug or biological product, in- 9 cluding the number of studies and study partici- 10 pants, and the other demographic characteristics of 11 the study participants. 12 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 13 Secretary may, by order and as necessary, modify 14 any aspect of the design of a postmarket study re- 15 quired in an order under paragraph (1) after issuing 16 such order. 17 ‘‘(5) STUDY RESULTS.—The results from a 18 study required under paragraph (1) shall be sub- 19 mitted to the Secretary as a supplement to the drug 20 application or biologics license application. 21 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 22 ‘‘(1) IN GENERAL.—A drug for which an appli- 23 cation has been submitted or approved under section 24 505(j) shall not be considered ineligible for approval 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 37 •S 3660 IS under that section or misbranded under section 502 1 on the basis that the labeling of the drug omits in- 2 formation relating to a disparity on the basis of ra- 3 cial or ethnic background as to the safety or effec- 4 tiveness of the drug, whether derived from investiga- 5 tions or studies required under this section or de- 6 rived from other sources, when the omitted informa- 7 tion is protected by patent or by exclusivity under 8 section 505(j)(5)(F). 9 ‘‘(2) LABELING.—Notwithstanding paragraph 10 (1), the Secretary may require that the labeling of 11 a drug approved under section 505(j) that omits in- 12 formation relating to a disparity on the basis of ra- 13 cial or ethnic background as to the safety or effec- 14 tiveness of the drug include a statement of any ap- 15 propriate contraindications, warnings, or precautions 16 related to the disparity that the Secretary considers 17 necessary. 18 ‘‘(d) DEFINITION.—The term ‘evidence that there 19 may be a disparity on the basis of racial or ethnic back- 20 ground as to the safety or effectiveness’, with respect to 21 a drug or biological product, includes— 22 ‘‘(1) evidence that there is a disparity on the 23 basis of racial or ethnic background as to safety or 24 effectiveness of a drug or biological product in the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 38 •S 3660 IS same chemical class as the drug or biological prod- 1 uct; 2 ‘‘(2) evidence that there is a disparity on the 3 basis of racial or ethnic background in the way the 4 drug or biological product is metabolized; and 5 ‘‘(3) other evidence as the Secretary may deter- 6 mine appropriate.’’. 7 (b) ENFORCEMENT.—Section 502 of the Federal 8 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 9 ed by adding at the end the following: 10 ‘‘(ee) If it is a drug and the holder of the approved 11 application under section 505 or license under section 351 12 of the Public Health Service Act for the drug has failed 13 to complete the investigations or studies, or comply with 14 any other requirement, of section 505G.’’. 15 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 16 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 17 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 18 required’’ the following: ‘‘, including postmarket studies 19 required under section 505G’’. 20 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE 21 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 22 Part B of title III of the Public Health Service Act 23 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 24 tion 317T the following: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 39 •S 3660 IS ‘‘SEC. 317U. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 1 LANDER HEALTH DATA. 2 ‘‘(a) DEFINITIONS.—In this section: 3 ‘‘(1) COMMUNITY GROUP.—The term ‘commu- 4 nity group’ means a group of NHOPI who are orga- 5 nized at the community level, and may include a 6 church group, social service group, national advocacy 7 organization, or cultural group. 8 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI- 9 ZATION.—The term ‘nonprofit, nongovernmental or- 10 ganization’ means a group of NHOPI with a dem- 11 onstrated history of addressing NHOPI issues, in- 12 cluding a NHOPI coalition. 13 ‘‘(3) DESIGNATED ORGANIZATION.—The term 14 ‘designated organization’ means an entity estab- 15 lished to represent NHOPI populations and which 16 has statutory responsibilities to provide, or has com- 17 munity support for providing, health care. 18 ‘‘(4) GOVERNMENT REPRESENTATIVES OF 19 NHOPI POPULATIONS.—The term ‘government rep- 20 resentatives of NHOPI populations’ means rep- 21 resentatives from Hawaii, American Samoa, the 22 Commonwealth of the Northern Mariana Islands, 23 the Federated States of Micronesia, Guam, the Re- 24 public of Palau, and the Republic of the Marshall Is- 25 lands. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 40 •S 3660 IS ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC 1 ISLANDERS (NHOPI).—The term ‘Native Hawaiians 2 and Other Pacific Islanders’ or ‘NHOPI’ means peo- 3 ple having origins in any of the original peoples of 4 American Samoa, the Commonwealth of the North- 5 ern Mariana Islands, the Federated States of Micro- 6 nesia, Guam, Hawaii, the Republic of the Marshall 7 Islands, the Republic of Palau, or any other Pacific 8 Island. 9 ‘‘(6) INSULAR AREA.—The term ‘insular area’ 10 means Guam, the Commonwealth of Northern Mar- 11 iana Islands, American Samoa, the United States 12 Virgin Islands, the Federated States of Micronesia, 13 the Republic of Palau, or the Republic of the Mar- 14 shall Islands. 15 ‘‘(b) NATIONAL STRATEGY.— 16 ‘‘(1) IN GENERAL.—The Secretary, acting 17 through the Director of the National Center for 18 Health Statistics (referred to in this section as 19 ‘NCHS’) of the Centers for Disease Control and 20 Prevention, and other agencies within the Depart- 21 ment of Health and Human Services as the Sec- 22 retary determines appropriate, shall develop and im- 23 plement an ongoing and sustainable national strat- 24 egy for identifying and evaluating the health status 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 41 •S 3660 IS and health care needs of NHOPI populations living 1 in the continental United States, Hawaii, American 2 Samoa, the Commonwealth of the Northern Mariana 3 Islands, the Federated States of Micronesia, Guam, 4 the Republic of Palau, and the Republic of the Mar- 5 shall Islands. 6 ‘‘(2) CONSULTATION.—In developing and imple- 7 menting a national strategy, as described in para- 8 graph (1), not later than 180 days after the date of 9 enactment of the Health Equity and Accountability 10 Act of 2018, the Secretary— 11 ‘‘(A) shall consult with representatives of 12 community groups, designated organizations, 13 and nonprofit, nongovernmental organizations 14 and with government representatives of NHOPI 15 populations; and 16 ‘‘(B) may solicit the participation of rep- 17 resentatives from other Federal departments. 18 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Director of NCHS, shall conduct a pre- 21 liminary health survey in order to identify the major 22 areas and regions in the continental United States, 23 Hawaii, American Samoa, the Commonwealth of the 24 Northern Mariana Islands, the Federated States of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 42 •S 3660 IS Micronesia, Guam, the Republic of Palau, and the 1 Republic of the Marshall Islands in which NHOPI 2 people reside. 3 ‘‘(2) CONTENTS.—The health survey described 4 in paragraph (1) shall include health data and any 5 other data the Secretary determines to be— 6 ‘‘(A) useful in determining health status 7 and health care needs; or 8 ‘‘(B) required for developing or imple- 9 menting a national strategy. 10 ‘‘(3) METHODOLOGY.—Methodology for the 11 health survey described in paragraph (1), including 12 plans for designing questions, implementation, sam- 13 pling, and analysis, shall be developed in consulta- 14 tion with community groups, designated organiza- 15 tions, nonprofit, nongovernmental organizations, and 16 government representatives of NHOPI populations, 17 as determined by the Secretary. 18 ‘‘(4) TIMEFRAME.—The survey required under 19 this subsection shall be completed not later than 18 20 months after the date of enactment of the Health 21 Equity and Accountability Act of 2018. 22 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 23 after the date of enactment of the Health Equity and Ac- 24 countability Act of 2018, the Secretary shall submit to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 43 •S 3660 IS Congress a progress report, which shall include the na- 1 tional strategy described in subsection (b)(1). 2 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND 3 MEDICINE DIVISION.— 4 ‘‘(1) IN GENERAL.—The Secretary shall enter 5 into an agreement with the Health and Medicine Di- 6 vision of the National Academies of Sciences, Engi- 7 neering, and Medicine to conduct a study, with input 8 from stakeholders in insular areas, on each of the 9 following: 10 ‘‘(A) The standards and definitions of 11 health care applied to health care systems in in- 12 sular areas and the appropriateness of such 13 standards and definitions. 14 ‘‘(B) The status and performance of health 15 care systems in insular areas, evaluated based 16 upon standards and definitions, as the Sec- 17 retary determines appropriate. 18 ‘‘(C) The effectiveness of donor aid in ad- 19 dressing health care needs and priorities in in- 20 sular areas. 21 ‘‘(D) The progress toward implementation 22 of recommendations of the Committee on 23 Health Care Services in the United States—As- 24 sociated Pacific Basin that are set forth in the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 44 •S 3660 IS 1998 report entitled ‘Pacific Partnerships for 1 Health: Charting a New Course’. 2 ‘‘(2) REPORT.—An agreement described in 3 paragraph (1) shall require the Health and Medicine 4 Division to submit to the Secretary and to Congress, 5 not later than 2 years after the date of the enact- 6 ment of the Health Equity and Accountability Act of 7 2018, a report containing a description of the results 8 of the study conducted under paragraph (1), includ- 9 ing the conclusions and recommendations of the 10 Health and Medicine Division for each of the items 11 described in subparagraphs (A) through (D) of such 12 paragraph. 13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this section, there are authorized to be appro- 15 priated such sums as may be necessary for fiscal years 16 2019 through 2024.’’. 17 SEC. 111. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 18 REPORTING REQUIREMENT. 19 Section 11(a) of the Food and Nutrition Act of 2008 20 (7 U.S.C. 2020(a)) is amended by adding at the end the 21 following: 22 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 23 REQUIREMENT.—With respect to any obligation of a 24 State agency to comply with the notification require- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 45 •S 3660 IS ment under paragraph (2) of section 421(e) of the 1 Personal Responsibility and Work Opportunity Rec- 2 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith- 3 standing the requirement to include in that notifica- 4 tion the names of the sponsor and the sponsored 5 alien involved, the State agency shall be considered 6 to have complied with the notification requirement if 7 the State agency submits to the Attorney General a 8 report that includes the aggregate number of excep- 9 tions granted by the State agency under paragraph 10 (1) of that section.’’. 11 TITLE II—CULTURALLY AND LIN- 12 GUISTICALLY APPROPRIATE 13 HEALTH AND HEALTH CARE 14 SEC. 201. DEFINITIONS; FINDINGS. 15 (a) DEFINITIONS.—In this title, the definitions in 16 section 3400 of the Public Health Service Act, as added 17 by section 204, shall apply. 18 (b) FINDINGS.—Congress finds the following: 19 (1) Effective communication is essential to 20 meaningful access to quality physical and mental 21 health care. 22 (2) Research indicates that the lack of appro- 23 priate language services creates language barriers 24 that result in increased risk of misdiagnosis, ineffec- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 46 •S 3660 IS tive treatment plans, and poor health outcomes for 1 individuals with limited-English proficiency and indi- 2 viduals with communication disabilities such as hear- 3 ing, vision, or print impairments. 4 (3) The number of limited-English-speaking 5 residents in the United States who speak English 6 less than very well and, therefore, cannot effectively 7 communicate with health and social service providers 8 continues to increase significantly. 9 (4) The responsibility to fund language services 10 in the provision of health care and health-care-re- 11 lated services to individuals with limited-English 12 proficiency and individuals with communication dis- 13 abilities such as hearing, vision, or print impair- 14 ments is a societal one that cannot fairly be placed 15 solely upon the health care, public health, or social 16 services community. 17 (5) Title VI of the Civil Rights Act of 1964 (42 18 U.S.C. 2000d et seq.) prohibits discrimination based 19 on the grounds of race, color, or national origin by 20 any entity receiving Federal financial assistance. In 21 order to avoid discrimination on the grounds of na- 22 tional origin, all programs or activities administered 23 by the Federal Government must take adequate 24 steps to ensure that their policies and procedures do 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 47 •S 3660 IS not deny or have the effect of denying individuals 1 with limited-English proficiency with equal access to 2 benefits and services for which such persons qualify. 3 (6) Both the Americans with Disabilities Act of 4 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita- 5 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 6 discrimination on the basis of disability and require 7 the provision of appropriate auxiliary aids and serv- 8 ices necessary to ensure effective communication 9 with individuals with disabilities. The type of auxil- 10 iary aid or service necessary to ensure effective com- 11 munication will vary in accordance with the method 12 of communication used by the individual; the nature, 13 length, and complexity of the communication in- 14 volved; and the context in which the communication 15 is taking place. A public accommodation should con- 16 sult with individuals with disabilities whenever pos- 17 sible to determine what type of auxiliary aid is need- 18 ed to ensure effective communication, but the ulti- 19 mate decision as to what measures to take rests with 20 the public accommodation, provided that the method 21 chosen results in effective communication. In order 22 to be effective, auxiliary aids and services must be 23 provided in accessible formats, in a timely manner, 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 48 •S 3660 IS and in such a way as to protect the privacy and 1 independence of the individual with a disability. 2 (7) Linguistic diversity in the health care and 3 health-care-related services workforce is important 4 for providing all patients the environment most con- 5 ducive to positive health outcomes. 6 (8) All members of the health care and health- 7 care-related services community should continue to 8 educate their staff and constituents about limited- 9 English-proficient and disability communication 10 issues and help them identify resources to improve 11 access to quality care for individuals with limited- 12 English proficiency and individuals with communica- 13 tion disabilities such as hearing, vision, or print im- 14 pairments. 15 (9) Access to English as a second language, and 16 sign language instructions, readers, and other auxil- 17 iary aids and services, are essential to ensure effec- 18 tive communication and eliminate the language bar- 19 riers that impede access to health care. 20 (10) Competent language services in health care 21 settings should be available as a matter of course. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 49 •S 3660 IS SEC. 202. IMPROVING ACCESS TO SERVICES FOR INDIVID- 1 UALS WITH LIMITED-ENGLISH PROFICIENCY. 2 (a) PURPOSE.—Consistent with the goals provided in 3 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 4 to improving access to services for persons with limited- 5 English proficiency), it is the purpose of this section— 6 (1) to improve Federal agency performance re- 7 garding access to federally conducted and federally 8 assisted programs and activities for individuals with 9 limited-English proficiency; 10 (2) to require each Federal agency to examine 11 the services it provides and develop and implement 12 a system by which individuals with limited-English 13 proficiency can obtain cultural competence and 14 meaningful access to those services consistent with, 15 and without substantially burdening, the funda- 16 mental mission of the agency; 17 (3) to require each Federal agency to ensure 18 that recipients of Federal financial assistance pro- 19 vide cultural competence and meaningful access to 20 applicants and beneficiaries that are individuals with 21 limited-English proficiency; 22 (4) to ensure that recipients of Federal finan- 23 cial assistance take reasonable steps, consistent with 24 the guidelines set forth in the ‘‘Guidance to Federal 25 Financial Assistance Recipients Regarding Title VI 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 50 •S 3660 IS Prohibition Against National Origin Discrimination 1 Affecting Limited English Proficient Persons (67 2 Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul- 3 turally and linguistically appropriate access to their 4 programs and activities by individuals with limited- 5 English proficiency; and 6 (5) to ensure compliance with title VI of the 7 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 8 and that health care providers and organizations do 9 not discriminate in the provision of services. 10 (b) FEDERALLY CONDUCTED PROGRAMS AND AC- 11 TIVITIES.— 12 (1) IN GENERAL.—Not later than 120 days 13 after the date of enactment of this Act, each Federal 14 agency providing financial assistance to, or admin- 15 istering, a health program or activity described in 16 section 203(a) shall prepare a plan to improve cul- 17 turally and linguistically appropriate access to such 18 program or activity with respect to individuals with 19 limited-English proficiency. Not later than 1 year 20 after the date of enactment of this title, each such 21 Federal agency shall ensure that such plan is fully 22 implemented. 23 (2) PLAN REQUIREMENT.—Each plan under 24 paragraph (1) shall include— 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 51 •S 3660 IS (A) the steps the agency will take to en- 1 sure that individuals with limited-English pro- 2 ficiency have access to each health program or 3 activity supported or administered by the agen- 4 cy; 5 (B) the policies and procedures for identi- 6 fying, assessing, and meeting the culturally and 7 linguistically appropriate language needs of its 8 beneficiaries that are individuals with limited- 9 English proficiency served by such program or 10 activity; 11 (C) the steps the agency will take for such 12 program or activity to be culturally and linguis- 13 tically appropriate by providing a range of lan- 14 guage assistance options, notice to individuals 15 with limited-English proficiency of the right to 16 competent language services, periodic training 17 of staff, monitoring and quality assessment of 18 the language services and, in appropriate cir- 19 cumstances, the translation of written mate- 20 rials; 21 (D) the steps the agency will take to en- 22 sure that applications, forms, and other rel- 23 evant documents for such program or activity 24 are competently translated into the primary 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 52 •S 3660 IS language of a client that is an individual with 1 limited-English proficiency where such mate- 2 rials are needed to improve access of such client 3 to such program or activity; 4 (E) the resources the agency will provide 5 to improve cultural and linguistic appropriate- 6 ness to assist recipients of Federal funds to im- 7 prove access to health care related programs 8 and activities for individuals with limited- 9 English proficiency; 10 (F) the resources the agency will provide 11 to ensure that competent language assistance is 12 provided to patients that are individuals with 13 limited-English proficiency by interpreters or 14 trained bilingual staff; and 15 (G) the resources the agency will provide 16 to ensure that family, particularly minor chil- 17 dren, and friends are not used to provide inter- 18 pretation services, except as permitted under 19 regulations implementing section 1557 of the 20 Patient Protection and Affordable Care Act (42 21 U.S.C. 18116). 22 (3) SUBMISSION OF PLAN TO DOJ.—Each agen- 23 cy that is required to prepare a plan under para- 24 graph (1) shall send a copy of such plan to the At- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 53 •S 3660 IS torney General, which shall serve as the central re- 1 pository of all such plans. 2 (4) RULE OF CONSTRUCTION.—Paragraph 3 (2)(G) shall not be construed to mean that emer- 4 gency rooms or similar entities that regularly pro- 5 vide health care services in medical emergencies are 6 exempt from legal or regulatory requirements related 7 to competent interpreter services. 8 SEC. 203. NATIONAL STANDARDS FOR CULTURALLY AND 9 LINGUISTICALLY APPROPRIATE SERVICES IN 10 HEALTH CARE. 11 (a) APPLICABILITY.—This section shall apply to any 12 health program or activity, any part of which is receiving 13 Federal financial assistance, including credits, subsidies, 14 or contracts of insurance, or any program or activity that 15 is administered by an executive agency or any entity estab- 16 lished under title I of the Patient Protection and Afford- 17 able Care Act (or amendments made thereby), as such 18 programs, activities, agencies, and entities are described 19 in section 1557(a) of the Patient Protection and Afford- 20 able Care Act (42 U.S.C. 18116(a)). 21 (b) STANDARDS.—Each program or activity de- 22 scribed in subsection (a)— 23 (1) shall implement strategies to recruit, retain, 24 and promote individuals at all levels to maintain a 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 54 •S 3660 IS diverse staff and leadership that can provide cul- 1 turally and linguistically appropriate health care to 2 patient populations of the service area of the pro- 3 gram or activity; 4 (2) shall educate and train governance, leader- 5 ship, and workforce at all levels and across all dis- 6 ciplines of the program or activity in culturally and 7 linguistically appropriate policies and practices on an 8 ongoing basis; 9 (3) shall offer and provide language assistance, 10 including trained bilingual staff and interpreter serv- 11 ices, to individuals with limited-English proficiency 12 or who have other communication needs, at no cost 13 to the individual at all points of contact, and during 14 all hours of operation, to facilitate timely access to 15 health care services and health-care-related services; 16 (4) shall for each language group consisting of 17 individuals with limited-English proficiency that con- 18 stitutes 5 percent or 500 individuals, whichever is 19 less, of the population of persons eligible to be 20 served or likely to be affected or encountered in the 21 service area of the program or activity, make avail- 22 able— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 55 •S 3660 IS (A) easily understood patient-related mate- 1 rials, including print and multimedia materials, 2 in the language of such language group; 3 (B) information or notices about termi- 4 nation of benefits in such language; and 5 (C) signage; 6 (5) shall develop and implement clear goals, 7 policies, operational plans, and management, ac- 8 countability, and oversight mechanisms to provide 9 culturally and linguistically appropriate services and 10 infuse them throughout the planning and operations 11 of the program or activity; 12 (6) shall conduct initial and ongoing organiza- 13 tional assessments of culturally and linguistically ap- 14 propriate services-related activities and integrate 15 valid linguistic, competence-related National Stand- 16 ards for Culturally and Linguistically Appropriate 17 Services (CLAS) measures into the internal audits, 18 performance improvement programs, patient satis- 19 faction assessments, continuous quality improvement 20 activities, and outcomes-based evaluations of the 21 program or activity and develop ways to standardize 22 the assessments; 23 (7) shall ensure that, consistent with the pri- 24 vacy protections provided for under the regulations 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 56 •S 3660 IS promulgated under section 264(c) of the Health In- 1 surance Portability and Accountability Act of 1996 2 (42 U.S.C. 1320–2 note), data on an individual re- 3 quired to be collected pursuant to section 3101, in- 4 cluding the individual’s alternative format pref- 5 erences and policy modification needs, are— 6 (A) collected in health records; 7 (B) integrated into the management infor- 8 mation systems of the program or activity; and 9 (C) periodically updated; 10 (8) shall maintain a current demographic, cul- 11 tural, and epidemiological profile of the community, 12 conduct regular assessments of community health 13 assets and needs, and use the results of such assess- 14 ments to accurately plan for and implement services 15 that respond to the cultural and linguistic character- 16 istics of the service area of the program or activity; 17 (9) shall develop participatory, collaborative 18 partnerships with communities and utilize a variety 19 of formal and informal mechanisms to facilitate 20 community and patient involvement in designing, 21 implementing, and evaluating policies and practices 22 to ensure culturally and linguistically appropriate 23 service-related activities; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 57 •S 3660 IS (10) shall ensure that conflict and grievance 1 resolution processes are culturally and linguistically 2 appropriate and capable of identifying, preventing, 3 and resolving cross-cultural conflicts or complaints 4 by patients; 5 (11) shall regularly make available to the public 6 information about their progress and successful in- 7 novations in implementing the standards under this 8 section and provide public notice in their commu- 9 nities about the availability of this information; and 10 (12) shall, if requested, regularly make avail- 11 able to the head of each Federal entity from which 12 Federal funds are provided, information about the 13 progress and successful innovations of the program 14 or activity in implementing the standards under this 15 section as required by the head of such entity. 16 (c) COMMENTS ACCEPTED THROUGH NOTICE AND 17 COMMENT RULEMAKING.—An agency carrying out a pro- 18 gram described in subsection (a) shall ensure that com- 19 ments with respect to such program that are accepted 20 through notice and comment rulemaking be accepted in 21 all languages and may not require such comments to be 22 submitted only in English. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 58 •S 3660 IS SEC. 204. CULTURALLY AND LINGUISTICALLY APPRO- 1 PRIATE HEALTH CARE IN THE PUBLIC 2 HEALTH SERVICE ACT. 3 The Public Health Service Act (42 U.S.C. 201 et 4 seq.) is amended by adding at the end the following: 5 ‘‘TITLE XXXIV—CULTURALLY 6 AND LINGUISTICALLY APPRO- 7 PRIATE HEALTH CARE 8 ‘‘SEC. 3400. DEFINITIONS. 9 ‘‘(a) IN GENERAL.—In this title: 10 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 11 respect to an individual, means a person who has 12 sufficient degree of proficiency in 2 languages. 13 ‘‘(2) CULTURAL.—The term ‘cultural’ means 14 relating to integrated patterns of human behavior 15 that include the language, thoughts, communica- 16 tions, actions, customs, beliefs, values, and institu- 17 tions of racial, ethnic, religious, or social groups, in- 18 cluding lesbian, gay, bisexual, transgender, queer, 19 and questioning individuals, and individuals with 20 physical and mental disabilities. 21 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP- 22 PROPRIATE.—The term ‘culturally and linguistically 23 appropriate’ means being respectful of and respon- 24 sive to the cultural and linguistic needs of all indi- 25 viduals. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 59 •S 3660 IS ‘‘(4) EFFECTIVE COMMUNICATION.—The term 1 ‘effective communication’ means an exchange of in- 2 formation between the provider of health care or 3 health-care-related services and the recipient of such 4 services who is limited in English proficiency, or has 5 a communication impairment such as a hearing, vi- 6 sion, speaking, or learning impairment, that enables 7 access to, understanding of, and benefit from health 8 care or health-care-related services, and full partici- 9 pation in the development of their treatment plan. 10 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 11 term ‘grievance resolution process’ means all aspects 12 of dispute resolution including filing complaints, 13 grievance and appeal procedures, and court action. 14 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 15 care group’ means a group of physicians organized, 16 at least in part, for the purposes of providing physi- 17 cian services under the Medicaid program under title 18 XIX of the Social Security Act, the State Children’s 19 Health Insurance Program under title XXI of such 20 Act, or the Medicare program under title XVIII of 21 such Act and may include a hospital and any other 22 individual or entity furnishing services covered under 23 any such program that is affiliated with the health 24 care group. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 60 •S 3660 IS ‘‘(7) HEALTH CARE SERVICES.—The term 1 ‘health care services’ means services that address 2 physical as well as mental health conditions in all 3 care settings. 4 ‘‘(8) HEALTH-CARE-RELATED SERVICES.—The 5 term ‘health-care-related services’ means human or 6 social services programs or activities that provide ac- 7 cess, referrals, or links to health care. 8 ‘‘(9) HEALTH EDUCATOR.—The term ‘health 9 educator’ includes a professional with a bacca- 10 laureate degree who is responsible for designing, im- 11 plementing, and evaluating individual and population 12 health promotion and chronic disease prevention pro- 13 grams. 14 ‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In- 15 dian’ and ‘Indian Tribe’ have the meanings given 16 such terms in section 4 of the Indian Self-Deter- 17 mination and Education Assistance Act. 18 ‘‘(11) INDIVIDUAL WITH A DISABILITY.—The 19 term ‘individual with a disability’ means any indi- 20 vidual who has a disability as defined for the pur- 21 pose of section 504 of the Rehabilitation Act of 22 1973. 23 ‘‘(12) INDIVIDUAL WITH LIMITED-ENGLISH 24 PROFICIENCY.—The term ‘individual with limited- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 61 •S 3660 IS English proficiency’ means an individual whose pri- 1 mary language for communication is not English 2 and who has a limited ability to read, write, speak, 3 or understand English. 4 ‘‘(13) INTEGRATED HEALTH CARE DELIVERY 5 SYSTEM.—The term ‘integrated health care delivery 6 system’ means an interdisciplinary system that 7 brings together providers from the primary health, 8 mental health, substance use disorder, and related 9 disciplines to improve the health outcomes of an in- 10 dividual. Such providers may include hospitals, 11 health, mental health, or substance use disorder clin- 12 ics and providers, home health agencies, ambulatory 13 surgery centers, skilled nursing facilities, rehabilita- 14 tion centers, and employed, independent, or con- 15 tracted physicians. 16 ‘‘(14) INTERPRETING; INTERPRETATION.—The 17 terms ‘interpreting’ and ‘interpretation’ mean the 18 transmission of a spoken, written, or signed message 19 from one language or format into another, faithfully, 20 accurately, and objectively. 21 ‘‘(15) LANGUAGE ACCESS.—The term ‘language 22 access’ means the provision of language services to 23 an individual with limited-English proficiency or an 24 individual with communication disabilities designed 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 62 •S 3660 IS to enhance that individual’s access to, understanding 1 of, or benefit from health care services or health- 2 care-related services. 3 ‘‘(16) LANGUAGE ASSISTANCE SERVICES.—The 4 term ‘language assistance services’ includes— 5 ‘‘(A) oral language assistance, including in- 6 terpretation in non-English languages provided 7 in-person or remotely by a qualified interpreter 8 for an individual with limited-English pro- 9 ficiency, and the use of qualified bilingual or 10 multilingual staff to communicate directly with 11 individuals with limited-English proficiency; 12 ‘‘(B) written translation, performed by a 13 qualified translator, of written content in paper 14 or electronic form into languages other than 15 English; and 16 ‘‘(C) taglines. 17 ‘‘(17) MINORITY.— 18 ‘‘(A) IN GENERAL.—The terms ‘minority’ 19 and ‘minorities’ refer to individuals from a mi- 20 nority group. 21 ‘‘(B) POPULATIONS.—The term ‘minority’, 22 with respect to populations, refers to racial and 23 ethnic minority groups, members of sexual and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 63 •S 3660 IS gender minority groups, and individuals with a 1 disability. 2 ‘‘(18) MINORITY GROUP.—The term ‘minority 3 group’ has the meaning given the term ‘racial and 4 ethnic minority group’. 5 ‘‘(19) ONSITE INTERPRETATION.—The term 6 ‘onsite interpretation’ means a method of inter- 7 preting or interpretation for which the interpreter is 8 in the physical presence of the provider of health 9 care services or health-care-related services and the 10 recipient of such services who is limited in English 11 proficiency or has a communication impairment such 12 as an impairment in hearing, vision, or learning. 13 ‘‘(20) QUALIFIED INTERPRETER FOR AN INDI- 14 VIDUAL WITH LIMITED-ENGLISH PROFICIENCY.— 15 The term ‘qualified interpreter for an individual with 16 limited-English proficiency’ means an interpreter 17 who via a remote interpreting service or an on-site 18 appearance— 19 ‘‘(A) adheres to generally accepted inter- 20 preter ethics principles, including client con- 21 fidentiality; 22 ‘‘(B) has demonstrated proficiency in 23 speaking and understanding both spoken 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 64 •S 3660 IS English and one or more other spoken lan- 1 guages; and 2 ‘‘(C) is able to interpret effectively, accu- 3 rately, and impartially, both receptively and ex- 4 pressly, to and from such languages and 5 English, using any necessary specialized vocab- 6 ulary, terminology, and phraseology. 7 ‘‘(21) QUALIFIED TRANSLATOR.—The term 8 ‘qualified translator’ means a translator who— 9 ‘‘(A) adheres to generally accepted trans- 10 lator ethics principles, including client confiden- 11 tiality; 12 ‘‘(B) has demonstrated proficiency in writ- 13 ing and understanding both written English 14 and one or more other written non-English lan- 15 guages; and 16 ‘‘(C) is able to translate effectively, accu- 17 rately, and impartially to and from such lan- 18 guages and English, using any necessary spe- 19 cialized vocabulary, terminology, and phrase- 20 ology. 21 ‘‘(22) RACIAL AND ETHNIC MINORITY GROUP.— 22 The term ‘racial and ethnic minority group’ means 23 Indians and Alaska Natives, African Americans (in- 24 cluding Caribbean Blacks, Africans, and other 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 65 •S 3660 IS Blacks), Asian Americans, Hispanics (including 1 Latinos), and Native Hawaiians and other Pacific 2 Islanders. 3 ‘‘(23) SEXUAL AND GENDER MINORITY 4 GROUP.—The term ‘sexual and gender minority 5 group’ encompasses lesbian, gay, bisexual, and 6 transgender populations, as well as those whose sex- 7 ual orientation, gender identity and expression, or 8 reproductive development varies from traditional, so- 9 cietal, cultural, or physiological norms. 10 ‘‘(24) SIGHT TRANSLATION.—The term ‘sight 11 translation’ means the transmission of a written 12 message in one language into a spoken or signed 13 message in another language, or an alternative for- 14 mat in English or another language. 15 ‘‘(25) STATE.—Notwithstanding section 2, the 16 term ‘State’ means each of the several States, the 17 District of Columbia, the Commonwealth of Puerto 18 Rico, the United States Virgin Islands, Guam, 19 American Samoa, and the Commonwealth of the 20 Northern Mariana Islands. 21 ‘‘(26) TELEPHONIC INTERPRETATION.—The 22 term ‘telephonic interpretation’ (also known as ‘over 23 the phone interpretation’ or ‘OPI’) means, with re- 24 spect to interpretation for an individual with limited- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 66 •S 3660 IS English proficiency, a method of interpretation in 1 which the interpreter is not in the physical presence 2 of the provider of health care services or health-care- 3 related services and such individual receiving such 4 services, but the interpreter is connected via tele- 5 phone. 6 ‘‘(27) TRANSLATION.—The term ‘translation’ 7 means the transmission of a written message in one 8 language into a written or signed message in an- 9 other language, and includes translation into an- 10 other language or alternative format, such as large 11 print font, Braille, audio recording, or CD. 12 ‘‘(28) VIDEO REMOTE INTERPRETING SERV- 13 ICES.—The term ‘video remote interpreting services’ 14 means the provision, in health care services or 15 health-care-related services, through a qualified in- 16 terpreter for an individual with limited-English pro- 17 ficiency, of video remote interpreting services that 18 are— 19 ‘‘(A) in real-time, full-motion video, and 20 audio over a dedicated high-speed, wide-band- 21 width video connection or wireless connection 22 that delivers high quality video images that do 23 not produce lags, choppy, blurry, or grainy im- 24 ages, or irregular pauses in communication; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 67 •S 3660 IS ‘‘(B) in a sharply delineated image that is 1 large enough to display. 2 ‘‘(29) VITAL DOCUMENT.—The term ‘vital doc- 3 ument’ includes applications for government pro- 4 grams that provide health care services, medical or 5 financial consent forms, financial assistance docu- 6 ments, letters containing important information re- 7 garding patient instructions (such as prescriptions, 8 referrals to other providers, and discharge plans) 9 and participation in a program (such as a Medicaid 10 managed care program), notices pertaining to the 11 reduction, denial, or termination of services or bene- 12 fits, notices of the right to appeal such actions, and 13 notices advising individuals with limited-English pro- 14 ficiency with communication disabilities of the avail- 15 ability of free language services, alternative formats, 16 and other outreach materials. 17 ‘‘(b) REFERENCE.—In any reference in this title to 18 a regulatory provision applicable to a ‘handicapped indi- 19 vidual’, the term ‘handicapped individual’ in such provi- 20 sion shall have the same meaning as the term ‘individual 21 with a disability’ as defined in subsection (a). 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 68 •S 3660 IS ‘‘Subtitle A—Resources and Innova- 1 tion for Culturally and Linguis- 2 tically Appropriate Health Care 3 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 4 AND LINGUISTICALLY APPROPRIATE HEALTH 5 CARE. 6 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 7 through the Director of the Agency for Healthcare Re- 8 search and Quality, shall establish and support a center 9 to be known as the ‘Robert T. Matsui Center for Cul- 10 turally and Linguistically Appropriate Health Care’ (re- 11 ferred to in this section as the ‘Center’) to carry out each 12 of the following activities: 13 ‘‘(1) INTERPRETATION SERVICES.—The Center 14 shall provide resources via the internet to identify 15 and link health care providers to competent inter- 16 preter and translation services. 17 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 18 ‘‘(A) VITAL DOCUMENTS.—The Center 19 shall provide, directly or through contract, vital 20 documents from competent translation services 21 for providers of health care services and health- 22 care-related services at no cost to such pro- 23 viders. Such documents may be submitted for 24 translation into non-English languages. Such 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 69 •S 3660 IS translation services shall be provided in a timely 1 and reasonable manner. The quality of such 2 translation services shall be monitored and re- 3 ported publicly. 4 ‘‘(B) FORMS.—For each form developed or 5 revised by the Secretary that will be used by in- 6 dividuals with limited-English proficiency in 7 health care or health-care-related settings, the 8 Center shall translate the form, at a minimum, 9 into the top 15 non-English languages in the 10 United States according to the most recent data 11 from the American Community Survey or its re- 12 placement. The translation shall be completed 13 within 45 days of the Secretary receiving final 14 approval of the form from the Office of Man- 15 agement and Budget. 16 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 17 PHONE NUMBER.—The Center shall provide, 18 through a toll-free number, a customer service line 19 for individuals with limited-English proficiency— 20 ‘‘(A) to obtain information about federally 21 conducted or funded health programs, including 22 the Medicare program under title XVIII of the 23 Social Security Act, the Medicaid program 24 under title XIX of such Act, and the State Chil- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 70 •S 3660 IS dren’s Health Insurance Program under title 1 XXI of such Act; 2 ‘‘(B) to obtain assistance with applying for 3 or accessing these programs and understanding 4 Federal notices written in English; and 5 ‘‘(C) to learn how to access language serv- 6 ices. 7 ‘‘(4) HEALTH INFORMATION CLEARING- 8 HOUSE.— 9 ‘‘(A) IN GENERAL.—The Center shall de- 10 velop and maintain an information clearing- 11 house to facilitate the provision of language 12 services by providers of health care services and 13 health-care-related services to reduce medical 14 errors, improve medical outcomes, improve cul- 15 tural competence, reduce health care costs 16 caused by miscommunication with individuals 17 with limited-English proficiency, and reduce or 18 eliminate the duplication of efforts to translate 19 materials. The clearinghouse shall include the 20 information described in subparagraphs (B) 21 through (F) and make such information avail- 22 able on the internet and in print. 23 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 24 ter shall collect and evaluate for accuracy, de- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 71 •S 3660 IS velop, and make available templates for stand- 1 ard documents that are necessary for patients 2 and consumers to access and make educated de- 3 cisions about their health care, including tem- 4 plates for each of the following: 5 ‘‘(i) Administrative and legal docu- 6 ments, including— 7 ‘‘(I) intake forms; 8 ‘‘(II) forms related to the Medi- 9 care program under title XVIII of the 10 Social Security Act, the Medicaid pro- 11 gram under title XIX of such Act, 12 and the State Children’s Health In- 13 surance Program under title XXI of 14 such Act, including eligibility informa- 15 tion for such programs; 16 ‘‘(III) forms informing patients 17 of the compliance and consent re- 18 quirements pursuant to the regula- 19 tions under section 264(c) of the 20 Health Insurance Portability and Ac- 21 countability Act of 1996 (42 U.S.C. 22 1320–2 note); and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 72 •S 3660 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.—In oper- 15 ating the clearinghouse, the Center shall— 16 ‘‘(i) ensure that the documents posted 17 in English and non-English languages are 18 culturally and linguistically appropriate; 19 ‘‘(ii) allow public review of the docu- 20 ments before dissemination in order to en- 21 sure that the documents are understand- 22 able and culturally and linguistically ap- 23 propriate for the target populations; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 73 •S 3660 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 individuals with limited-English proficiency, in- 16 cluding case studies using de-identified patient 17 information, program summaries, and program 18 evaluations. 19 ‘‘(E) CULTURALLY AND LINGUISTICALLY 20 APPROPRIATE MATERIALS.—The Center shall 21 provide information relating to culturally and 22 linguistically appropriate health care for minor- 23 ity populations residing in the United States to 24 all health care providers and health-care-related 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 74 •S 3660 IS services at no cost. Such information shall in- 1 clude— 2 ‘‘(i) tenets of culturally and linguis- 3 tically appropriate care; 4 ‘‘(ii) culturally and linguistically ap- 5 propriate self-assessment tools; 6 ‘‘(iii) culturally and linguistically ap- 7 propriate training tools; 8 ‘‘(iv) strategic plans to increase cul- 9 tural and linguistic appropriateness in dif- 10 ferent types of providers of health care 11 services and health-care-related services, 12 including regional collaborations among 13 health care organizations; and 14 ‘‘(v) culturally and linguistically ap- 15 propriate 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 3402 regarding successful innovations in 22 implementing the obligations under this sub- 23 section and provide public notice in the entities’ 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 75 •S 3660 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) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 7 rector shall collaborate with the Deputy Assistant Sec- 8 retary for Minority Health, the Administrator of the Cen- 9 ters for Medicare & Medicaid Services, and the Adminis- 10 trator of the Health Resources and Services Administra- 11 tion to notify health care providers and health care organi- 12 zations about the availability of language access services 13 by the Center. 14 ‘‘(d) EDUCATION.—The Secretary, directly or 15 through contract, shall undertake a national education 16 campaign to inform providers, individuals with limited- 17 English proficiency, health professionals, graduate 18 schools, and community health centers about— 19 ‘‘(1) Federal and State laws and guidelines gov- 20 erning access to language services; 21 ‘‘(2) the value of using trained interpreters and 22 the risks associated with using family members, 23 friends, minors, and untrained bilingual staff; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 76 •S 3660 IS ‘‘(3) funding sources for developing and imple- 1 menting language services; and 2 ‘‘(4) promising practices to effectively provide 3 language services. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated to carry out this section 6 $5,000,000 for each of fiscal years 2019 through 2023. 7 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS- 8 TICALLY APPROPRIATE HEALTH CARE 9 GRANTS. 10 ‘‘(a) IN GENERAL.— 11 ‘‘(1) GRANTS.—The Secretary, acting through 12 the Director of the Agency for Healthcare Research 13 and Quality, shall award grants to eligible entities to 14 enable such entities to design, implement, and evalu- 15 ate innovative, cost-effective programs to improve 16 culturally and linguistically appropriate access to 17 health care services for individuals with limited- 18 English proficiency. 19 ‘‘(2) COORDINATION.—The Director of the 20 Agency for Healthcare Research and Quality shall 21 coordinate with, and ensure the participation of, 22 other agencies including the Health Resources and 23 Services Administration, the National Institute on 24 Minority Health and Health Disparities at the Na- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 77 •S 3660 IS tional Institutes of Health, and the Office of Minor- 1 ity Health, regarding the design and evaluation of 2 the grants program. 3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 4 under subsection (a) an entity shall— 5 ‘‘(1) be— 6 ‘‘(A) a city, county, Indian Tribe, State, or 7 subdivision thereof; 8 ‘‘(B) an organization described in section 9 501(c)(3) of the Internal Revenue Code of 1986 10 and exempt from tax under section 501(a) of 11 such Code; 12 ‘‘(C) a community health, mental health, 13 or substance use disorder center or clinic; 14 ‘‘(D) a solo or group physician practice; 15 ‘‘(E) an integrated health care delivery 16 system; 17 ‘‘(F) a public hospital; 18 ‘‘(G) a health care group, university, or 19 college; or 20 ‘‘(H) any other entity designated by the 21 Secretary; and 22 ‘‘(2) prepare and submit to the Secretary an 23 application, at such time, in such manner, and con- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 78 •S 3660 IS taining such additional information as the Secretary 1 may reasonably require. 2 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 3 ceived through a grant under this section to— 4 ‘‘(1) develop, implement, and evaluate models of 5 providing competent interpretation services through 6 onsite interpretation, telephonic interpretation, or 7 video remote interpreting services; 8 ‘‘(2) implement strategies to recruit, retain, and 9 promote individuals at all levels of the organization 10 to maintain a diverse staff and leadership that can 11 promote and provide language services to patient 12 populations of the service area of the entity; 13 ‘‘(3) develop and maintain a needs assessment 14 that identifies the current demographic, cultural, 15 and epidemiological profile of the community to ac- 16 curately plan for and implement language services 17 needed in the service area of the entity; 18 ‘‘(4) develop a strategic plan to implement lan- 19 guage services; 20 ‘‘(5) develop participatory, collaborative part- 21 nerships with communities encompassing the patient 22 populations of individuals with limited-English pro- 23 ficiency served by the grant to gain input in design- 24 ing and implementing language services; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 79 •S 3660 IS ‘‘(6) develop and implement grievance resolu- 1 tion processes that are culturally and linguistically 2 appropriate and capable of identifying, preventing, 3 and resolving complaints by individuals with limited- 4 English proficiency; 5 ‘‘(7) develop short-term medical and mental 6 health interpretation training courses and incentives 7 for bilingual health care staff who are asked to pro- 8 vide interpretation services in the workplace; 9 ‘‘(8) develop formal training programs, includ- 10 ing continued professional development and edu- 11 cation programs as well as supervision, for individ- 12 uals interested in becoming dedicated health care in- 13 terpreters and culturally and linguistically appro- 14 priate providers; 15 ‘‘(9) provide staff language training instruction, 16 which shall include information on the practical limi- 17 tations of such instruction for nonnative speakers; 18 ‘‘(10) develop policies that address compensa- 19 tion in salary for staff who receive training to be- 20 come either a staff interpreter or bilingual provider; 21 ‘‘(11) develop other language assistance services 22 as determined appropriate by the Secretary; 23 ‘‘(12) develop, implement, and evaluate models 24 of improving cultural competence, including cultural 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 80 •S 3660 IS competence programs for community health workers; 1 and 2 ‘‘(13) ensure that, consistent with the privacy 3 protections provided for under the regulations pro- 4 mulgated under section 264(c) of the Health Insur- 5 ance Portability and Accountability Act of 1996 and 6 any applicable State privacy laws, data on the indi- 7 vidual patient or recipient’s race, ethnicity, and pri- 8 mary language are collected (and periodically up- 9 dated) in health records and integrated into the or- 10 ganization’s information management systems or 11 any similar system used to store and retrieve data. 12 ‘‘(d) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to entities that pri- 14 marily engage in providing direct care and that have devel- 15 oped partnerships with community organizations or with 16 agencies with experience in improving language access. 17 ‘‘(e) EVALUATION.— 18 ‘‘(1) BY GRANTEES.—An entity that receives a 19 grant under this section shall submit to the Sec- 20 retary an evaluation that describes, in the manner 21 and to the extent required by the Secretary, the ac- 22 tivities carried out with funds received under the 23 grant, and how such activities improved access to 24 health care services and health-care-related services 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 81 •S 3660 IS and the quality of health care for individuals with 1 limited-English proficiency. Such evaluation shall be 2 collected and disseminated through the Robert T. 3 Matsui Center for Culturally and Linguistically Ap- 4 propriate Health Care established under section 5 3401. The Director of the Agency for Healthcare 6 Research and Quality shall notify grantees of the 7 availability of technical assistance for the evaluation 8 and provide such assistance upon request. 9 ‘‘(2) BY SECRETARY.—The Director of the 10 Agency for Healthcare Research and Quality shall 11 evaluate or arrange with other individuals or organi- 12 zations to evaluate projects funded under this sec- 13 tion. 14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 15 is authorized to be appropriated to carry out this section, 16 $5,000,000 for each of fiscal years 2019 through 2023. 17 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM- 18 PETENCE. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Director of the Agency for Healthcare Research and 21 Quality, shall expand research concerning language access 22 in the provision of health care services. 23 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 24 Healthcare Research and Quality may conduct the re- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 82 •S 3660 IS search described in subsection (a) or enter into contracts 1 with other individuals or organizations to conduct such re- 2 search. 3 ‘‘(c) USE OF FUNDS.—Research conducted under 4 this section shall be designed to do one or more of the 5 following: 6 ‘‘(1) To identify the barriers to mental and be- 7 havioral services that are faced by individuals with 8 limited-English proficiency. 9 ‘‘(2) To identify health care providers’ and 10 health administrators’ attitudes, knowledge, and 11 awareness of the barriers to quality health care serv- 12 ices that are faced by individuals with limited- 13 English proficiency. 14 ‘‘(3) To identify optimal approaches for deliv- 15 ering language access. 16 ‘‘(4) To identify best practices for data collec- 17 tion, including— 18 ‘‘(A) the collection by providers of health 19 care services and health-care-related services of 20 data on the race, ethnicity, and primary lan- 21 guage of recipients of such services, taking into 22 account existing research conducted by the Gov- 23 ernment or private sector; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 83 •S 3660 IS ‘‘(B) the development and implementation 1 of data collection and reporting systems; and 2 ‘‘(C) effective privacy safeguards for col- 3 lected data. 4 ‘‘(5) To develop a minimum data collection set 5 for primary language. 6 ‘‘(6) To evaluate the most effective ways in 7 which the Secretary can create or coordinate, and 8 subsidize or otherwise fund, telephonic interpretation 9 services for health care providers, taking into consid- 10 eration, among other factors, the flexibility necessary 11 for such a system to accommodate variations in— 12 ‘‘(A) provider type; 13 ‘‘(B) languages needed and their frequency 14 of use; 15 ‘‘(C) type of encounter; 16 ‘‘(D) time of encounter, including regular 17 business hours and after hours; and 18 ‘‘(E) location of encounter. 19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 $5,000,000 for each of fiscal years 2019 through 2023.’’. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 84 •S 3660 IS SEC. 205. PILOT PROGRAM FOR IMPROVEMENT AND DE- 1 VELOPMENT OF STATE MEDICAL INTER- 2 PRETING SERVICES. 3 (a) GRANTS AUTHORIZED.—The Secretary shall 4 award 1 grant in accordance with this section to each of 5 3 States (to be selected by the Secretary) to assist each 6 such State in designing, implementing, and evaluating a 7 statewide program to provide onsite interpreter services 8 under the State Medicaid plan. 9 (b) GRANT PERIOD.—A grant awarded under this 10 section is authorized for the period of 3 fiscal years begin- 11 ning on October 1, 2019, and ending on September 30, 12 2022. 13 (c) PREFERENCE.—In awarding a grant under this 14 section, the Secretary shall give preference to a State— 15 (1) that has a high proportion of qualified LEP 16 enrollees, as determined by the Secretary; 17 (2) that has a large number of qualified LEP 18 enrollees, as determined by the Secretary; 19 (3) that has a high growth rate of the popu- 20 lation of individuals with limited-English proficiency, 21 as determined by the Secretary; and 22 (4) that has a population of qualified LEP en- 23 rollees that is linguistically diverse, requiring inter- 24 preter services in at least 200 non-English lan- 25 guages. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 85 •S 3660 IS (d) USE OF FUNDS.—A State receiving a grant under 1 this section shall use the grant funds to— 2 (1) ensure that all health care providers in the 3 State participating in the State Medicaid plan have 4 access to onsite interpreter services, for the purpose 5 of enabling effective communication between such 6 providers and qualified LEP enrollees during the 7 furnishing of items and services and administrative 8 interactions; 9 (2) establish, expand, procure, or contract for— 10 (A) a statewide health care information 11 technology system that is designed to achieve 12 efficiencies and economies of scale with respect 13 to onsite interpreter services provided to health 14 care providers in the State participating in the 15 State Medicaid plan; and 16 (B) an entity to administer such system, 17 the duties of which shall include— 18 (i) procuring and scheduling inter- 19 preter services for qualified LEP enrollees; 20 (ii) procuring and scheduling inter- 21 preter services for individuals with limited- 22 English proficiency seeking to enroll in the 23 State Medicaid plan; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 86 •S 3660 IS (iii) ensuring that interpreters receive 1 payment for interpreter services rendered 2 under the system; and 3 (iv) consulting regularly with organi- 4 zations representing consumers, inter- 5 preters, and health care providers; and 6 (3) develop mechanisms to establish, improve, 7 and strengthen the competency of the medical inter- 8 pretation workforce that serves qualified LEP enroll- 9 ees in the State, including a national certification 10 process that is valid, credible, and vendor-neutral. 11 (e) APPLICATION.—To receive a grant under this sec- 12 tion, a State shall submit an application at such time and 13 containing such information as the Secretary may require, 14 which shall include the following: 15 (1) A description of the language access needs 16 of individuals in the State enrolled in the State Med- 17 icaid plan. 18 (2) A description of the extent to which the 19 program will— 20 (A) use the grant funds for the purposes 21 described in subsection (d); 22 (B) meet the health care needs of rural 23 populations of the State; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 87 •S 3660 IS (C) collect information that accurately 1 tracks the language services requested by con- 2 sumers as compared to the language services 3 provided by health care providers in the State 4 participating in the State Medicaid plan. 5 (3) A description of how the program will be 6 evaluated, including a proposal for collaboration with 7 organizations representing interpreters, consumers, 8 and individuals with limited-English proficiency. 9 (f) DEFINITIONS.—In this section: 10 (1) QUALIFIED LEP ENROLLEE.—The term 11 ‘‘qualified LEP enrollee’’ means an individual— 12 (A) who is limited-English proficient; and 13 (B) who is enrolled in a State Medicaid 14 plan. 15 (2) STATE.—The term ‘‘State’’ has the mean- 16 ing given the term in section 1101(a)(1) of the So- 17 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 18 poses of title XIX of such Act. 19 (3) STATE MEDICAID PLAN.—The term ‘‘State 20 Medicaid plan’’ means a State plan under title XIX 21 of the Social Security Act (42 U.S.C. 1396 et seq.) 22 or a waiver of such a plan. 23 (4) UNITED STATES.—The term ‘‘United 24 States’’ has the meaning given the term in section 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 88 •S 3660 IS 1101(a)(2) of the Social Security Act (42 U.S.C. 1 1301(a)(2)), for purposes of title XIX of such Act. 2 (g) FUNDING.— 3 (1) AUTHORIZATION OF APPROPRIATIONS.— 4 There is authorized to be appropriated $5,000,000 5 to carry out this section. 6 (2) AVAILABILITY OF FUNDS.—Amounts appro- 7 priated pursuant to the authorization in paragraph 8 (1) are authorized to remain available without fiscal 9 year limitation. 10 (3) INCREASED FEDERAL FINANCIAL PARTICI- 11 PATION.—Section 1903(a)(2)(E) of the Social Secu- 12 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 13 inserting ‘‘(or, in the case of a State that was 14 awarded a grant under section 203 of the Health 15 Equity and Accountability Act of 2018, 100 percent 16 for each quarter occurring during the grant period 17 specified in subsection (b) of such section)’’ after 18 ‘‘75 percent’’. 19 (h) LIMITATION.—No Federal funds awarded under 20 this section may be used to provide interpreter services 21 from a location outside the United States. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 89 •S 3660 IS SEC. 206. TRAINING TOMORROW’S DOCTORS FOR CUL- 1 TURALLY AND LINGUISTICALLY APPRO- 2 PRIATE CARE: GRADUATE MEDICAL EDU- 3 CATION. 4 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 5 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 6 1395ww(h)(4)) is amended by adding at the end the fol- 7 lowing new subparagraph: 8 ‘‘(L) TREATMENT OF CULTURALLY AND 9 LINGUISTICALLY APPROPRIATE TRAINING.—In 10 determining a hospital’s number of full-time 11 equivalent residents for purposes of this sub- 12 section, all the time that is spent by an intern 13 or resident in an approved medical residency 14 training program for education and training in 15 culturally and linguistically appropriate service 16 delivery shall be counted toward the determina- 17 tion of full-time equivalency.’’. 18 (b) INDIRECT MEDICAL EDUCATION.—Section 19 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 20 1395ww(d)(5)(B)) is amended— 21 (1) by redesignating the clause (x) added by 22 section 5505(b) of the Patient Protection and Af- 23 fordable Care Act as clause (xi); and 24 (2) by adding at the end the following new 25 clause: 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 90 •S 3660 IS ‘‘(xii) The provisions of subparagraph (L) of 1 subsection (h)(4) shall apply under this subpara- 2 graph in the same manner as they apply under such 3 subsection.’’. 4 (c) EFFECTIVE DATE.—The amendments made by 5 subsections (a) and (b) shall apply with respect to pay- 6 ments made to hospitals on or after the date that is one 7 year after the date of the enactment of this Act. 8 SEC. 207. FEDERAL REIMBURSEMENT FOR CULTURALLY 9 AND LINGUISTICALLY APPROPRIATE SERV- 10 ICES UNDER THE MEDICARE, MEDICAID, AND 11 STATE CHILDREN’S HEALTH INSURANCE 12 PROGRAMS. 13 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 14 PROVIDERS.— 15 (1) ESTABLISHMENT.— 16 (A) IN GENERAL.—Not later than 6 17 months after the date of the enactment of this 18 Act, the Secretary of Health and Human Serv- 19 ices, acting through the Centers for Medicare & 20 Medicaid Services and in consultation with the 21 Center for Medicare and Medicaid Innovation, 22 shall establish a demonstration program under 23 which the Secretary shall award grants to eligi- 24 ble Medicare service providers to improve com- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 91 •S 3660 IS munication between such providers and Medi- 1 care beneficiaries who are English learners, in- 2 cluding beneficiaries who live in diverse and un- 3 derserved communities. 4 (B) APPLICATION OF INNOVATION 5 RULES.—The demonstration project under sub- 6 paragraph (A) shall be conducted in a manner 7 that is consistent with the applicable provisions 8 of subsections (b), (c), and (d) of section 1115A 9 of the Social Security Act (42 U.S.C. 1315a). 10 (C) NUMBER OF GRANTS.—To the extent 11 practicable, the Secretary shall award not less 12 than 24 grants under this subsection. 13 (D) GRANT PERIOD.—Except as provided 14 under paragraph (2)(D), each grant awarded 15 under this subsection shall be for a 3-year pe- 16 riod. 17 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 18 ble for a grant under this subsection, an entity must 19 meet the following requirements: 20 (A) MEDICARE PROVIDER.—The entity 21 must be— 22 (i) a provider of services under part A 23 of title XVIII of the Social Security Act; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 92 •S 3660 IS (ii) a provider of services under part 1 B of such title; 2 (iii) a Medicare Advantage organiza- 3 tion offering a Medicare Advantage plan 4 under part C of such title; or 5 (iv) a PDP sponsor offering a pre- 6 scription drug plan under part D of such 7 title. 8 (B) UNDERSERVED COMMUNITIES.—The 9 entity must serve a community that, with re- 10 spect to necessary language services for improv- 11 ing access and utilization of health care among 12 English learners, is disproportionally under- 13 served. 14 (C) APPLICATION.—The entity must pre- 15 pare and submit to the Secretary an applica- 16 tion, at such time, in such manner, and accom- 17 panied by such additional information as the 18 Secretary may require. 19 (D) REPORTING.—In the case of a grantee 20 that received a grant under this subsection in 21 a previous year, such grantee is only eligible for 22 continued payments under a grant under this 23 subsection if the grantee met the reporting re- 24 quirements under paragraph (9) for such year. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 93 •S 3660 IS If a grantee fails to meet the requirement of 1 such paragraph for the first year of a grant, the 2 Secretary may terminate the grant and solicit 3 applications from new grantees to participate in 4 the demonstration program. 5 (3) DISTRIBUTION.—To the extent feasible, the 6 Secretary shall award— 7 (A) at least 6 grants to providers of serv- 8 ices described in paragraph (2)(A)(i); 9 (B) at least 6 grants to service providers 10 described in paragraph (2)(A)(ii); 11 (C) at least 6 grants to organizations de- 12 scribed in paragraph (2)(A)(iii); and 13 (D) at least 6 grants to sponsors described 14 in paragraph (2)(A)(iv). 15 (4) CONSIDERATIONS IN AWARDING GRANTS.— 16 (A) VARIATION IN GRANTEES.—In award- 17 ing grants under this subsection, the Secretary 18 shall select grantees to ensure the following: 19 (i) The grantees provide many dif- 20 ferent types of language services. 21 (ii) The grantees serve Medicare bene- 22 ficiaries who speak different languages, 23 and who, as a population, have differing 24 needs for language services. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 94 •S 3660 IS (iii) The grantees serve Medicare 1 beneficiaries in both urban and rural set- 2 tings. 3 (iv) The grantees serve Medicare 4 beneficiaries in at least two geographic re- 5 gions, as defined by the Secretary. 6 (v) The grantees serve Medicare bene- 7 ficiaries in at least two large metropolitan 8 statistical areas with racial, ethnic, sexual, 9 gender, disability, and economically diverse 10 populations. 11 (B) PRIORITY FOR PARTNERSHIPS WITH 12 COMMUNITY ORGANIZATIONS AND AGENCIES.— 13 In awarding grants under this subsection, the 14 Secretary shall give priority to eligible entities 15 that have a partnership with— 16 (i) a community organization; or 17 (ii) a consortia of community organi- 18 zations, State agencies, and local agencies, 19 that has experience in providing language serv- 20 ices. 21 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 22 SERVICES.— 23 (A) IN GENERAL.—Subject to subpara- 24 graph (E), a grantee may only use grant funds 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 95 •S 3660 IS received under this subsection to pay for the 1 provision of competent language services to 2 Medicare beneficiaries who are English learn- 3 ers. 4 (B) COMPETENT LANGUAGE SERVICES DE- 5 FINED.—For purposes of this subsection, the 6 term ‘‘competent language services’’ means— 7 (i) interpreter and translation services 8 that— 9 (I) subject to the exceptions 10 under subparagraph (C)— 11 (aa) if the grantee operates 12 in a State that has statewide 13 health care interpreter standards, 14 meet the State standards cur- 15 rently in effect; or 16 (bb) if the grantee operates 17 in a State that does not have 18 statewide health care interpreter 19 standards, utilizes competent in- 20 terpreters who follow the Na- 21 tional Council on Interpreting in 22 Health Care’s Code of Ethics and 23 Standards of Practice; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 96 •S 3660 IS (II) that, in the case of inter- 1 preter services, are provided 2 through— 3 (aa) onsite interpretation; 4 (bb) telephonic interpreta- 5 tion; or 6 (cc) video interpretation; 7 and 8 (ii) the direct provision of health care 9 or health-care-related services by a com- 10 petent bilingual health care provider. 11 (C) EXCEPTIONS.—The requirements of 12 subparagraph (B)(i)(I) do not apply, with re- 13 spect to interpreter and translation services and 14 a grantee— 15 (i) in the case of a Medicare bene- 16 ficiary who is an English learner if— 17 (I) such beneficiary has been in- 18 formed, in the beneficiary’s primary 19 language, of the availability of free in- 20 terpreter and translation services and 21 the beneficiary instead requests that a 22 family member, friend, or other per- 23 son provide such services; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 97 •S 3660 IS (II) the grantee documents such 1 request in the beneficiary’s medical 2 record; or 3 (ii) in the case of a medical emergency 4 where the delay directly associated with ob- 5 taining a competent interpreter or trans- 6 lation services would jeopardize the health 7 of the patient. 8 Clause (ii) shall not be construed to exempt 9 emergency rooms or similar entities that regu- 10 larly provide health care services in medical 11 emergencies to patients who are English learn- 12 ers from any applicable legal or regulatory re- 13 quirements related to providing competent in- 14 terpreter and translation services without undue 15 delay. 16 (D) MEDICARE ADVANTAGE ORGANIZA- 17 TIONS AND PDP SPONSORS.—If a grantee is a 18 Medicare Advantage organization offering a 19 Medicare Advantage plan under part C of title 20 XVIII of the Social Security Act or a PDP 21 sponsor offering a prescription drug plan under 22 part D of such title, such entity must provide 23 at least 50 percent of the grant funds that the 24 entity receives under this subsection directly to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 98 •S 3660 IS the entity’s network providers (including all 1 health providers and pharmacists) for the pur- 2 pose of providing support for such providers to 3 provide competent language services to Medi- 4 care beneficiaries who are English learners. 5 (E) ADMINISTRATIVE AND REPORTING 6 COSTS.—A grantee may use up to 10 percent of 7 the grant funds to pay for administrative costs 8 associated with the provision of competent lan- 9 guage services and for reporting required under 10 paragraph (9). 11 (6) DETERMINATION OF AMOUNT OF GRANT 12 PAYMENTS.— 13 (A) IN GENERAL.—Payments to grantees 14 under this subsection shall be calculated based 15 on the estimated numbers of Medicare bene- 16 ficiaries who are English learners in a grantee’s 17 service area utilizing— 18 (i) data on the numbers of English 19 learners who speak English less than ‘‘very 20 well’’ from the most recently available data 21 from the Bureau of the Census or other 22 State-based study the Secretary determines 23 likely to yield accurate data regarding the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 99 •S 3660 IS number of such individuals in such service 1 area; or 2 (ii) data provided by the grantee, if 3 the grantee routinely collects data on the 4 primary language of the Medicare bene- 5 ficiaries that the grantee serves and the 6 Secretary determines that the data is accu- 7 rate and shows a greater number of 8 English learners than would be estimated 9 using the data under clause (i). 10 (B) DISCRETION OF SECRETARY.—Subject 11 to subparagraph (C), the amount of payment 12 made to a grantee under this subsection may be 13 modified annually at the discretion of the Sec- 14 retary, based on changes in the data under sub- 15 paragraph (A) with respect to the service area 16 of a grantee for the year. 17 (C) LIMITATION ON AMOUNT.—The 18 amount of a grant made under this subsection 19 to a grantee may not exceed $500,000 for the 20 period under paragraph (1)(D). 21 (7) ASSURANCES.—Grantees under this sub- 22 section shall, as a condition of receiving a grant 23 under this subsection— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 100 •S 3660 IS (A) ensure that clinical and support staff 1 receive appropriate ongoing education and 2 training in linguistically appropriate service de- 3 livery; 4 (B) ensure the linguistic competence of bi- 5 lingual providers; 6 (C) offer and provide appropriate language 7 services at no additional charge to each patient 8 who is an English learner for all points of con- 9 tact between the patient and the grantee, in a 10 timely manner during all hours of operation; 11 (D) notify Medicare beneficiaries of their 12 right to receive language services in their pri- 13 mary language; 14 (E) post signage in the primary languages 15 commonly used by the patient population in the 16 service area of the organization; and 17 (F) ensure that— 18 (i) primary language data are col- 19 lected for recipients of language services 20 and such data are consistent with stand- 21 ards developed under title XXXIV of the 22 Public Health Service Act, as added by 23 section 202 of this Act, to the extent such 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 101 •S 3660 IS standards are available upon the initiation 1 of the demonstration program; and 2 (ii) consistent with the privacy protec- 3 tions provided under the regulations pro- 4 mulgated pursuant to section 264(c) of the 5 Health Insurance Portability and Account- 6 ability Act of 1996 (42 U.S.C. 1320d–2 7 note), if the recipient of language services 8 is a minor or is incapacitated, primary lan- 9 guage data are collected on the parent or 10 legal guardian of such recipient. 11 (8) NO COST SHARING.—Medicare beneficiaries 12 who are English learners shall not have to pay cost 13 sharing or co-payments for competent language serv- 14 ices provided under this demonstration program. 15 (9) REPORTING REQUIREMENTS FOR GRANT- 16 EES.—Not later than the end of each calendar year, 17 a grantee that receives funds under this subsection 18 in such year shall submit to the Secretary a report 19 that includes the following information: 20 (A) The number of Medicare beneficiaries 21 to whom competent language services are pro- 22 vided. 23 (B) The primary languages of those Medi- 24 care beneficiaries. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 102 •S 3660 IS (C) The types of language services pro- 1 vided to such beneficiaries. 2 (D) Whether such language services were 3 provided by employees of the grantee or 4 through a contract with external contractors or 5 agencies. 6 (E) The types of interpretation services 7 provided to such beneficiaries, and the approxi- 8 mate length of time such service is provided to 9 such beneficiaries. 10 (F) The costs of providing competent lan- 11 guage services. 12 (G) An account of the training or accredi- 13 tation of bilingual staff, interpreters, and trans- 14 lators providing services funded by the grant 15 under this subsection. 16 (10) EVALUATION AND REPORT TO CON- 17 GRESS.—Not later than 1 year after the completion 18 of a 3-year grant under this subsection, the Sec- 19 retary shall conduct an evaluation of the demonstra- 20 tion program under this subsection and shall submit 21 to the Congress a report that includes the following: 22 (A) An analysis of the patient outcomes 23 and the costs of furnishing care to the Medicare 24 beneficiaries who are English learners partici- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 103 •S 3660 IS pating in the project as compared to such out- 1 comes and costs for such Medicare beneficiaries 2 not participating, based on the data provided 3 under paragraph (9) and any other information 4 available to the Secretary. 5 (B) The effect of delivering language serv- 6 ices on— 7 (i) Medicare beneficiary access to care 8 and utilization of services; 9 (ii) the efficiency and cost effective- 10 ness of health care delivery; 11 (iii) patient satisfaction; 12 (iv) health outcomes; and 13 (v) the provision of culturally appro- 14 priate services provided to such bene- 15 ficiaries. 16 (C) The extent to which bilingual staff, in- 17 terpreters, and translators providing services 18 under such demonstration were trained or ac- 19 credited and the nature of accreditation or 20 training needed by type of provider, service, or 21 other category as determined by the Secretary 22 to ensure the provision of high-quality interpre- 23 tation, translation, or other language services to 24 Medicare beneficiaries if such services are ex- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 104 •S 3660 IS panded pursuant to section 1115A(c) of the So- 1 cial Security Act (42 U.S.C. 1315a(c)). 2 (D) Recommendations, if any, regarding 3 the extension of such project to the entire Medi- 4 care Program, subject to the provisions of such 5 section 1115A(c). 6 (11) APPROPRIATIONS.—There is appropriated 7 to carry out this subsection, in equal parts from the 8 Federal Hospital Insurance Trust Fund under sec- 9 tion 1817 of the Social Security Act (42 U.S.C. 10 1395i) and the Federal Supplementary Medical In- 11 surance Trust Fund under section 1841 of such Act 12 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 13 of the demonstration program. 14 (12) ENGLISH LEARNER DEFINED.—In this 15 subsection, the term ‘‘English learner’’ has the 16 meaning given such term in section 8101(20) of the 17 Elementary and Secondary Education Act of 1965, 18 except that subparagraphs (A), (B), and (D) of such 19 section shall not apply. 20 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE 21 MEDICARE PROGRAM.— 22 (1) INCLUSION AS RURAL HEALTH CLINIC 23 SERVICES.—Section 1861 of the Social Security Act 24 (42 U.S.C. 1395x) is amended— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 105 •S 3660 IS (A) in subsection (aa)(1)— 1 (i) in subparagraph (B), by striking 2 ‘‘and’’ at the end; 3 (ii) by adding ‘‘and’’ at the end of 4 subparagraph (C); and 5 (iii) by inserting after subparagraph 6 (C) the following new subparagraph: 7 ‘‘(D) language assistance services as defined in 8 subsection (jjj)(1),’’; and 9 (B) by adding at the end the following new 10 subsection: 11 ‘‘Language Assistance Services and Related Terms 12 ‘‘(jjj)(1) The term ‘language assistance services’ 13 means ‘language access’ or ‘language assistance services’ 14 (as those terms are defined in section 3400 of the Public 15 Health Service Act) furnished by a ‘qualified interpreter 16 for an individual with limited-English proficiency’ or a 17 ‘qualified translator’ (as those terms are defined in such 18 section 3400) to an ‘individual with limited English pro- 19 ficiency’ (as defined in such section 3400) or an ‘English 20 learner’ (as defined in paragraph (2)). 21 ‘‘(2) The term ‘English learner’ has the meaning 22 given that term in section 8101(20) of the Elementary and 23 Secondary Education Act of 1965, except that subpara- 24 graphs (A), (B), and (D) of such section shall not apply.’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 106 •S 3660 IS (2) COVERAGE.—Section 1832(a)(2) of the So- 1 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 2 ed— 3 (A) by striking ‘‘and’’ at the end of sub- 4 paragraph (I); 5 (B) by striking the period at the end of 6 subparagraph (J) and inserting ‘‘; and’’; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(K) language assistance services (as de- 10 fined in section 1861(jjj)(1)).’’. 11 (3) PAYMENT.—Section 1833(a) of the Social 12 Security Act (42 U.S.C. 1395l(a)) is amended— 13 (A) by striking ‘‘and’’ at the end of para- 14 graph (8); 15 (B) by striking the period at the end of 16 paragraph (9) and inserting ‘‘; and’’; and 17 (C) by inserting after paragraph (9) the 18 following new paragraph: 19 ‘‘(10) in the case of language assistance serv- 20 ices (as defined in section 1861(jjj)(1)), 100 percent 21 of the reasonable charges for such services, as deter- 22 mined in consultation with the Medicare Payment 23 Advisory Commission.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 107 •S 3660 IS (4) WAIVER OF BUDGET NEUTRALITY.—For 1 the 3-year period beginning on the date of enact- 2 ment of this section, the budget neutrality provision 3 of section 1848(c)(2)(B)(ii) of the Social Security 4 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 5 apply with respect to language assistance services 6 (as defined in section 1861(jjj)(1) of such Act). 7 (c) MEDICARE PARTS C AND D.— 8 (1) IN GENERAL.—Medicare Advantage plans 9 under part C of title XVIII of the Social Security 10 Act and prescription drug plans under part D of 11 such title shall comply with title VI of the Civil 12 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 13 section 1557 of the Patient Protection and Afford- 14 able Care Act (42 U.S.C. 18116) to provide effective 15 language services to enrollees of such plans. 16 (2) MEDICARE ADVANTAGE PLANS AND PRE- 17 SCRIPTION DRUG PLANS REPORTING REQUIRE- 18 MENT.—Section 1857(e) of the Social Security Act 19 (42 U.S.C. 1395w–27(e)) is amended by adding at 20 the end the following new paragraph: 21 ‘‘(5) REPORTING REQUIREMENTS RELATING TO 22 EFFECTIVE LANGUAGE SERVICES.—A contract under 23 this part shall require a Medicare Advantage organi- 24 zation (and, through application of section 1860D– 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 108 •S 3660 IS 12(b)(3)(D), a contract under section 1860D–12 1 shall require a PDP sponsor) to annually submit 2 (for each year of the contract) a report that contains 3 information on the internal policies and procedures 4 of the organization (or sponsor) related to recruit- 5 ment and retention efforts directed to workforce di- 6 versity and linguistically and culturally appropriate 7 provision of services in each of the following con- 8 texts: 9 ‘‘(A) The collection of data in a manner 10 that meets the requirements of title I of the 11 Health Equity and Accountability Act of 2018, 12 regarding the enrollee population. 13 ‘‘(B) Education of staff and contractors 14 who have routine contact with enrollees regard- 15 ing the various needs of the diverse enrollee 16 population. 17 ‘‘(C) Evaluation of the language services 18 programs and services offered by the organiza- 19 tion (or sponsor) with respect to the enrollee 20 population, such as through analysis of com- 21 plaints or satisfaction survey results. 22 ‘‘(D) Methods by which the plan provides 23 to the Secretary information regarding the eth- 24 nic diversity of the enrollee population. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 109 •S 3660 IS ‘‘(E) The periodic provision of educational 1 information to plan enrollees on the language 2 services and programs offered by the organiza- 3 tion (or sponsor).’’. 4 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 5 AND CHIP.— 6 (1) PAYMENTS TO STATES.—Section 7 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 8 1396b(a)(2)(E)), as amended by section 203(g)(3), 9 is further amended by— 10 (A) striking ‘‘75’’ and inserting ‘‘90’’; 11 (B) striking ‘‘translation or interpretation 12 services’’ and inserting ‘‘language assistance 13 services’’; and 14 (C) striking ‘‘children of families’’ and in- 15 serting ‘‘individuals’’. 16 (2) STATE PLAN REQUIREMENTS.—Section 17 1902(a)(10)(A) of the Social Security Act (42 18 U.S.C. 1396a(a)(10)(A)) is amended by striking 19 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 20 (3) DEFINITION OF MEDICAL ASSISTANCE.— 21 Section 1905(a) of the Social Security Act (42 22 U.S.C. 1396d(a)) is amended by— 23 (A) in paragraph (28), by striking ‘‘and’’ 24 at the end; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 110 •S 3660 IS (B) by redesignating paragraph (29) as 1 paragraph (30); and 2 (C) by inserting after paragraph (28) the 3 following new paragraph: 4 ‘‘(29) language assistance services, as such 5 term is defined in section 1861(jjj)(1), provided in 6 a timely manner to individuals with limited-English 7 proficiency as defined in section 3400 of the Public 8 Health Service Act; and’’. 9 (4) USE OF DEDUCTIONS AND COST SHAR- 10 ING.—Section 1916(a)(2) of the Social Security Act 11 (42 U.S.C. 1396o(a)(2)) is amended by— 12 (A) by striking ‘‘or’’ at the end of subpara- 13 graph (D); 14 (B) by striking ‘‘; and’’ at the end of sub- 15 paragraph (E) and inserting ‘‘, or’’; and 16 (C) by adding at the end the following new 17 subparagraph: 18 ‘‘(F) language assistance services described 19 in section 1905(a)(29); and’’. 20 (5) CHIP COVERAGE REQUIREMENTS.—Section 21 2103 of the Social Security Act (42 U.S.C. 1397cc) 22 is amended— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 111 •S 3660 IS (A) in subsection (a), in the matter before 1 paragraph (1), by striking ‘‘and (7)’’ and in- 2 serting ‘‘(7), and (9)’’; and 3 (B) in subsection (c), by adding at the end 4 the following new paragraph: 5 ‘‘(9) LANGUAGE ASSISTANCE SERVICES.—The 6 child health assistance provided to a targeted low-in- 7 come child shall include coverage of language assist- 8 ance services, as such term is defined in section 9 1861(jjj)(1), provided in a timely manner to individ- 10 uals with limited-English proficiency (as defined in 11 section 3400 of the Public Health Service Act).’’; 12 and 13 (C) in subsection (e)(2)— 14 (i) in the heading, by striking ‘‘PRE- 15 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 16 (ii) by inserting ‘‘or subsection (c)(9)’’ 17 after ‘‘subsection (c)(1)(D)’’. 18 (6) DEFINITION OF CHILD HEALTH ASSIST- 19 ANCE.—Section 2110(a)(27) of the Social Security 20 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik- 21 ing ‘‘translation’’ and inserting ‘‘language assistance 22 services as described in section 2103(c)(9)’’. 23 (7) STATE DATA COLLECTION.—Pursuant to 24 the reporting requirement described in section 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 112 •S 3660 IS 2107(b)(1) of the Social Security Act (42 U.S.C. 1 1397gg(b)(1)), the Secretary of Health and Human 2 Services shall require that States collect data on— 3 (A) the primary language of individuals re- 4 ceiving child health assistance under title XXI 5 of the Social Security Act (42 U.S.C. 1397aa et 6 seq.); and 7 (B) in the case of such individuals who are 8 minors or incapacitated, the primary language 9 of the individual’s parent or guardian. 10 (8) CHIP PAYMENTS TO STATES.—Section 11 2105 of the Social Security Act (42 U.S.C. 1397ee) 12 is amended— 13 (A) in subsection (a)(1), by striking ‘‘75’’ 14 and inserting ‘‘90’’; and 15 (B) in subsection (c)(2)(A), by inserting 16 before the period at the end the following: ‘‘, 17 except that expenditures pursuant to clause (iv) 18 of subparagraph (D) of such paragraph shall 19 not count towards this total’’. 20 (e) FUNDING LANGUAGE ASSISTANCE SERVICES 21 FURNISHED BY PROVIDERS OF HEALTH CARE AND 22 HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH 23 RATES OF UNINSURED LEP INDIVIDUALS.— 24 (1) PAYMENT OF COSTS.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 113 •S 3660 IS (A) IN GENERAL.—Subject to subpara- 1 graph (B), the Secretary of Health and Human 2 Services (referred to in this subsection as the 3 ‘‘Secretary’’) shall make payments (on a quar- 4 terly basis) directly to eligible entities to sup- 5 port the provision of language assistance serv- 6 ices to English learners in an amount equal to 7 an eligible entity’s eligible costs for providing 8 such services for the quarter. 9 (B) FUNDING.—Out of any funds in the 10 Treasury not otherwise appropriated, there are 11 appropriated to the Secretary of Health and 12 Human Services such sums as may be nec- 13 essary for each of fiscal years 2019 through 14 2023. 15 (C) RELATION TO MEDICAID DSH.—Pay- 16 ments under this subsection shall not offset or 17 reduce payments under section 1923 of the So- 18 cial Security Act (42 U.S.C. 1396r–4), nor 19 shall payments under such section be consid- 20 ered when determining uncompensated costs as- 21 sociated with the provision of language assist- 22 ance services for the purposes of this section. 23 (2) METHODOLOGY FOR PAYMENT OF 24 CLAIMS.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 114 •S 3660 IS (A) IN GENERAL.—The Secretary shall es- 1 tablish a methodology to determine the average 2 per person cost of language assistance services. 3 (B) DIFFERENT ENTITIES.—In estab- 4 lishing such methodology, the Secretary may es- 5 tablish different methodologies for different 6 types of eligible entities. 7 (C) NO INDIVIDUAL CLAIMS.—The Sec- 8 retary may not require eligible entities to sub- 9 mit individual claims for language assistance 10 services for individual patients as a requirement 11 for payment under this subsection. 12 (3) 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 (4) GUIDELINES.—Not later than 6 months 20 after the date of enactment of this Act, the Sec- 21 retary shall establish and distribute guidelines con- 22 cerning the implementation of this subsection. 23 (5) REPORTING REQUIREMENTS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 115 •S 3660 IS (A) REPORT TO SECRETARY.—Entities re- 1 ceiving payment under this subsection shall pro- 2 vide the Secretary with a quarterly report on 3 how the entity used such funds. Such report 4 shall contain aggregate (and may not contain 5 individualized) data collected using the instru- 6 ment under paragraph (3) and shall otherwise 7 be in a form and manner determined by the 8 Secretary. 9 (B) REPORT TO CONGRESS.—Not later 10 than 2 years after the date of enactment of this 11 Act, and every 2 years thereafter, the Secretary 12 shall submit a report to Congress concerning 13 the implementation of this subsection. 14 (6) DEFINITIONS.—In this subsection: 15 (A) ELIGIBLE COSTS.—The term ‘‘eligible 16 costs’’ means, with respect to an eligible entity 17 that provides language assistance services to 18 English learners, the product of— 19 (i) the average per person cost of lan- 20 guage assistance services, determined ac- 21 cording to the methodology devised under 22 paragraph (2); and 23 (ii) the number of English learners 24 who are provided language assistance serv- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 116 •S 3660 IS ices by the entity and for whom no reim- 1 bursement is available for such services 2 under the amendments made by sub- 3 sections (a), (b), (c), or (d) or by private 4 health insurance. 5 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 6 entity’’ means an entity that— 7 (i) is a Medicaid provider that is— 8 (I) a physician; 9 (II) a hospital with a low-income 10 utilization rate (as defined in section 11 1923(b)(3) of the Social Security Act 12 (42 U.S.C. 1396r–4(b)(3))) of greater 13 than 25 percent; or 14 (III) a federally qualified health 15 center (as defined in section 16 1905(l)(2)(B) of the Social Security 17 Act (42 U.S.C. 1396d(l)(2)(B))); 18 (ii) not later than 6 months after the 19 date of the enactment of this Act, provides 20 language assistance services to not less 21 than 8 percent of the entity’s total number 22 of patients; and 23 (iii) prepares and submits an applica- 24 tion to the Secretary, at such time, in such 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 117 •S 3660 IS manner, and accompanied by such infor- 1 mation as the Secretary may require, to 2 ascertain the entity’s eligibility for funding 3 under this subsection. 4 (C) ENGLISH LEARNER.—The term 5 ‘‘English learner’’ has the meaning given such 6 term in section 8101(20) of the Elementary 7 and Secondary Education Act of 1965, except 8 that subparagraphs (A), (B), and (D) of such 9 section shall not apply. 10 (D) LANGUAGE ASSISTANCE SERVICES.— 11 The term ‘‘language assistance services’’ has 12 the meaning given such term in section 13 1861(jjj)(1) of the Social Security Act, as 14 added by subsection (b). 15 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 16 OTHER LAWS.—Nothing in this section shall be construed 17 to limit otherwise existing obligations of recipients of Fed- 18 eral financial assistance under title VI of the Civil Rights 19 Act of 1964 (42 U.S.C. 2000d et seq.) or other laws that 20 protect the civil rights of individuals. 21 (g) EFFECTIVE DATE.— 22 (1) IN GENERAL.—Except as otherwise pro- 23 vided and subject to paragraph (2), the amendments 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 118 •S 3660 IS made by this section shall take effect on January 1, 1 2019. 2 (2) EXCEPTION IF STATE LEGISLATION RE- 3 QUIRED.—In the case of a State plan for medical as- 4 sistance under title XIX of the Social Security Act 5 which the Secretary of Health and Human Services 6 determines requires State legislation (other than leg- 7 islation appropriating funds) in order for the plan to 8 meet the additional requirement imposed by the 9 amendments made by this section, the State plan 10 shall not be regarded as failing to comply with the 11 requirements of such title solely on the basis of its 12 failure to meet this additional requirement before 13 the first day of the first calendar quarter beginning 14 after the close of the first regular session of the 15 State legislature that begins after the date of the en- 16 actment of this Act. For purposes of the previous 17 sentence, in the case of a State that has a 2-year 18 legislative session, each year of such session shall be 19 deemed to be a separate regular session of the State 20 legislature. 21 SEC. 208. INCREASING UNDERSTANDING OF AND IMPROV- 22 ING HEALTH LITERACY. 23 (a) IN GENERAL.—The Secretary, acting through the 24 Director of the Agency for Healthcare Research and Qual- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 119 •S 3660 IS ity with respect to grants under subsection (c)(1) and 1 through the Administrator of the Health Resources and 2 Services Administration with respect to grants under sub- 3 section (c)(2), in consultation with the Director of the Na- 4 tional Institute on Minority Health and Health Disparities 5 and the Deputy Assistant Secretary for Minority Health, 6 shall award grants to eligible entities to improve health 7 care for patient populations that have low functional 8 health literacy. 9 (b) ELIGIBILITY.—To be eligible to receive a grant 10 under subsection (a), an entity shall— 11 (1) be a hospital, health center or clinic, health 12 plan, or other health entity (including a nonprofit 13 minority health organization or association); and 14 (2) prepare and submit to the Secretary an ap- 15 plication at such time, in such manner, and con- 16 taining such information as the Secretary may rea- 17 sonably require. 18 (c) USE OF FUNDS.— 19 (1) AGENCY FOR HEALTHCARE RESEARCH AND 20 QUALITY.—A grant awarded under subsection (a) 21 through the Director of the Agency for Healthcare 22 Research and Quality shall be used— 23 (A) to define and increase the under- 24 standing of health literacy; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 120 •S 3660 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. 6 (2) HEALTH RESOURCES AND SERVICES ADMIN- 7 ISTRATION.—A grant awarded under subsection (a) 8 through the Administrator of the Health Resources 9 and Services Administration shall be used to conduct 10 demonstration projects for interventions for patients 11 with low 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 disease management 16 programs addressing mental, physical, oral, and 17 behavioral health conditions for patients with 18 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 121 •S 3660 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. 5 (d) DEFINITIONS.—In this section, the term ‘‘low 6 health literacy’’ means the inability of an individual to ob- 7 tain, process, and understand basic health information 8 and services needed to make appropriate health decisions. 9 (e) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section, 11 such sums as may be necessary for each of fiscal years 12 2019 through 2023. 13 SEC. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR AC- 14 TIVITIES RECEIVING FEDERAL FUNDS. 15 (a) COVERED ENTITY; COVERED PROGRAM OR AC- 16 TIVITY.—In this section— 17 (1) the term ‘‘covered entity’’ means an entity 18 carrying out a covered program or activity; and 19 (2) the term ‘‘covered program or activity’’ 20 means any health program or activity, any part of 21 which is receiving Federal financial assistance, in- 22 cluding credits, subsidies, or contracts of insurance, 23 and any program or activity that is administered by 24 an executive agency or any entity established under 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 122 •S 3660 IS title I of the Patient Protection and Affordable Care 1 Act (or amendments made thereby), as such pro- 2 grams, activities, agencies, and entities are described 3 in section 1557(a) of the Patient Protection and Af- 4 fordable Care Act (42 U.S.C. 18116(a)). 5 (b) REQUIREMENTS.—A covered entity, in order to 6 ensure the right of individuals with limited-English pro- 7 ficiency to receive access to quality health care through 8 the covered program or activity, shall— 9 (1) ensure that appropriate clinical and support 10 staff receive ongoing education and training in cul- 11 turally and linguistically appropriate service delivery; 12 (2) offer and provide appropriate language as- 13 sistance services at no additional charge to each pa- 14 tient that is an individual with limited-English pro- 15 ficiency at all points of contact, in a timely manner 16 during all hours of operation; 17 (3) notify patients of their right to receive lan- 18 guage services in their primary language; and 19 (4) utilize only qualified interpreters for an in- 20 dividual with limited-English proficiency or qualified 21 translators, except as provided in subsection (c). 22 (c) EXEMPTIONS.—The requirements of subsection 23 (b)(4) shall not apply as follows: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 123 •S 3660 IS (1) When a patient requests the use of family, 1 friends, or other persons untrained in interpretation 2 or translation if each of the following conditions are 3 met: 4 (A) The interpreter requested by the pa- 5 tient is over the age of 18. 6 (B) The covered entity informs the patient 7 in the primary language of the patient that he 8 or she has the option of having the entity pro- 9 vide to the patient an interpreter and trans- 10 lation services without charge. 11 (C) The covered entity informs the patient 12 that the entity may not require an individual 13 with a limited-English proficiency to use a fam- 14 ily member or friend as an interpreter. 15 (D) The covered entity evaluates whether 16 the person the patient wishes to use as an in- 17 terpreter is competent. If the covered entity has 18 reason to believe that such person is not com- 19 petent as an interpreter, the entity provides its 20 own interpreter to protect the covered entity 21 from liability if the patient’s interpreter is later 22 found not competent. 23 (E) If the covered entity has reason to be- 24 lieve that there is a conflict of interest between 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 124 •S 3660 IS the interpreter and patient, the covered entity 1 may not use the patient’s interpreter. 2 (F) The covered entity has the patient sign 3 a waiver, witnessed by at least 1 individual not 4 related to the patient, that includes the infor- 5 mation stated in subparagraphs (A) through 6 (E) and is translated into the patient’s primary 7 language. 8 (2) When a medical emergency exists and the 9 delay directly associated with obtaining competent 10 interpreter or translation services would jeopardize 11 the health of the patient, but only until a competent 12 interpreter or translation service is available. 13 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 14 shall not be construed to mean that emergency rooms or 15 similar entities that regularly provide health care services 16 in medical emergencies are exempt from legal or regu- 17 latory requirements related to competent interpreter serv- 18 ices. 19 SEC. 210. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 20 TURALLY AND LINGUISTICALLY APPRO- 21 PRIATE HEALTH CARE SERVICES. 22 (a) REPORT.—Not later than 1 year after the date 23 of enactment of this Act and annually thereafter, the Sec- 24 retary of Health and Human Services shall enter into a 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 125 •S 3660 IS contract with the National Academy of Medicine for the 1 preparation and publication of a report that describes 2 Federal efforts to ensure that all individuals with limited- 3 English proficiency have meaningful access to health care 4 services and health-care-related services that are culturally 5 and linguistically appropriate. Such report shall include— 6 (1) a description and evaluation of the activities 7 carried out under this Act; 8 (2) a description and analysis of best practices, 9 model programs, guidelines, and other effective 10 strategies for providing access to culturally and lin- 11 guistically appropriate health care services; 12 (3) recommendations on the development and 13 implementation of policies and practices by providers 14 of health care services and health-care-related serv- 15 ices for individuals with limited-English proficiency; 16 (4) recommend guidelines or standards for 17 health literacy and plain language, informed consent, 18 discharge instructions, and written communications, 19 and for improvement of health care access; 20 (5) a description of the effect of providing lan- 21 guage services on quality of health care and access 22 to care; and 23 (6) a description of the costs associated with or 24 savings related to the provision of language services. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 126 •S 3660 IS (b) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2019 through 2023. 4 SEC. 211. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 5 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 6 cation is authorized to provide grants to eligible entities 7 for the provision of English as a second language (in this 8 section referred to ‘‘ESL’’) instruction and shall deter- 9 mine, after consultation with appropriate stakeholders, the 10 mechanism for administering and distributing such 11 grants. 12 (b) ELIGIBLE ENTITY DEFINED.—In this section, 13 the term ‘‘eligible entity’’ means a State or community- 14 based organization that employs and serves minority popu- 15 lations. 16 (c) APPLICATION.—An eligible entity may apply for 17 a grant under this section by submitting such information 18 as the Secretary of Education may require and in such 19 form and manner as the Secretary may require. 20 (d) USE OF GRANT.—As a condition of receiving a 21 grant under this section, an eligible entity shall— 22 (1) develop and implement a plan for assuring 23 the availability of ESL instruction that effectively 24 integrates information about the nature of the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 127 •S 3660 IS United States health care system, how to access 1 care, and any special language skills that may be re- 2 quired for individuals to access and regularly nego- 3 tiate the system effectively; 4 (2) develop a plan, including, where appro- 5 priate, public-private partnerships, for making ESL 6 instruction progressively available to all individuals 7 seeking instruction; and 8 (3) maintain current ESL instruction efforts by 9 using funds available under this section to supple- 10 ment rather than supplant any funds expended for 11 ESL instruction in the State as of January 1, 2019. 12 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 13 Secretary of Education shall— 14 (1) collect and publicize annual data on how 15 much Federal, State, and local governments spend 16 on ESL instruction; 17 (2) collect data from State and local govern- 18 ments to identify the unmet needs of English lan- 19 guage learners for appropriate ESL instruction, in- 20 cluding— 21 (A) the preferred written and spoken lan- 22 guage of such English language learners; 23 (B) the extent of waiting lists for ESL in- 24 struction, including how many programs main- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 128 •S 3660 IS tain waiting lists and, for programs that do not 1 have waiting lists, the reasons why not; 2 (C) the availability of programs to geo- 3 graphically isolated communities; 4 (D) the impact of course enrollment poli- 5 cies, including open enrollment, on the avail- 6 ability of ESL instruction; 7 (E) the number individuals in the State 8 and each participating locality; 9 (F) the effectiveness of the instruction in 10 meeting the needs of individuals receiving in- 11 struction and those needing instruction; 12 (G) as assessment of the need for pro- 13 grams that integrate job training and ESL in- 14 struction, to assist individuals to obtain better 15 jobs; and 16 (H) the availability of ESL slots by State 17 and locality; 18 (3) determine the cost and most appropriate 19 methods of making ESL instruction available to all 20 English language learners seeking instruction; and 21 (4) not later than 1 year after the date of en- 22 actment of this Act, issue a report to Congress that 23 assesses the information collected in paragraphs (1), 24 (2), and (3) and makes recommendations on steps 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 129 •S 3660 IS that should be taken to progressively realize the goal 1 of making ESL instruction available to all English 2 language learners seeking instruction. 3 (f) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to the Secretary of Edu- 5 cation $250,000,000 for each of fiscal years 2019 through 6 2022 to carry out this section. 7 SEC. 212. IMPLEMENTATION. 8 (a) GENERAL PROVISIONS.— 9 (1) IMMUNITY.—A State shall not be immune 10 under the 11th Amendment to the Constitution of 11 the United States from suit in Federal court for a 12 violation of this title (including an amendment made 13 by this title). 14 (2) REMEDIES.—In a suit against a State for 15 a violation of this title (including an amendment 16 made by this title), remedies (including remedies 17 both at law and in equity) are available for such a 18 violation to the same extent as such remedies are 19 available for such a violation in a suit against any 20 public or private entity other than a State. 21 (b) RULE OF CONSTRUCTION.—Nothing in this title 22 shall be construed to limit otherwise existing obligations 23 of recipients of Federal financial assistance under title VI 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 130 •S 3660 IS of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 1 or any other Federal statute. 2 SEC. 213. LANGUAGE ACCESS SERVICES. 3 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 4 the Patient Protection and Affordable Care Act (42 5 U.S.C. 18022(b)(1)) is amended by adding at the end the 6 following: 7 ‘‘(K) Language access services, including 8 oral interpretation and written translations.’’. 9 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 10 COVERAGE.— 11 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 12 Internal Revenue Code of 1986 is amended by redes- 13 ignating clauses (iii) and (iv) as clauses (iv) and (v), 14 respectively, and by inserting after clause (ii) the fol- 15 lowing new clause: 16 ‘‘(iii) COVERAGE MUST INCLUDE LAN- 17 GUAGE ACCESS AND SERVICES.—Except as 18 provided in clause (iv), 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 131 •S 3660 IS guage access services, including oral inter- 1 pretation and written translations.’’. 2 (2) CONFORMING AMENDMENTS.— 3 (A) Section 36B(c)(2)(C) of such Code is 4 amended by striking ‘‘clause (iii)’’ each place it 5 appears in clauses (i) and (ii) and inserting 6 ‘‘clause (iv)’’. 7 (B) Section 36B(c)(2)(C)(iv) of such Code, 8 as redesignated by this subsection, is amended 9 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 10 and (iii)’’. 11 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 12 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 13 amended— 14 (1) by striking ‘‘and’’ at the end of subpara- 15 graph (C); 16 (2) by striking the period at the end of sub- 17 paragraph (D) and inserting ‘‘; and’’; and 18 (3) by adding at the end the following new sub- 19 paragraph: 20 ‘‘(E) reduce health disparities through the 21 provision of language access services, including 22 oral interpretation and written translations.’’. 23 (d) REGULATIONS REGARDING INTERNAL CLAIMS 24 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 132 •S 3660 IS HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 1 The Secretary of the Treasury, the Secretary of Labor, 2 and the Secretary of Health and Human Services shall 3 amend the regulations in section 54.9815–2719(e) of title 4 26, Code of Federal Regulations, section 2590.715– 5 2719(e) of title 29, Code of Federal Regulations, and sec- 6 tion 147.136(e) of title 45, Code of Federal Regulations, 7 respectively, to require group health plans and health in- 8 surance issuers offering group or individual health insur- 9 ance coverage to which such sections apply— 10 (1) to provide oral interpretation services with- 11 out any threshold requirements; 12 (2) to provide in the English versions of all no- 13 tices a statement prominently displayed in not less 14 than 15 non-English languages clearly indicating 15 how to access the language services provided by the 16 plan or issuer; and 17 (3) with respect to the requirements for pro- 18 viding relevant notices in a culturally and linguis- 19 tically appropriate manner in the applicable non- 20 English languages, to apply a threshold that 5 per- 21 cent of the population, or not less than 500 individ- 22 uals, in the county is literate only in the same non- 23 English language in order for the language to be 24 considered an applicable non-English language. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 133 •S 3660 IS (e) DATA COLLECTION AND REPORTING.—The Sec- 1 retary of Health and Human Services shall— 2 (1) amend the single streamlined application 3 form developed pursuant to section 1413 of the Pa- 4 tient Protection and Affordable Care Act (42 U.S.C. 5 18083) to collect the preferred spoken and written 6 language for each household member applying for 7 coverage under a qualified health plan through an 8 Exchange under title I of the Patient Protection and 9 Affordable Care Act; 10 (2) require navigators, certified application 11 counselors, and other individuals assisting with en- 12 rollment to collect and report requests for language 13 assistance; and 14 (3) require the toll-free telephone hotlines es- 15 tablished pursuant to section 1311(d)(4)(B) of the 16 Patient Protection and Affordable Care Act (42 17 U.S.C. 18031(d)(4)(B)) to submit an annual report 18 documenting the number of language assistance re- 19 quests, the types of languages requested, the range 20 and average wait time for a consumer to speak with 21 an interpreter, and any steps the hotline, and any 22 entity contracting with the Secretary to provide lan- 23 guage services, have taken to actively address some 24 of the consumer complaints. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 134 •S 3660 IS (f) EFFECTIVE DATE.—The amendments made by 1 this section shall not apply to plans beginning prior to the 2 date of the enactment of this Act. 3 TITLE III—HEALTH WORKFORCE 4 DIVERSITY 5 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 6 ACT. 7 Title XXXIV of the Public Health Service Act, as 8 added by section 204, is amended by adding at the end 9 the following: 10 ‘‘Subtitle B—Diversifying the 11 Health Care Workplace 12 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 13 DIVERSITY. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Bureau of Health Workforce of the Health Resources 16 and Services Administration, shall award a grant to an 17 entity determined appropriate by the Secretary for the es- 18 tablishment of a national working group on workforce di- 19 versity. 20 ‘‘(b) REPRESENTATION.—In establishing the national 21 working group under subsection (a): 22 ‘‘(1) The grantee shall ensure that the group 23 has representatives of each of the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 135 •S 3660 IS ‘‘(A) The Health Resources and Services 1 Administration. 2 ‘‘(B) The Department of Health and 3 Human Services Data Council. 4 ‘‘(C) The Office of Minority Health of the 5 Department of Health and Human Services. 6 ‘‘(D) The Substance Abuse and Mental 7 Health Services Administration. 8 ‘‘(E) The Bureau of Labor Statistics of 9 the Department of Labor. 10 ‘‘(F) The National Institute on Minority 11 Health and Health Disparities. 12 ‘‘(G) The Agency for Healthcare Research 13 and Quality. 14 ‘‘(H) The Institute of Medicine Study 15 Committee for the 2004 workforce diversity re- 16 port. 17 ‘‘(I) The Indian Health Service. 18 ‘‘(J) The Department of Education. 19 ‘‘(K) Minority-serving academic institu- 20 tions. 21 ‘‘(L) Consumer organizations. 22 ‘‘(M) Health professional associations, in- 23 cluding those that represent underrepresented 24 minority populations. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 136 •S 3660 IS ‘‘(N) Researchers in the area of health 1 workforce. 2 ‘‘(O) Health workforce accreditation enti- 3 ties. 4 ‘‘(P) Private (including nonprofit) founda- 5 tions that have sponsored workforce diversity 6 initiatives. 7 ‘‘(Q) Local and State health departments. 8 ‘‘(R) Representatives of community mem- 9 bers to be included on admissions committees 10 for health profession schools pursuant to sub- 11 section (c)(9). 12 ‘‘(S) National community-based organiza- 13 tions that serve as a national intermediary to 14 their urban affiliate members and have dem- 15 onstrated capacity to train health care profes- 16 sionals. 17 ‘‘(T) The Veterans Health Administration. 18 ‘‘(U) Other entities determined appropriate 19 by the Secretary. 20 ‘‘(2) The grantee shall ensure that, in addition 21 to the representatives under paragraph (1), the 22 working group has not less than 5 health professions 23 students representing various health profession fields 24 and levels of training. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 137 •S 3660 IS ‘‘(c) ACTIVITIES.—The working group established 1 under subsection (a) shall convene at least twice each year 2 to complete the following activities: 3 ‘‘(1) Review public and private health workforce 4 diversity initiatives. 5 ‘‘(2) Identify successful health workforce diver- 6 sity programs and practices. 7 ‘‘(3) Examine challenges relating to the devel- 8 opment and implementation of health workforce di- 9 versity initiatives. 10 ‘‘(4) Draft a national strategic work plan for 11 health workforce diversity, including recommenda- 12 tions for public and private sector initiatives. 13 ‘‘(5) Develop a framework and methods for the 14 evaluation of current and future health workforce di- 15 versity initiatives. 16 ‘‘(6) Develop recommended standards for work- 17 force diversity that could be applicable to all health 18 professions programs and programs funded under 19 this Act. 20 ‘‘(7) Develop guidelines to train health profes- 21 sionals to care for a diverse population. 22 ‘‘(8) Develop a workforce data collection or 23 tracking system to identify where racial and ethnic 24 minority health professionals practice. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 138 •S 3660 IS ‘‘(9) Develop a strategy for the inclusion of 1 community members on admissions committees for 2 health profession schools. 3 ‘‘(10) Help with monitoring and implementation 4 of standards for diversity, equity, and inclusion. 5 ‘‘(11) Other activities determined appropriate 6 by the Secretary. 7 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 8 the establishment of the working group under subsection 9 (a), and annually thereafter, the working group shall pre- 10 pare and make available to the general public for com- 11 ment, an annual report on the activities of the working 12 group. Such report shall include the recommendations of 13 the working group for improving health workforce diver- 14 sity. 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2019 through 2024. 19 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 20 WORKFORCE DIVERSITY. 21 ‘‘(a) IN GENERAL.—The Secretary, acting through 22 the Deputy Assistant Secretary for Minority Health, and 23 in collaboration with the Bureau of Health Workforce 24 within the Health Resources and Services Administration 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 139 •S 3660 IS and the National Institute on Minority Health and Health 1 Disparities, shall establish a technical clearinghouse on 2 health workforce diversity within the Office of Minority 3 Health and coordinate current and future clearinghouses 4 related to health workforce diversity. 5 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 6 house established under subsection (a) shall offer the fol- 7 lowing information and services: 8 ‘‘(1) Information on the importance of health 9 workforce diversity. 10 ‘‘(2) Statistical information relating to under- 11 represented minority representation in health and al- 12 lied health professions and occupations. 13 ‘‘(3) Model health workforce diversity practices 14 and programs, including integrated models of care. 15 ‘‘(4) Admissions policies that promote health 16 workforce diversity and are in compliance with Fed- 17 eral and State laws. 18 ‘‘(5) Retainment policies that promote comple- 19 tion of health profession degrees for underserved 20 populations. 21 ‘‘(6) Lists of scholarship, loan repayment, and 22 loan cancellation grants as well as fellowship infor- 23 mation for underserved populations for health pro- 24 fessions schools. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 140 •S 3660 IS ‘‘(7) Foundation and other large organizational 1 initiatives relating to health workforce diversity. 2 ‘‘(c) CONSULTATION.—In carrying out this section, 3 the Secretary shall consult with non-Federal entities which 4 may include minority health professional associations and 5 minority sections of major health professional associations 6 to ensure the adequacy and accuracy of information. 7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2019 through 2024. 11 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 12 WORKFORCE DIVERSITY, EQUITY, AND IN- 13 CLUSION. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Administrator of the Health Resources and Services 16 Administration and the Centers for Disease Control and 17 Prevention, shall award grants to eligible entities that 18 demonstrate a commitment to health workforce diversity. 19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 20 under subsection (a), an entity shall— 21 ‘‘(1) be an educational institution or entity that 22 historically produces or trains meaningful numbers 23 of underrepresented minority health professionals, 24 including— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 141 •S 3660 IS ‘‘(A) part B institutions, as defined in sec- 1 tion 322 of the Higher Education Act of 1965; 2 ‘‘(B) Hispanic-serving health professions 3 schools; 4 ‘‘(C) Hispanic-serving institutions, as de- 5 fined in section 502 of such Act; 6 ‘‘(D) Tribal colleges or universities, as de- 7 fined in section 316 of such Act; 8 ‘‘(E) Asian American and Native American 9 Pacific Islander-serving institutions, as defined 10 in section 371(c) of such Act; 11 ‘‘(F) institutions that have programs to re- 12 cruit and retain underrepresented minority 13 health professionals, in which a significant 14 number of the enrolled participants are under- 15 represented minorities; 16 ‘‘(G) health professional associations, 17 which may include underrepresented minority 18 health professional associations; and 19 ‘‘(H) institutions, including national and 20 regional community-based organizations with 21 demonstrated commitment to a diversified 22 workforce— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 142 •S 3660 IS ‘‘(i) located in communities with pre- 1 dominantly underrepresented minority pop- 2 ulations; 3 ‘‘(ii) with whom partnerships have 4 been formed for the purpose of increasing 5 workforce diversity; and 6 ‘‘(iii) in which at least 20 percent of 7 the enrolled participants are underrep- 8 resented minorities; and 9 ‘‘(2) submit to the Secretary an application at 10 such time, in such manner, and containing such in- 11 formation as the Secretary may require. 12 ‘‘(c) USE OF FUNDS.—Amounts received under a 13 grant under subsection (a) shall be used to expand existing 14 workforce diversity programs, implement new workforce 15 diversity programs, or evaluate existing or new workforce 16 diversity programs, including with respect to mental 17 health care professions. Such programs shall enhance di- 18 versity by considering minority status as part of an indi- 19 vidualized consideration of qualifications. Possible activi- 20 ties may include— 21 ‘‘(1) educational outreach programs relating to 22 opportunities in the health professions; 23 ‘‘(2) scholarship, fellowship, grant, loan repay- 24 ment, and loan cancellation programs; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 143 •S 3660 IS ‘‘(3) postbaccalaureate programs; 1 ‘‘(4) academic enrichment programs, particu- 2 larly targeting those who would not be competitive 3 for health professions schools; 4 ‘‘(5) supporting workforce diversity in kinder- 5 garten through 12th grade and other health pipeline 6 programs; 7 ‘‘(6) mentoring programs; 8 ‘‘(7) internship or rotation programs involving 9 hospitals, health systems, health plans, and other 10 health entities; 11 ‘‘(8) community partnership development for 12 purposes relating to workforce diversity; or 13 ‘‘(9) leadership training. 14 ‘‘(d) REPORTS.—Not later than 1 year after receiving 15 a grant under this section, and annually for the term of 16 the grant, a grantee shall submit to the Secretary a report 17 that summarizes and evaluates all activities conducted 18 under the grant. 19 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section, 21 such sums as may be necessary for each of fiscal years 22 2019 through 2024. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 144 •S 3660 IS ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 1 RESEARCHERS. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the National Institutes of Health, the Di- 4 rector of the Centers for Disease Control and Prevention, 5 the Commissioner of Food and Drugs, the Director of the 6 Agency for Healthcare Research and Quality, and the Ad- 7 ministrator of the Health Resources and Services Admin- 8 istration, shall award grants that expand existing opportu- 9 nities for scientists and researchers and promote the inclu- 10 sion of underrepresented minorities in the health profes- 11 sions. 12 ‘‘(b) RESEARCH FUNDING.—The head of each agency 13 listed in subsection (a) shall establish or expand existing 14 programs to provide research funding to scientists and re- 15 searchers in training. Under such programs, the head of 16 each such entity shall give priority in allocating research 17 funding to support health research in traditionally under- 18 served communities, including underrepresented minority 19 communities, and research classified as community or 20 participatory. 21 ‘‘(c) DATA COLLECTION.—The head of each agency 22 listed in subsection (a) shall collect data on the number 23 (expressed as an absolute number and a percentage) of 24 underrepresented minority and nonminority applicants 25 who receive and are denied agency funding at every stage 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 145 •S 3660 IS of review. Such data shall be reported annually to the Sec- 1 retary and the appropriate committees of Congress. 2 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 3 retary shall establish a student loan reimbursement pro- 4 gram to provide student loan reimbursement assistance to 5 researchers who focus on racial and ethnic disparities in 6 health. The Secretary shall promulgate regulations to de- 7 fine the scope and procedures for the program under this 8 subsection. 9 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 10 retary shall establish a student loan cancellation program 11 to provide student loan cancellation assistance to research- 12 ers who focus on racial and ethnic disparities in health. 13 Students participating in the program shall make a min- 14 imum 5-year commitment to work at an accredited health 15 profession school. The Secretary shall promulgate addi- 16 tional regulations to define the scope and procedures for 17 the program under this subsection. 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated to carry out this section, 20 such sums as may be necessary for each of fiscal years 21 2019 through 2024. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 146 •S 3660 IS ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 1 PROFESSIONALS. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the Centers for Disease Control and Pre- 4 vention, the Assistant Secretary for Mental Health and 5 Substance Use, the Administrator of the Health Resources 6 and Services Administration, and the Administrator of the 7 Centers for Medicare & Medicaid Services, shall establish 8 a program to award grants to eligible individuals for ca- 9 reer support in nonresearch-related health and wellness 10 professions. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 12 under subsection (a), an individual shall— 13 ‘‘(1) be a student in a health professions school, 14 a graduate of such a school who is working in a 15 health profession, an individual working in a health 16 or wellness profession (including mental and behav- 17 ioral health), or a faculty member of such a school; 18 and 19 ‘‘(2) submit to the Secretary an application at 20 such time, in such manner, and containing such in- 21 formation as the Secretary may require. 22 ‘‘(c) USE OF FUNDS.—An individual shall use 23 amounts received under a grant under this section to— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 147 •S 3660 IS ‘‘(1) support the individual’s health activities or 1 projects that involve underserved communities, in- 2 cluding racial and ethnic minority communities; 3 ‘‘(2) support health-related career advancement 4 activities; 5 ‘‘(3) to pay, or as reimbursement for payments 6 of, student loans or training or credentialing costs 7 for individuals who are health professionals and are 8 focused on health issues affecting underserved com- 9 munities, including racial and ethnic minority com- 10 munities; and 11 ‘‘(4) to establish and promote leadership train- 12 ing programs to decrease health disparities and to 13 increase cultural competence with the goal of in- 14 creasing diversity in leadership positions. 15 ‘‘(d) DEFINITION.—In this section, the term ‘career 16 in nonresearch-related health and wellness professions’ 17 means employment or intended employment in the field 18 of public health, health policy, health management, health 19 administration, medicine, nursing, pharmacy, psychology, 20 social work, psychiatry, other mental and behavioral 21 health, allied health, community health, social work, or 22 other fields determined appropriate by the Secretary, 23 other than in a position that involves research. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 148 •S 3660 IS ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2019 through 2024. 4 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 5 VERSITY ON QUALITY. 6 ‘‘(a) IN GENERAL.—The Director of the Agency for 7 Healthcare Research and Quality, in collaboration with 8 the Deputy Assistant Secretary for Minority Health and 9 the Director of the National Institute on Minority Health 10 and Health Disparities, shall award grants to eligible enti- 11 ties to expand research on the link between health work- 12 force diversity and quality health care. 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 research entity or other entity determined ap- 17 propriate by the Director; and 18 ‘‘(2) submit to the Secretary an application at 19 such time, in such manner, and containing such in- 20 formation as the Secretary may require. 21 ‘‘(c) USE OF FUNDS.—Amounts received under a 22 grant awarded under subsection (a) shall be used to sup- 23 port research that investigates the effect of health work- 24 force diversity on— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 149 •S 3660 IS ‘‘(1) language access; 1 ‘‘(2) cultural competence; 2 ‘‘(3) patient satisfaction; 3 ‘‘(4) timeliness of care; 4 ‘‘(5) safety of care; 5 ‘‘(6) effectiveness of care; 6 ‘‘(7) efficiency of care; 7 ‘‘(8) patient outcomes; 8 ‘‘(9) community engagement; 9 ‘‘(10) resource allocation; 10 ‘‘(11) organizational structure; 11 ‘‘(12) compliance of care; or 12 ‘‘(13) other topics determined appropriate by 13 the Director. 14 ‘‘(d) PRIORITY.—In awarding grants under sub- 15 section (a), the Director shall give individualized consider- 16 ation to all relevant aspects of the applicant’s background. 17 Consideration of prior research experience involving the 18 health of underserved communities shall be such a factor. 19 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2019 through 2024. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 150 •S 3660 IS ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 1 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 2 through the Office of Minority Health, in collaboration 3 with the National Institute on Minority Health and Health 4 Disparities, the Office for Civil Rights, the Centers for 5 Disease Control and Prevention, the Centers for Medicare 6 & Medicaid Services, the Health Resources and Services 7 Administration, and other appropriate public and private 8 entities, shall establish and coordinate a health and health 9 care disparities education program to support, develop, 10 and implement educational initiatives and outreach strate- 11 gies that inform health care professionals and the public 12 about the existence of and methods to reduce racial and 13 ethnic disparities in health and health care. 14 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 15 cation program established under subsection (a), shall, 16 through the use of public awareness and outreach cam- 17 paigns targeting the general public and the medical com- 18 munity at large— 19 ‘‘(1) disseminate scientific evidence for the ex- 20 istence and extent of racial and ethnic disparities in 21 health care, including disparities that are not other- 22 wise attributable to known factors such as access to 23 care, patient preferences, or appropriateness of 24 intervention, as described in the 2002 Institute of 25 Medicine Report entitled ‘Unequal Treatment: Con- 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 151 •S 3660 IS fronting Racial and Ethnic Disparities in Health 1 Care’, as well as the impact of disparities related to 2 age, disability status, socioeconomic status, sex, gen- 3 der identity, and sexual orientation on racial and 4 ethnic minorities; 5 ‘‘(2) disseminate new research findings to 6 health care providers and patients to assist them in 7 understanding, reducing, and eliminating health and 8 health care disparities; 9 ‘‘(3) disseminate information about the impact 10 of linguistic and cultural barriers on health care 11 quality and the obligation of health providers who 12 receive Federal financial assistance to ensure that 13 individuals with limited-English proficiency have ac- 14 cess to language access services; 15 ‘‘(4) disseminate information about the impor- 16 tance and legality of racial, ethnic, disability status, 17 socioeconomic status, sex, gender identity, and sex- 18 ual orientation, and primary language data collec- 19 tion, analysis, and reporting; 20 ‘‘(5) design and implement specific educational 21 initiatives to health care providers relating to health 22 and health care disparities; 23 ‘‘(6) assess the impact of the programs estab- 24 lished under this section in raising awareness of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 152 •S 3660 IS health and health care disparities and providing in- 1 formation on available resources; and 2 ‘‘(7) design and implement specific educational 3 initiatives to educate the health care workforce relat- 4 ing to unconscious bias. 5 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2019 through 2024.’’. 9 SEC. 302. HISPANIC-SERVING INSTITUTIONS, HISTORI- 10 CALLY BLACK COLLEGES AND UNIVERSITIES, 11 AND TRIBAL COLLEGES. 12 (a) IN GENERAL.—Part B of title VII of the Public 13 Health Service Act (42 U.S.C. 293 et seq.) is amended 14 by adding at the end the following: 15 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 16 CALLY BLACK COLLEGES AND UNIVERSITIES, 17 AND TRIBAL COLLEGES. 18 ‘‘(a) IN GENERAL.—The Secretary, acting through 19 the Administrator of the Health Resources and Services 20 Administration and in consultation with the Secretary of 21 Education, shall award grants to hispanic-serving institu- 22 tions, historically black colleges and universities, Tribal 23 Colleges or Universities, regional community based organi- 24 zations, and national minority medical associations, for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 153 •S 3660 IS scholarships and counseling services to prepare underrep- 1 resented minority individuals to enroll in and graduate 2 from health professional schools and to increase services 3 for underrepresented minority students including— 4 ‘‘(1) mentoring with underrepresented health 5 professionals; and 6 ‘‘(2) providing financial assistance information 7 for continued education and applications to health 8 professional schools. 9 ‘‘(b) DEFINITIONS.—In this section: 10 ‘‘(1) HISPANIC SERVING INSTITUTION.—The 11 term ‘hispanic-serving institution’ means an entity 12 that— 13 ‘‘(A) is a school or program for which 14 there is a definition under 799B; 15 ‘‘(B) has an enrollment of full-time equiva- 16 lent students that is made up of at least 9 per- 17 cent Hispanic students; 18 ‘‘(C) has been effective in carrying out pro- 19 grams to recruit Hispanic individuals to enroll 20 in and graduate from the school; 21 ‘‘(D) has been effective in recruiting and 22 retaining Hispanic faculty members; 23 ‘‘(E) has a significant number of graduates 24 who are providing health services to medically 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 154 •S 3660 IS underserved populations or to individuals in 1 health professional shortage areas; and 2 ‘‘(F) is a Hispanic Center of Excellence in 3 Health Professions Education designated under 4 section 736(d)(2) of the Public Health Service 5 Act (42 U.S.C. 293(d)(2)). 6 ‘‘(2) HISTORICALLY BLACK COLLEGES AND 7 UNIVERSITY.—The term ‘historically black college 8 and university’ has the meaning given the term ‘part 9 B institution’ as defined in section 322 of the High- 10 er Education Act of 1965. 11 ‘‘(3) TRIBAL COLLEGE OR UNIVERSITY.—The 12 term ‘Tribal College or University’ has the meaning 13 given such term in section 316(b) of such Act. 14 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 15 carrying out the National Health Service Corps Loan Re- 16 payment Program established under subpart III of part 17 D of title III and the loan repayment program under sec- 18 tion 317F, the Secretary shall ensure, notwithstanding 19 such subpart or section, that loan repayments of not less 20 than $50,000 per year per person are awarded for repay- 21 ment of loans incurred for enrollment or participation of 22 underrepresented minority individuals in health profes- 23 sional schools and other health programs described in this 24 section.’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 155 •S 3660 IS SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 1 DISEASE CONTROL AND PREVENTION. 2 Section 317F(c) of the Public Health Service Act (42 3 U.S.C. 247b–7(c)) is amended— 4 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 5 (2) by inserting before the period at the end the 6 following: ‘‘, $750,000 for fiscal year 2019, and such 7 sums as may be necessary for each of the fiscal 8 years 2020 through 2024’’. 9 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 10 GREE PROGRAMS AT SCHOOLS OF PUBLIC 11 HEALTH AND SCHOOLS OF ALLIED HEALTH. 12 Part B of title VII of the Public Health Service Act 13 (42 U.S.C. 293 et seq.), as amended by section 302, is 14 further amended by adding at the end the following: 15 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 16 GREE PROGRAMS. 17 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 18 acting through the Administrator of the Health Resources 19 and Services Administration, in consultation with the Di- 20 rector of the Centers for Disease Control and Prevention, 21 the Director of the Agency for Healthcare Research and 22 Quality, and the Deputy Assistant Secretary for Minority 23 Health, shall enter into cooperative agreements with 24 schools of public health and schools of allied health to de- 25 sign and implement online degree programs. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 156 •S 3660 IS ‘‘(b) PRIORITY.—In entering into cooperative agree- 1 ments under this section, the Secretary shall give priority 2 to any school of public health or school of allied health 3 that has an established track record of serving medically 4 underserved communities. 5 ‘‘(c) REQUIREMENTS.—As a condition of entering 6 into a cooperative agreement with the Secretary under this 7 section, a school of public health or school of allied health 8 shall agree to design and implement an online degree pro- 9 gram that meets the following restrictions: 10 ‘‘(1) Enrollment of individuals who have ob- 11 tained a secondary school diploma or its recognized 12 equivalent. 13 ‘‘(2) Maintaining a significant enrollment of 14 underrepresented minority or disadvantaged stu- 15 dents. 16 ‘‘(3) Achieving a high completion rate of en- 17 rolled underrepresented minority or disadvantaged 18 students. 19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2019 through 2024.’’. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 157 •S 3660 IS SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 1 NATIONAL HEALTH CARE WORKFORCE COM- 2 MISSION. 3 It is the sense of Congress that the National Health 4 Care Workforce Commission established by section 5101 5 of the Patient Protection and Affordable Care Act (42 6 U.S.C. 294q) should, in carrying out its assigned duties 7 under that section, give attention to the needs of racial 8 and ethnic minorities, individuals with lower socio- 9 economic status, individuals with mental, developmental, 10 and physical disabilities, lesbian, gay, bisexual, 11 transgender, queer, and questioning populations, and indi- 12 viduals who are members of multiple minority or special 13 population groups. 14 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 15 Subtitle B of title XXXIV of the Public Health Serv- 16 ice Act, as added by section 301, is further amended by 17 inserting after section 3417 the following: 18 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 19 SERVICES CORPS. 20 ‘‘(a) IN GENERAL.—The Director of the Centers for 21 Disease Control and Prevention, in collaboration with the 22 Administrator of the Health Resources and Services Ad- 23 ministration and the Deputy Assistant Secretary for Mi- 24 nority Health, shall award grants to eligible entities to in- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 158 •S 3660 IS crease awareness among secondary and postsecondary stu- 1 dents of career opportunities in the health professions. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 3 under subsection (a), an entity shall— 4 ‘‘(1) be a clinical, public health, or health serv- 5 ices organization, community-based or nonprofit en- 6 tity, or other entity determined appropriate by the 7 Director of the Centers for Disease Control and Pre- 8 vention; 9 ‘‘(2) serve a health professional shortage area, 10 as determined by the Secretary; 11 ‘‘(3) work with students, including those from 12 racial and ethnic minority backgrounds, that have 13 expressed an interest in the health professions; and 14 ‘‘(4) submit to the Secretary an application at 15 such time, in such manner, and containing such in- 16 formation as the Secretary may require. 17 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 18 section (a) shall be used to support internships that will 19 increase awareness among students of non-research-based, 20 career opportunities in the following health professions: 21 ‘‘(1) Medicine. 22 ‘‘(2) Nursing. 23 ‘‘(3) Public health. 24 ‘‘(4) Pharmacy. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 159 •S 3660 IS ‘‘(5) Health administration and management. 1 ‘‘(6) Health policy. 2 ‘‘(7) Psychology. 3 ‘‘(8) Dentistry. 4 ‘‘(9) International health. 5 ‘‘(10) Social work. 6 ‘‘(11) Allied health. 7 ‘‘(12) Psychiatry. 8 ‘‘(13) Hospice care. 9 ‘‘(14) Community health, patient navigation, 10 and peer support. 11 ‘‘(15) Other professions determined appropriate 12 by the Director of the Centers for Disease Control 13 and Prevention. 14 ‘‘(d) PRIORITY.—In awarding grants under sub- 15 section (a), the Director of the Centers for Disease Con- 16 trol and Prevention shall give priority to those entities 17 that— 18 ‘‘(1) serve a high proportion of individuals from 19 disadvantaged backgrounds; 20 ‘‘(2) have experience in health disparity elimi- 21 nation programs; 22 ‘‘(3) facilitate the entry of disadvantaged indi- 23 viduals into institutions of higher education; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 160 •S 3660 IS ‘‘(4) provide counseling or other services de- 1 signed to assist disadvantaged individuals in success- 2 fully completing their education at the postsecondary 3 level. 4 ‘‘(e) STIPENDS.— 5 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 6 an entity receiving a grant under this section may 7 use the funds made available through such grant to 8 award stipends for educational and living expenses 9 to students participating in the internship supported 10 by the grant. 11 ‘‘(2) LIMITATIONS.—A stipend awarded under 12 paragraph (1) to an individual— 13 ‘‘(A) may not be provided for a period that 14 exceeds 6 months; and 15 ‘‘(B) may not exceed $20 per day for an 16 individual (notwithstanding any other provision 17 of law regarding the amount of a stipend). 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2019 through 2024. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 161 •S 3660 IS ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 1 PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Centers for 3 Disease Control and Prevention, in collaboration with the 4 Deputy Assistant Secretary for Minority Health, shall 5 award scholarships to eligible individuals under subsection 6 (b) who seek a career in public health. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 8 arship under subsection (a), an individual shall— 9 ‘‘(1) have interest, knowledge, or skill in public 10 health research or public health practice, or other 11 health professions as determined appropriate by the 12 Director of the Centers for Disease Control and Pre- 13 vention; 14 ‘‘(2) reside in a health professional shortage 15 area as determined by the Secretary; 16 ‘‘(3) demonstrate promise for becoming a leader 17 in public health; 18 ‘‘(4) secure admission to a 4-year institution of 19 higher education; and 20 ‘‘(5) submit to the Secretary an application at 21 such time, in such manner, and containing such in- 22 formation as the Secretary may require. 23 ‘‘(c) USE OF FUNDS.—Amounts received under an 24 award under subsection (a) shall be used to support oppor- 25 tunities for students to become public health professionals. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 162 •S 3660 IS ‘‘(d) PRIORITY.—In awarding grants under sub- 1 section (a), the Director shall give priority to those stu- 2 dents that— 3 ‘‘(1) are from disadvantaged backgrounds; 4 ‘‘(2) have secured admissions to a minority- 5 serving institution; and 6 ‘‘(3) have identified a health professional as a 7 mentor at their school or institution and an aca- 8 demic advisor to assist in the completion of their 9 baccalaureate degree. 10 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 11 payment of scholarships under this section for such indi- 12 viduals for any period of education in student under- 13 graduate tenure, except that such a scholarship may not 14 be provided to an individual for more than 4 years, and 15 such a scholarship may not exceed $10,000 per academic 16 year for an individual (notwithstanding any other provi- 17 sion of law regarding the amount of a scholarship). 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2019 through 2024. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 163 •S 3660 IS ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 1 FELLOWSHIP PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Centers for 3 Disease Control and Prevention, in collaboration with the 4 Deputy Assistant Secretary for Minority Health, the As- 5 sistant Secretary for Mental Health and Substance Use, 6 and the Director of the Indian Health Services, shall 7 award research fellowships to eligible individuals under 8 subsection (b) to conduct research that will examine gen- 9 der and health disparities and to pursue a career in the 10 health professions. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 12 ship under subsection (a), an individual shall— 13 ‘‘(1) have experience in health research or pub- 14 lic health practice; 15 ‘‘(2) reside in a health professional shortage 16 area as designated by the Secretary under section 17 332; 18 ‘‘(3) have expressed an interest in the health 19 professions; 20 ‘‘(4) demonstrate promise for becoming a leader 21 in the field of women’s health; 22 ‘‘(5) secure admission to a health professions 23 school or graduate program with an emphasis in 24 gender studies; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 164 •S 3660 IS ‘‘(6) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 4 subsection (a) to an eligible individual shall be used to 5 support an opportunity for the individual to become a re- 6 searcher and advance the research base on the intersection 7 between gender and health. 8 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 9 section (a), the Director of the Centers for Disease Con- 10 trol and Prevention shall give priority to those applicants 11 that— 12 ‘‘(1) are from disadvantaged backgrounds; and 13 ‘‘(2) have identified a mentor and academic ad- 14 visor who will assist in the completion of their grad- 15 uate or professional degree and have secured a re- 16 search assistant position with a researcher working 17 in the area of gender and health. 18 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 19 Disease Control and Prevention may approve fellowships 20 for individuals under this section for any period of edu- 21 cation in the student’s graduate or health profession ten- 22 ure, except that such a fellowship may not be provided 23 to an individual for more than 3 years, and such a fellow- 24 ship may not exceed $18,000 per academic year for an 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 165 •S 3660 IS individual (notwithstanding any other provision of law re- 1 garding the amount of a fellowship). 2 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 3 is authorized to be appropriated to carry out this section 4 such sums as may be necessary for each of fiscal years 5 2019 through 2024. 6 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 7 HEALTH FELLOWSHIP PROGRAM. 8 ‘‘(a) IN GENERAL.—The Director of the Agency for 9 Healthcare Research and Quality, in collaboration with 10 the Deputy Assistant Secretary for Minority Health, shall 11 award research fellowships to eligible individuals under 12 subsection (b) to advance their understanding of inter- 13 national health. 14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 15 ship under subsection (a), an individual shall— 16 ‘‘(1) have educational experience in the field of 17 international health; 18 ‘‘(2) reside in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) demonstrate promise for becoming a leader 21 in the field of international health; 22 ‘‘(4) be a college senior or recent graduate of 23 a 4-year institution of higher education; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 166 •S 3660 IS ‘‘(5) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 4 subsection (a) to an eligible individual shall be used to 5 support an opportunity for the individual to become a 6 health professional and to advance the knowledge of the 7 individual about international issues relating to health 8 care access and quality. 9 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 10 section (a), the Director shall give priority to eligible indi- 11 viduals that— 12 ‘‘(1) are from a disadvantaged background; and 13 ‘‘(2) have identified a mentor at a health pro- 14 fessions school or institution, an academic advisor to 15 assist in the completion of their graduate or profes- 16 sional degree, and an advisor from an international 17 health non-governmental organization, private volun- 18 teer organization, or other international institution 19 or program that focuses on increasing health care 20 access and quality for residents in developing coun- 21 tries. 22 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 23 this section may not— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 167 •S 3660 IS ‘‘(1) be provided to an eligible individual for 1 more than a period of 6 months; 2 ‘‘(2) be awarded to a graduate of a 4-year insti- 3 tution of higher education that has not been enrolled 4 in such institution for more than 1 year; and 5 ‘‘(3) exceed $4,000 per academic year (notwith- 6 standing any other provision of law regarding the 7 amount of a fellowship). 8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 9 is authorized to be appropriated to carry out this section, 10 such sums as may be necessary for each of fiscal years 11 2019 through 2024. 12 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 13 GRAM. 14 ‘‘(a) IN GENERAL.—The Director of the Agency for 15 Healthcare Research and Quality, the Director of the Cen- 16 ters for Medicare & Medicaid Services, and the Adminis- 17 trator of the Health Resources and Services Administra- 18 tion, in collaboration with the Deputy Assistant Secretary 19 for Minority Health, shall award grants to eligible entities 20 to expose entering graduate students to the health profes- 21 sions. 22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 23 under subsection (a), an entity shall— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 168 •S 3660 IS ‘‘(1) be a clinical, public health, or health serv- 1 ices organization, community-based, academic, or 2 nonprofit entity, or other entity determined appro- 3 priate by the Director of the Agency for Healthcare 4 Research and Quality; 5 ‘‘(2) serve in a health professional shortage 6 area as designated by the Secretary under section 7 332; 8 ‘‘(3) work with students obtaining a degree in 9 the health professions; and 10 ‘‘(4) submit to the Secretary an application at 11 such time, in such manner, and containing such in- 12 formation as the Secretary may require. 13 ‘‘(c) USE OF FUNDS.—Amounts received under a 14 grant awarded under subsection (a) shall be used to sup- 15 port opportunities that expose students to non-research- 16 based health professions, including— 17 ‘‘(1) public health policy; 18 ‘‘(2) health care and pharmaceutical policy; 19 ‘‘(3) health care administration and manage- 20 ment; 21 ‘‘(4) health economics; and 22 ‘‘(5) other professions determined appropriate 23 by the Director of the Agency for Healthcare Re- 24 search and Quality, the Director of the Centers for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 169 •S 3660 IS Medicare & Medicaid Services, or the Administrator 1 of the Health Resources and Services Administra- 2 tion. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director of the Agency for Healthcare Re- 5 search and Quality, the Director of the Centers for Medi- 6 care & Medicaid Services, and the Administrator of the 7 Health Resources and Services Administration, in collabo- 8 ration with the Deputy Assistant for Secretary for Minor- 9 ity Health, shall give priority to those entities that— 10 ‘‘(1) have experience with health disparity elimi- 11 nation programs; 12 ‘‘(2) facilitate training in the fields described in 13 subsection (c); and 14 ‘‘(3) provide counseling or other services de- 15 signed to assist students in successfully completing 16 their education at the postsecondary level. 17 ‘‘(e) STIPENDS.— 18 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 19 an entity receiving a grant under this section may 20 use the funds made available through such grant to 21 award stipends for educational and living expenses 22 to students participating in the opportunities sup- 23 ported by the grant. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 170 •S 3660 IS ‘‘(2) LIMITATIONS.—A stipend awarded under 1 paragraph (1) to an individual— 2 ‘‘(A) may not be provided for a period that 3 exceeds 2 months; and 4 ‘‘(B) may not exceed $100 per day (not- 5 withstanding any other provision of law regard- 6 ing the amount of a stipend). 7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2019 through 2024. 11 ‘‘SEC. 3420C. LEADERSHIP FELLOWSHIP PROGRAMS. 12 ‘‘(a) IN GENERAL.—The Secretary shall award 13 grants to national minority medical or health professional 14 associations to develop leadership fellowship programs for 15 underrepresented health professionals in order to— 16 ‘‘(1) assist such professionals in becoming fu- 17 ture leaders in public health and health care delivery 18 institutions; and 19 ‘‘(2) increase diversity in decision-making posi- 20 tions that can improve the health of underserved 21 communities. 22 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro- 23 gram supported under this section shall— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 171 •S 3660 IS ‘‘(1) focus on training mid-career physicians 1 and health care executives who have documented 2 leadership experience and a commitment to public 3 health services in underserved communities; and 4 ‘‘(2) support Federal public health policy and 5 budget programs, and priorities that impact health 6 equity, through activities such as didactic lectures 7 and leader site visits. 8 ‘‘(c) PERIOD OF GRANTS.—The period during which 9 payments are made under a grant awarded under sub- 10 section (a) may not exceed 1 year.’’. 11 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 12 PROGRAM. 13 Section 402E of the Higher Education Act of 1965 14 (20 U.S.C. 1070a–15) is amended by striking subsection 15 (g) and inserting the following: 16 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 17 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 18 ordinate with the Secretary of Health and Human Serv- 19 ices to ensure that there is collaboration between the goals 20 of the program under this section and programs of the 21 Health Resources and Services Administration that pro- 22 mote health workforce diversity. The Secretary of Edu- 23 cation shall take such measures as may be necessary to 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 172 •S 3660 IS encourage students participating in projects assisted 1 under this section to consider health profession careers. 2 ‘‘(h) FUNDING.—From amounts appropriated pursu- 3 ant to the authority of section 402A(g), the Secretary 4 shall, to the extent practicable, allocate funds for projects 5 authorized by this section in an amount which is not less 6 than $31,000,000 for each of the fiscal years 2019 7 through 2025.’’. 8 SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 9 EQUIVALENT RESIDENTS FOR COST-REPORT- 10 ING PERIODS. 11 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 12 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 13 amended by section 204(a), is amended— 14 (1) in subparagraph (E), by striking ‘‘Subject 15 to subparagraphs (J) and (K), such rules’’ and in- 16 serting ‘‘Subject to subparagraphs (J), (K), and 17 (M), such rules’’; 18 (2) in subparagraph (J), by striking ‘‘Such 19 rules’’ and inserting ‘‘Subject to subparagraph (M), 20 such rules’’; 21 (3) in subparagraph (K), by striking ‘‘In deter- 22 mining’’ and inserting ‘‘Subject to subparagraph 23 (M), in determining’’; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 173 •S 3660 IS (4) by adding at the end the following new sub- 1 paragraph: 2 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 3 AND INTERNS.—For purposes of cost-reporting 4 periods beginning on or after October 1, 2019, 5 in determining the hospital’s number of full- 6 time equivalent residents for purposes of this 7 paragraph, all the time spent by an intern or 8 resident in an approved medical residency train- 9 ing program shall be counted toward the deter- 10 mination of full-time equivalency if the hos- 11 pital— 12 ‘‘(i) is recognized as a subsection (d) 13 hospital; 14 ‘‘(ii) is recognized as a subsection (d) 15 Puerto Rico hospital; 16 ‘‘(iii) is reimbursed under a reim- 17 bursement system authorized under section 18 1814(b)(3); or 19 ‘‘(iv) is a provider-based hospital out- 20 patient department.’’. 21 (b) IME DETERMINATIONS.—Section 22 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 23 1395ww(d)(5)(B)(xi)), as redesignated by section 204(b), 24 is amended— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 174 •S 3660 IS (1) in subclause (II), by striking ‘‘In deter- 1 mining’’ and inserting ‘‘Subject to subclause (IV), in 2 determining’’; 3 (2) in subclause (III), by striking ‘‘In deter- 4 mining’’ and inserting ‘‘Subject to subclause (IV), in 5 determining’’; and 6 (3) by inserting after subclause (III) the fol- 7 lowing new subclause: 8 ‘‘(IV) For purposes of cost-reporting peri- 9 ods beginning on or after October 1, 2019, the 10 provisions of subparagraph (M) of subsection 11 (h)(4) shall apply under this subparagraph in 12 the same manner as they apply under such sub- 13 section.’’. 14 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 15 FOR LOCAL HEALTH EQUITY. 16 (a) GRANTS.—The Secretary of Health and Human 17 Services, acting jointly with the Secretary of Education 18 and the Secretary of Labor, shall make grants to institu- 19 tions of higher education for the purposes of— 20 (1) in accordance with subsection (b), devel- 21 oping capacity— 22 (A) to build an evidence base for successful 23 strategies for increasing local health equity; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 175 •S 3660 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 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 institution of higher education 13 shall agree to use the grant to build an evidence base for 14 successful strategies for increasing local health equity, and 15 to serve as a national model of driving local health equity, 16 by supporting— 17 (1) resources to strengthen institutional metrics 18 and capacity to execute institution-wide health work- 19 force goals that can serve as models for increasing 20 health equity in communities across the United 21 States; 22 (2) collaborations among a cohort of institu- 23 tions in implementing systemic change, partnership 24 development, and programmatic efforts supportive of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 176 •S 3660 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 institution of 9 higher education shall agree to use the grant to develop 10 a strategic partnership with the community in which the 11 institution 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 pipeline programs in the bio- 23 medical sciences and health professions, including by 24 developing partnerships between institutions of high- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 177 •S 3660 IS er education and elementary schools and secondary 1 schools to recruit the next generation of health pro- 2 fessionals earlier in the pipeline to a health care ca- 3 reer. 4 SEC. 310. 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: 9 ‘‘(r) 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, in accord- 13 ance with paragraph (2), on any eligible Federal Di- 14 rect Loan not in default for a borrower who— 15 ‘‘(A) has made 120 monthly payments on 16 the eligible Federal Direct Loan after October 17 1, 2016, 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 178 •S 3660 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 179 •S 3660 IS ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 1 No borrower may, for the same employment as a 2 mental health or behavioral health social worker, re- 3 ceive a reduction of loan obligations under both this 4 subsection and subsection (m), 428J, 428K, 428L, 5 or 460. 6 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 7 RECT LOAN.—In this subsection, the term ‘eligible 8 Federal Direct Loan’ means a Federal Direct Staf- 9 ford Loan, Federal Direct PLUS Loan, Federal Di- 10 rect Unsubsidized Stafford Loan, or a Federal Di- 11 rect Consolidation Loan.’’. 12 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 13 (a) ESTABLISHMENT.—There is established in the 14 Health Resources and Services Administration of the De- 15 partment of Health and Human Services a Health Profes- 16 sions Workforce Fund to provide for expanded and sus- 17 tained national investment in the health professions and 18 nursing workforce development programs under title VII 19 and title VIII of the Public Health Service Act (42 U.S.C. 20 292 et seq; 42 U.S.C. 296 et seq). 21 (b) FUNDING.— 22 (1) IN GENERAL.—There is authorized to be 23 appropriated, and there is appropriated, out of any 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 180 •S 3660 IS monies in the Treasury not otherwise appropriated, 1 to the Health Professions Workforce Fund— 2 (A) $355,000,000 for fiscal year 2019; 3 (B) $375,000,000 for fiscal year 2020; 4 (C) $392,000,000 for fiscal year 2021; 5 (D) $412,000,000 for fiscal year 2022; 6 (E) $432,000,000 for fiscal year 2023; 7 (F) $454,000,000 for fiscal year 2024; 8 (G) $476,000,000 for fiscal year 2025; 9 (H) $500,000,000 for fiscal year 2026; 10 (I) $525,000,000 for fiscal year 2027; and 11 (J) $552,000,000 for fiscal year 2028. 12 (2) HEALTH PROFESSIONS EDUCATION PRO- 13 GRAMS.—For the purpose of carrying out health 14 professions education programs authorized under 15 title VII of the Public Health Service Act, in addi- 16 tion to any other amounts authorized to be appro- 17 priated for such purpose, there is authorized to be 18 appropriated out of any monies in the Health Pro- 19 fessions Workforce Fund, the following: 20 (A) $240,000,000 for fiscal year 2019. 21 (B) $253,000,000 for fiscal year 2020. 22 (C) $265,000,000 for fiscal year 2021. 23 (D) $278,000,000 for fiscal year 2022. 24 (E) $292,000,000 for fiscal year 2023. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 181 •S 3660 IS (F) $307,000,000 for fiscal year 2024. 1 (G) $322,000,000 for fiscal year 2025. 2 (H) $338,000,000 for fiscal year 2026. 3 (I) $355,000,000 for fiscal year 2027. 4 (J) $373,000,000 for fiscal year 2028. 5 (3) NURSING WORKFORCE DEVELOPMENT PRO- 6 GRAMS.—For the purpose of carrying out nursing 7 workforce development programs authorized under 8 Title VIII of the Public Health Service Act, in addi- 9 tion to any other amounts authorized to be appro- 10 priated for such purpose, there is authorized to be 11 appropriated out of any monies in the Health Pro- 12 fessions Workforce Fund, the following: 13 (A) $115,000,000 for fiscal year 2019. 14 (B) $122,000,000 for fiscal year 2020. 15 (C) $127,000,000 for fiscal year 2021. 16 (D) $134,000,000 for fiscal year 2022. 17 (E) $140,000,000 for fiscal year 2023. 18 (F) $147,000,000 for fiscal year 2024. 19 (G) $154,000,000 for fiscal year 2025. 20 (H) $162,000,000 for fiscal year 2026. 21 (I) $170,000,000 for fiscal year 2027. 22 (J) $179,000,000 for fiscal year 2028. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 182 •S 3660 IS SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 1 GRADUATE MEDICAL EDUCATION. 2 (a) FINDINGS.—Congress finds the following: 3 (1) Projections by the Association of American 4 Medical Colleges and other expert entities, such as 5 the Health Resources and Services Administration, 6 have indicated a nationwide shortage of up to 7 104,900 physicians, split evenly between primary 8 care and specialists, by 2030. 9 (2) Primarily due to the growing and aging 10 population, over the next decade, physician demand 11 is expected to grow up to 17 percent. 12 (3) The United States Census Bureau estimates 13 that the United States population will grow from 14 321 million in 2015 to 347 million in 2025. Further, 15 the number of Medicare beneficiaries is estimated to 16 increase from 47,800,000 in 2015 to approximately 17 66,000,000 in 2025. 18 (4) Approximately 36 percent of practicing phy- 19 sicians are over the age of 55 and are likely to retire 20 within the next decade. 21 (5) A nationwide physician shortage will result 22 in many people in the United States waiting longer 23 and traveling farther for health care; seeking non- 24 emergent care in emergency departments; and delay- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 183 •S 3660 IS ing treatment until their health care needs become 1 more serious, complex, and costly. 2 (6) Changing demographics (such as an aging 3 population), new health care delivery models (such 4 as medical homes), and other factors (such as dis- 5 aster preparedness) are contributing to a shortage of 6 both generalist and specialist physicians. 7 (7) These shortages will have the most severe 8 impact on vulnerable and underserved populations, 9 including racial and ethnic minorities and the ap- 10 proximately 20 percent of people in the United 11 States who live in rural or inner-city locations des- 12 ignated as health professional shortage areas. 13 (8) The health care utilization equity model of 14 the Association of American Medical Colleges esti- 15 mates that if racial and ethnic minorities and indi- 16 viduals from rural areas utilized health care in a 17 similar way to their Caucasian counterparts living in 18 metropolitan areas, the physician shortage would re- 19 quire an additional 96,000 physicians. 20 (9) To address the physician shortage, medical 21 education and training need to be accessible for stu- 22 dents and physicians from all backgrounds. Inter- 23 national graduates play an important role in health 24 care in the United States, representing roughly 25 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 184 •S 3660 IS percent of the health care workforce. Immigration 1 pathways like student, exchange-visitor, and employ- 2 ment visas, and programs like the National Interest 3 Waiver and Conrad 30 J–1 Visa Waiver, help im- 4 prove health access across the United States. 5 (10) United States medical school enrollment 6 will grow by 30 percent from 2018 to 2019 to help 7 reduce the shortage of quality physicians in the 8 United States. 9 (11) An increase in United States medical 10 school graduates must be accompanied by an in- 11 crease of 4,000 graduate medical education training 12 positions each year. 13 (12) Graduate medical education programs and 14 teaching hospitals provide venues in which the next 15 generation of physicians learns to work collabo- 16 ratively with other physicians and health profes- 17 sionals, adopt more efficient care delivery models 18 (such as care coordination and medical homes), in- 19 corporate health information technology and elec- 20 tronic health records in every aspect of their work, 21 apply new methods of assuring quality and safety, 22 and participate in groundbreaking clinical and public 23 health research. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 185 •S 3660 IS (13) The Medicare program under title XVIII 1 of the Social Security Act (42 U.S.C. 1395 et seq.) 2 (having more beneficiaries than any other health 3 care program), supports its ‘‘fair share’’ of the costs 4 associated with graduate medical education. 5 (14) In general, the level of support of graduate 6 medical education by the Medicare program has 7 been capped since 1997 and has not been increased 8 to support the expansion of graduate medical edu- 9 cation programs needed to avert the projected physi- 10 cian shortage or to accommodate the increase in 11 United States medical school graduates. 12 (b) SENSE OF CONGRESS.—It is the sense of Con- 13 gress that eliminating the limit of the number of residency 14 positions that receive some level of Medicare support 15 under section 1886(h) of the Social Security Act (42 16 U.S.C. 1395ww(h)), also referred to as the Medical grad- 17 uate medical education cap, is critical to— 18 (1) ensuring an appropriate supply of physi- 19 cians to meet the health care needs in the United 20 States; 21 (2) facilitating equitable access for all who seek 22 health care; and 23 (3) mitigating disparities in health and health 24 care. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 186 •S 3660 IS SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION- 1 ALLY EDUCATED HEALTH PROFESSIONALS. 2 (a) FINDINGS.—Congress finds the following: 3 (1) According to the Association of Schools and 4 Programs of Public Health, projections indicate a 5 nationwide shortage of up to 250,000 public health 6 workers needed by 2020. 7 (2) Similar trends are projected for other health 8 professions indicating shortages across disciplines, 9 including within the fields of nursing (500,000 by 10 2025), dentistry (15,000 by 2025), pharmacy 11 (38,000 by 2030), mental and behavioral health, pri- 12 mary care (46,000 by 2025), and community and al- 13 lied health. 14 (3) A nationwide health workforce shortage will 15 result in serious health threats and more severe and 16 costly health care needs, due to, in part, a delayed 17 response to food-borne outbreaks, emerging infec- 18 tious diseases, natural disasters, fewer cancer 19 screenings, and delayed treatment. 20 (4) Vulnerable and underserved populations and 21 health professional shortage areas will be most se- 22 verely impacted by the health workforce shortage. 23 (5) According to the Migration Policy Institute, 24 more than 2,000,000 college-educated immigrants in 25 the United States today are unemployed or under- 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 187 •S 3660 IS employed in low- or semi-skilled jobs that fail to 1 draw on their education and expertise. 2 (6) Approximately 2 out of every 5 internation- 3 ally educated immigrants are unemployed or under- 4 employed. 5 (7) According to the Drexel University Center 6 for Labor Markets and Policy, underemployment for 7 internationally educated immigrant women is 28 per- 8 cent higher than for their male counterparts. 9 (8) According to the Drexel University Center 10 for Labor Markets and Policy, the mean annual 11 earnings of underemployed immigrants were 12 $32,000, or 43 percent less than United States born 13 college graduates employed in the college labor mar- 14 ket. 15 (9) According to Upwardly Global and the Wel- 16 come Back Initiative, with proper guidance and sup- 17 port, underemployed skilled immigrants typically in- 18 crease their income by 215 percent to 900 percent. 19 (10) According to the Brookings Institution and 20 the Partnership for a New American Economy, im- 21 migrants working in the health workforce are, on av- 22 erage, better educated than United States-born 23 workers in the health workforce. 24 (b) GRANTS TO ELIGIBLE ENTITIES.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 188 •S 3660 IS (1) AUTHORITY TO PROVIDE GRANTS.—The 1 Secretary of Health and Human Services, acting 2 through the Bureau of Health Workforce within the 3 Health Resources and Services Administration, the 4 National Institute on Minority Health and Health 5 Disparities, or the Office of Minority Health (in this 6 section referred to as the ‘‘Secretary’’), may award 7 grants to eligible entities to carry out activities de- 8 scribed in subsection (c). 9 (2) ELIGIBILITY.—To be eligible to receive a 10 grant under this section, an entity shall— 11 (A) be a clinical, public health, or health 12 services organization, a community-based or 13 nonprofit entity, an academic institution, a 14 faith-based organization, a State, county, or 15 local government, an area health education cen- 16 ter, or another entity determined appropriate by 17 the Secretary; and 18 (B) submit to the Secretary an application 19 at such time, in such manner, and containing 20 such information as the Secretary may require. 21 (c) AUTHORIZED ACTIVITIES.—A grant awarded 22 under this section shall be used— 23 (1) to provide services to assist unemployed and 24 underemployed skilled immigrants, residing in the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 189 •S 3660 IS United States, who have legal, permanent work au- 1 thorization and who are internationally educated 2 health professionals, enter into the health workforce 3 of the United States with employment matching 4 their health professional skills and education, and 5 advance in employment to positions that better 6 match their health professional education and exper- 7 tise; 8 (2) to provide training opportunities to reduce 9 barriers to entry and advancement in the health 10 workforce for skilled, internationally educated immi- 11 grants; 12 (3) to educate employers regarding the abilities 13 and capacities of internationally educated health 14 professionals; 15 (4) to assist in the evaluation of foreign creden- 16 tials; 17 (5) to support preceptorships for international 18 medical graduates in hospital primary care training; 19 and 20 (6) to facilitate access to contextualized and ac- 21 celerated courses on English as a second language. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 190 •S 3660 IS TITLE IV—IMPROVING HEALTH 1 CARE ACCESS AND QUALITY 2 Subtitle A—Expansion of Coverage 3 SEC. 401. AMENDMENT TO THE PUBLIC HEALTH SERVICE 4 ACT. 5 Title XXXIV of the Public Health Service Act, as 6 amended by titles I, II, III, and IX of this Act, is further 7 amended by inserting after subtitle D the following: 8 ‘‘Subtitle E—Reconstruction and 9 Improvement Grants for Public 10 Health Care Facilities Serving 11 Pacific Islanders and the Insu- 12 lar Areas 13 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 14 INITIATIVES. 15 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 16 with the Administrator of the Health Resources and Serv- 17 ices Administration, the Director of the Agency for 18 Healthcare Research and Quality, and the Administrator 19 of the Centers for Medicare & Medicaid Services, shall 20 award grants to eligible entities for the conduct of dem- 21 onstration projects to improve the quality of and access 22 to health care. 23 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 24 under subsection (a), an entity shall— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 191 •S 3660 IS ‘‘(1) be a health center, hospital, health plan, 1 health system, community clinic, or other health en- 2 tity determined appropriate by the Secretary— 3 ‘‘(A) that, by legal mandate or explicitly 4 adopted mission, provides patients with access 5 to services regardless of their ability to pay; 6 ‘‘(B) that provides care or treatment for a 7 substantial number of patients who are unin- 8 sured, are receiving assistance under a State 9 plan under title XIX of the Social Security Act 10 (or under a waiver of such plan), or are mem- 11 bers of vulnerable populations, as determined 12 by the Secretary; and 13 ‘‘(C)(i) with respect to which, not less than 14 50 percent of the entity’s patient population is 15 made up of racial and ethnic minority groups; 16 or 17 ‘‘(ii) that— 18 ‘‘(I) serves a disproportionate percent- 19 age of local patients that are from a racial 20 and ethnic minority group, or that has a 21 patient population, at least 50 percent of 22 which is composed of individuals with lim- 23 ited-English proficiency; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 192 •S 3660 IS ‘‘(II) provides an assurance that 1 amounts received under the grant will be 2 used only to support quality improvement 3 activities in the racial and ethnic minority 4 population served; and 5 ‘‘(2) prepare and submit to the Secretary an 6 application at such time, in such manner, and con- 7 taining such information as the Secretary may re- 8 quire. 9 ‘‘(c) PRIORITY.—In awarding grants under sub- 10 section (a), the Secretary shall give priority to applicants 11 under subsection (b)(2) that— 12 ‘‘(1) demonstrate an intent to operate as part 13 of a health care partnership, network, collaborative, 14 coalition, or alliance where each member entity con- 15 tributes to the design, implementation, and evalua- 16 tion of the proposed intervention; or 17 ‘‘(2) intend to use funds to carry out system- 18 wide changes with respect to health care quality im- 19 provement, including— 20 ‘‘(A) improved systems for data collection 21 and reporting; 22 ‘‘(B) innovative collaborative or similar 23 processes; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 193 •S 3660 IS ‘‘(C) group programs with behavioral or 1 self-management interventions; 2 ‘‘(D) case management services; 3 ‘‘(E) physician or patient reminder sys- 4 tems; 5 ‘‘(F) educational interventions; or 6 ‘‘(G) other activities determined appro- 7 priate by the Secretary. 8 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 9 received under a grant under subsection (a) to support 10 the implementation and evaluation of health care quality 11 improvement activities or minority health and health care 12 disparity reduction activities that include— 13 ‘‘(1) with respect to health care systems, activi- 14 ties relating to improving— 15 ‘‘(A) patient safety; 16 ‘‘(B) timeliness of care; 17 ‘‘(C) effectiveness of care; 18 ‘‘(D) efficiency of care; 19 ‘‘(E) patient centeredness; and 20 ‘‘(F) health information technology; and 21 ‘‘(2) with respect to patients, activities relating 22 to— 23 ‘‘(A) staying healthy; 24 ‘‘(B) getting well, mentally and physically; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 194 •S 3660 IS ‘‘(C) living effectively with illness or dis- 1 ability; 2 ‘‘(D) coping with end-of-life issues; and 3 ‘‘(E) shared decisionmaking. 4 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 5 provide financial and other technical assistance to grant- 6 ees under this section for the development of common data 7 systems. 8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2019 through 2024. 12 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 13 ‘‘(a) IN GENERAL.—The Secretary, acting through 14 the Administrator of the Health Resources and Services 15 Administration, shall designate centers of excellence at 16 public hospitals, and other health systems serving large 17 numbers of minority patients, that— 18 ‘‘(1) meet the requirements of section 19 3451(b)(1); 20 ‘‘(2) demonstrate excellence in providing care to 21 minority populations; and 22 ‘‘(3) demonstrate excellence in reducing dispari- 23 ties in health and health care. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 195 •S 3660 IS ‘‘(b) REQUIREMENTS.—A hospital or health system 1 that serves as a center of excellence under subsection (a) 2 shall— 3 ‘‘(1) design, implement, and evaluate programs 4 and policies relating to the delivery of care in ra- 5 cially, ethnically, and linguistically diverse popu- 6 lations; 7 ‘‘(2) provide training and technical assistance 8 to other hospitals and health systems relating to the 9 provision of quality health care to minority popu- 10 lations; and 11 ‘‘(3) develop activities for graduate or con- 12 tinuing medical education that institutionalize a 13 focus on cultural competence training for health care 14 providers. 15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section, 17 such sums as may be necessary for each of fiscal years 18 2019 through 2024. 19 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 20 FOR PUBLIC HEALTH CARE FACILITIES SERV- 21 ING PACIFIC ISLANDERS AND THE INSULAR 22 AREAS. 23 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 24 rect financial assistance to designated health care pro- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 196 •S 3660 IS viders and community health centers in American Samoa, 1 Guam, the Commonwealth of the Northern Mariana Is- 2 lands, the United States Virgin Islands, Puerto Rico, and 3 Hawaii for the purposes of reconstructing and improving 4 health care facilities and services in a culturally competent 5 and sustainable manner. 6 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 7 nancial assistance under subsection (a), an entity shall be 8 a public health facility or community health center located 9 in American Samoa, Guam, the Commonwealth of the 10 Northern Mariana Islands, the United States Virgin Is- 11 lands, Puerto Rico, or Hawaii that— 12 ‘‘(1) is owned or operated by— 13 ‘‘(A) the Government of American Samoa, 14 Guam, the Commonwealth of the Northern 15 Mariana Islands, the United States Virgin Is- 16 lands, Puerto Rico, or Hawaii or a unit of local 17 government; or 18 ‘‘(B) a nonprofit organization; and 19 ‘‘(2)(A) provides care or treatment for a sub- 20 stantial number of patients who are uninsured, re- 21 ceiving assistance under title XVIII of the Social Se- 22 curity Act, or a State plan under title XIX of such 23 Act (or under a waiver of such plan), or who are 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 197 •S 3660 IS members of a vulnerable population, as determined 1 by the Secretary; or 2 ‘‘(B) serves a disproportionate percentage of 3 local patients that are from a racial and ethnic mi- 4 nority group. 5 ‘‘(c) REPORT.—Not later than 180 days after the 6 date of enactment of this title and annually thereafter, the 7 Secretary shall submit to the Congress and the President 8 a report that includes an assessment of health resources 9 and facilities serving populations in American Samoa, 10 Guam, the Commonwealth of the Northern Mariana Is- 11 lands, the United States Virgin Islands, Puerto Rico, and 12 Hawaii. In preparing such report, the Secretary shall— 13 ‘‘(1) consult with and obtain information on all 14 health care facilities needs from the entities receiv- 15 ing direct financial assistance under subsection (a); 16 ‘‘(2) include all amounts of Federal assistance 17 received by each such entity in the preceding fiscal 18 year; 19 ‘‘(3) review the total unmet needs of health care 20 facilities serving American Samoa, Guam, the Com- 21 monwealth of the Northern Mariana Islands, the 22 United States Virgin Islands, Puerto Rico, and Ha- 23 waii, including needs for renovation and expansion 24 of existing facilities; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 198 •S 3660 IS ‘‘(4) include a strategic plan for addressing the 1 needs of each such population identified in the re- 2 port; and 3 ‘‘(5) evaluate the effectiveness of the care pro- 4 vided by measuring patient outcomes and cost meas- 5 ures. 6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated such sums as necessary 8 to carry out this section.’’. 9 SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 10 RIERS TO ACCESS TO AFFORDABLE HEALTH 11 CARE UNDER ACA. 12 (a) IN GENERAL.— 13 (1) PREMIUM TAX CREDITS.—Section 36B of 14 the Internal Revenue Code of 1986 is amended— 15 (A) in subsection (c)(1)(B)— 16 (i) by amending the heading to read 17 as follows: ‘‘SPECIAL RULE FOR CERTAIN 18 INDIVIDUALS INELIGIBLE FOR MEDICAID 19 DUE TO STATUS’’, and 20 (ii) in clause (ii), by striking ‘‘lawfully 21 present in the United States, but’’ and in- 22 serting ‘‘who’’, and 23 (B) by striking subsection (e). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 199 •S 3660 IS (2) COST-SHARING REDUCTIONS.—Section 1402 1 of the Patient Protection and Affordable Care Act 2 (42 U.S.C. 18071) is amended by striking sub- 3 section (e). 4 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 5 Section 1331(e)(1)(B) of the Patient Protection and 6 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 7 amended by striking ‘‘lawfully present in the United 8 States’’. 9 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 10 Section 1412 of the Patient Protection and Afford- 11 able Care Act (42 U.S.C. 18082) is amended by 12 striking subsection (d). 13 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 14 SENTIAL COVERAGE.—Section 5000A(d) of the In- 15 ternal Revenue Code of 1986 is amended by striking 16 paragraph (3) and by redesignating paragraph (4) 17 as paragraph (3). 18 (b) CONFORMING AMENDMENTS.— 19 (1) Section 1411(a) of the Patient Protection 20 and Affordable Care Act (42 U.S.C. 18081(a)) is 21 amended by striking paragraph (1) and redesig- 22 nating paragraphs (2), (3), and (4) as paragraphs 23 (1), (2), and (3), respectively. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 200 •S 3660 IS (2) Section 1312(f) of the Patient Protection 1 and Affordable Care Act (42 U.S.C. 18032(f)) is 2 amended— 3 (A) in the heading, by striking ‘‘; ACCESS 4 LIMITED TO CITIZENS AND LAWFUL RESI- 5 DENTS’’; and 6 (B) by striking paragraph (3). 7 SEC. 403. STUDY ON THE UNINSURED. 8 (a) IN GENERAL.—The Secretary of Health and 9 Human Services (in this section referred to as the ‘‘Sec- 10 retary’’) shall— 11 (1) conduct a study, in accordance with the 12 standards under section 3101 of the Public Health 13 Service Act (42 U.S.C. 300kk), on the demographic 14 characteristics of the population of individuals who 15 do not have health insurance coverage or oral health 16 coverage; and 17 (2) predict, based on such study, the demo- 18 graphic characteristics of the population of individ- 19 uals who would remain without health insurance cov- 20 erage after the end of any annual open enrollment 21 or any special enrollment period or upon enactment 22 and implementation of any legislative changes to the 23 Patient Protection and Affordable Care Act (Public 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 201 •S 3660 IS Law 111–148) that affect the number of persons eli- 1 gible for coverage. 2 (b) REPORTING REQUIREMENTS.— 3 (1) IN GENERAL.—Not later than 12 months 4 after the date of the enactment of this Act, the Sec- 5 retary shall submit to the Congress the results of 6 the study under subsection (a)(1) and the prediction 7 made under subsection (a)(2). 8 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 9 ISTICS.—The Secretary shall— 10 (A) report the demographic characteristics 11 under paragraphs (1) and (2) of subsection (a) 12 on the basis of racial and ethnic group, and 13 shall stratify the reporting on each racial and 14 ethnic group by other demographic characteris- 15 tics that can impact access to health insurance 16 coverage, such as sexual orientation, gender 17 identity, primary language, disability status, 18 sex, socioeconomic status, age group, and citi- 19 zenship and immigration status, in a manner 20 consistent with title I of this Act, including the 21 amendments made by such title; and 22 (B) not use such report to engage in or an- 23 ticipate any deportation or immigration related 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 202 •S 3660 IS enforcement action by any entity, including the 1 Department of Homeland Security. 2 SEC. 404. MEDICAID IN THE TERRITORIES. 3 (a) ELIMINATION OF GENERAL MEDICAID FUNDING 4 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 5 (1) IN GENERAL.—Section 1108 of the Social 6 Security Act (42 U.S.C. 1308) is amended— 7 (A) in subsection (f), in the matter before 8 paragraph (1), by striking ‘‘subsection (g)’’ and 9 inserting ‘‘subsections (g) and (h)’’; 10 (B) in subsection (g)(2), in the matter be- 11 fore subparagraph (A), by inserting ‘‘and sub- 12 section (h)’’ after ‘‘paragraphs (3) and (5)’’; 13 and 14 (C) by adding at the end the following new 15 subsection: 16 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS 17 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE 18 UNITED STATES, GUAM, THE NORTHERN MARIANA IS- 19 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 20 shall not apply to Puerto Rico, the Virgin Islands of the 21 United States, Guam, the Northern Mariana Islands, and 22 American Samoa beginning with fiscal year 2019.’’. 23 (2) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 203 •S 3660 IS (A) Section 1902(j) of the Social Security 1 Act (42 U.S.C. 1396a(j)) is amended by strik- 2 ing ‘‘, the limitation in section 1108(f),’’. 3 (B) Section 1903(u) of the Social Security 4 Act (42 U.S.C. 1396b(u)) is amended by strik- 5 ing paragraph (4). 6 (C) Section 1323(c)(1) of the Patient Pro- 7 tection and Affordable Care Act (42 U.S.C. 8 18043(c)(1)) is amended by striking ‘‘2019’’ 9 and inserting ‘‘2018’’. 10 (3) EFFECTIVE DATE.—The amendments made 11 by this section shall apply beginning with fiscal year 12 2019. 13 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 14 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR 15 TERRITORIES.—Section 1905(b) of the Social Security 16 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 17 inserting ‘‘for fiscal years before fiscal year 2019’’ after 18 ‘‘American Samoa’’. 19 SEC. 405. EXTENSION OF MEDICARE SECONDARY PAYER. 20 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 21 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 22 ed— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 204 •S 3660 IS (1) in the last sentence, by inserting ‘‘, and be- 1 fore January 1, 2019’’ after ‘‘prior to such date)’’; 2 and 3 (2) by adding at the end the following new sen- 4 tence: ‘‘Effective for items and services furnished on 5 or after January 1, 2019 (with respect to periods 6 beginning on or after the date that is 42 months 7 prior to such date), clauses (i) and (ii) shall be ap- 8 plied by substituting ‘42-month’ for ‘12-month’ each 9 place it appears.’’. 10 (b) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect on the date of enactment of 12 this Act. For purposes of determining an individual’s sta- 13 tus under section 1862(b)(1)(C) of the Social Security Act 14 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 15 (a), an individual who is within the coordinating period 16 as of the date of enactment of this Act shall have that 17 period extended to the full 42 months described in the last 18 sentence of such section, as added by the amendment 19 made by subsection (a)(2). 20 SEC. 406. BORDER HEALTH GRANTS. 21 (a) DEFINITIONS.—In this section: 22 (1) BORDER AREA.—The term ‘‘border area’’ 23 means the United States-Mexico Border Area, as de- 24 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 205 •S 3660 IS fined in section 8 of the United States-Mexico Bor- 1 der Health Commission Act (22 U.S.C. 290n–6). 2 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 3 ty’’ means an entity that is located in the border 4 area and is any of the following: 5 (A) A State, local government, or Tribal 6 government. 7 (B) Public institution of higher education. 8 (C) Nonprofit health organization. 9 (D) Community health center. 10 (E) Community clinic that is a health cen- 11 ter receiving assistance under section 330 of the 12 Public Health Service Act (42 U.S.C. 254b). 13 (b) AUTHORIZATION.—From funds appropriated 14 under subsection (f), the Secretary of Health and Human 15 Services (in this section referred to as the ‘‘Secretary’’), 16 acting through the United States members of the United 17 States-Mexico Border Health Commission, shall award 18 grants to eligible entities to address priorities and rec- 19 ommendations to improve the health of border area resi- 20 dents that are established by— 21 (1) the United States members of the United 22 States-Mexico Border Health Commission; 23 (2) the State border health offices; and 24 (3) the Secretary. 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 206 •S 3660 IS (c) APPLICATION.—An eligible entity that desires a 1 grant under subsection (b) shall submit an application to 2 the Secretary at such time, in such manner, and con- 3 taining such information as the Secretary may require. 4 (d) USE OF FUNDS.—An eligible entity that receives 5 a grant under subsection (b) shall use the grant funds 6 for— 7 (1) programs relating to— 8 (A) maternal and child health; 9 (B) primary care and preventative health; 10 (C) public health and public health infra- 11 structure; 12 (D) musculoskeletal health and obesity; 13 (E) health education and promotion; 14 (F) oral health; 15 (G) mental and behavioral health; 16 (H) substance use disorders; 17 (I) health conditions that have a high prev- 18 alence in the border area; 19 (J) medical and health services research; 20 (K) workforce training and development; 21 (L) community health workers, patient 22 navigators, and promotoras; 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 207 •S 3660 IS (M) health care infrastructure problems in 1 the border area (including planning and con- 2 struction grants); 3 (N) health disparities in the border area; 4 (O) environmental health; and 5 (P) outreach and enrollment services with 6 respect to Federal programs (including pro- 7 grams authorized under titles XIX and XXI of 8 the Social Security Act (42 U.S.C. 1396 et seq.; 9 42 U.S.C. 1397aa et seq.)); and 10 (2) other programs determined appropriate by 11 the Secretary. 12 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 13 vided to an eligible entity awarded a grant under sub- 14 section (b) shall be used to supplement and not supplant 15 other funds available to the eligible entity to carry out the 16 activities described in subsection (d). 17 (f) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section, 19 $200,000,000 for fiscal year 2019, and such sums as may 20 be necessary for each succeeding fiscal year. 21 SEC. 407. REMOVING MEDICARE BARRIER TO HEALTH 22 CARE. 23 (a) PART A.—Section 1818(a)(3) of the Social Secu- 24 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 208 •S 3660 IS ‘‘an alien’’ and all that follows through ‘‘under this sec- 1 tion’’ and inserting ‘‘an individual who is lawfully present 2 in the United States’’. 3 (b) PART B.—Section 1836(2) of the Social Security 4 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 5 alien’’ and all that follows through ‘‘under this part’’ and 6 inserting ‘‘an individual who is lawfully present in the 7 United States’’. 8 SEC. 408. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 9 PROVIDED BY URBAN INDIAN HEALTH CEN- 10 TERS. 11 (a) IN GENERAL.—The third sentence of section 12 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 13 is amended by inserting ‘‘or are received through a pro- 14 gram operated by an urban Indian organization through 15 a grant or contract under title V of such Act’’ after ‘‘(as 16 defined in section 4 of the Indian Health Care Improve- 17 ment Act)’’. 18 (b) EFFECTIVE DATE.—The amendment made by 19 this section shall apply to medical assistance provided on 20 or after the date of enactment of this Act. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 209 •S 3660 IS SEC. 409. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 1 PROVIDED TO A NATIVE HAWAIIAN THROUGH 2 A FEDERALLY QUALIFIED HEALTH CENTER 3 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 4 TEM UNDER THE MEDICAID PROGRAM. 5 (a) IN GENERAL.—The third sentence of section 6 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 7 as amended by section 408(a), is amended by inserting 8 before the period the following: ‘‘, and with respect to 9 medical assistance provided to a Native Hawaiian (as de- 10 fined in section 12(2) of the Native Hawaiian Health Care 11 Improvement Act) through a federally qualified health 12 center or a Native Hawaiian health care system (as de- 13 fined in section 12(6) of such Act), whether directly, by 14 referral, or under contract or other arrangement between 15 such federally qualified health center or Native Hawaiian 16 health care system and another health care provider’’. 17 (b) EFFECTIVE DATE.—The amendment made by 18 this section shall apply to medical assistance provided on 19 or after the date of enactment of this Act. 20 Subtitle B—Expansion of Access 21 SEC. 410. PROTECTING SENSITIVE LOCATIONS. 22 Section 287 of the Immigration and Nationality Act 23 (8 U.S.C. 1357) is amended— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 210 •S 3660 IS (1) by striking ‘‘Service’’ each place such term 1 appears and inserting ‘‘Department of Homeland 2 Security’’; 3 (2) by striking ‘‘Attorney General’’ each place 4 such term appears and inserting ‘‘Secretary of 5 Homeland Security’’; 6 (3) in subsection (f)(1), by striking ‘‘Commis- 7 sioner’’ and inserting ‘‘Director of U.S. Citizenship 8 and Immigration Services’’; 9 (4) in subsection (h)— 10 (A) by striking ‘‘of the Immigration and 11 Nationality Act’’; and 12 (B) by striking ‘‘of such Act’’; and 13 (5) by adding at the end the following: 14 ‘‘(i)(1) In this subsection: 15 ‘‘(A) The term ‘appropriate committees of Con- 16 gress’ means— 17 ‘‘(i) the Committee on Homeland Security 18 and Governmental Affairs of the Senate; 19 ‘‘(ii) the Committee on the Judiciary of the 20 Senate; 21 ‘‘(iii) the Committee on Homeland Security 22 of the House of Representatives; and 23 ‘‘(iv) the Committee on the Judiciary of 24 the House of Representatives. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 211 •S 3660 IS ‘‘(B) The term ‘enforcement action’— 1 ‘‘(i) means an apprehension, arrest, inter- 2 view, request for identification, search, or sur- 3 veillance for the purposes of immigration en- 4 forcement; and 5 ‘‘(ii) includes an enforcement action at, or 6 focused on, a sensitive location that is part of 7 a joint case led by another law enforcement 8 agency. 9 ‘‘(C) The term ‘exigent circumstances’ means a 10 situation involving— 11 ‘‘(i) the imminent risk of death, violence, 12 or physical harm to any person or property, in- 13 cluding a situation implicating terrorism or the 14 national security of the United States; 15 ‘‘(ii) the immediate arrest or pursuit of a 16 dangerous felon, terrorist suspect, or other indi- 17 vidual presenting an imminent danger; or 18 ‘‘(iii) the imminent risk of destruction of 19 evidence that is material to an ongoing criminal 20 case. 21 ‘‘(D) The term ‘prior approval’ means— 22 ‘‘(i) in the case of officers and agents of 23 U.S. Immigration and Customs Enforcement, 24 prior written approval to carry out an enforce- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 212 •S 3660 IS ment action involving a specific individual or in- 1 dividuals authorized by— 2 ‘‘(I) the Assistant Director of Oper- 3 ations, Homeland Security Investigations; 4 ‘‘(II) the Executive Associate Direc- 5 tor, Homeland Security Investigations; 6 ‘‘(III) the Assistant Director for Field 7 Operations, Enforcement and Removal Op- 8 erations; or 9 ‘‘(IV) the Executive Associate Direc- 10 tor for Field Operations, Enforcement and 11 Removal Operations; 12 ‘‘(ii) in the case of officers and agents of 13 U.S. Customs and Border Protection, prior 14 written approval to carry out an enforcement 15 action involving a specific individual or individ- 16 uals authorized by— 17 ‘‘(I) a Chief Patrol Agent; 18 ‘‘(II) the Director of Field Operations; 19 ‘‘(III) the Director of Air and Marine 20 Operations; or 21 ‘‘(IV) the Internal Affairs Special 22 Agent in Charge; and 23 ‘‘(iii) in the case of other Federal, State, 24 or local law enforcement officers, to carry out 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 213 •S 3660 IS an enforcement action involving a specific indi- 1 vidual or individuals authorized by— 2 ‘‘(I) the head of the Federal agency 3 carrying out the enforcement action; or 4 ‘‘(II) the head of the State or local 5 law enforcement agency carrying out the 6 enforcement action. 7 ‘‘(E) The term ‘sensitive location’ includes all of 8 the physical space located within 1,000 feet of— 9 ‘‘(i) any medical treatment or health care 10 facility, including any hospital, doctor’s office, 11 accredited health clinic, alcohol or drug treat- 12 ment center, or emergent or urgent care facil- 13 ity; 14 ‘‘(ii) any public or private school, including 15 any known and licensed day care facility, pre- 16 school, other early learning program facility, 17 primary school, secondary school, postsecondary 18 school (including colleges and universities), or 19 other institution of learning (including voca- 20 tional or trade schools); 21 ‘‘(iii) any scholastic or education-related 22 activity or event, including field trips and inter- 23 scholastic events; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 214 •S 3660 IS ‘‘(iv) any school bus or school bus stop 1 during periods when school children are present 2 on the bus or at the stop; 3 ‘‘(v) any organization that— 4 ‘‘(I) assists children, pregnant women, 5 victims of crime or abuse, or individuals 6 with significant mental or physical disabil- 7 ities; or 8 ‘‘(II) provides disaster or emergency 9 social services and assistance; 10 ‘‘(vi) any church, synagogue, mosque, or 11 other place of worship, including buildings 12 rented for the purpose of religious services, re- 13 treats, counseling, workshops, instruction, and 14 education; 15 ‘‘(vii) any Federal, State, or local court- 16 house, including the office of an individual’s 17 legal counsel or representative, and a probation, 18 parole, or supervised release office; 19 ‘‘(viii) the site of a funeral, wedding, or 20 other religious ceremony or observance; 21 ‘‘(ix) any public demonstration, such as a 22 march, rally, or parade; 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 215 •S 3660 IS ‘‘(x) any domestic violence shelter, rape 1 crisis center, supervised visitation center, family 2 justice center, or victim services provider; or 3 ‘‘(xi) any other location specified by the 4 Secretary of Homeland Security for purposes of 5 this subsection. 6 ‘‘(2)(A) An enforcement action may not take place 7 at, or be focused on, a sensitive location unless— 8 ‘‘(i) the action involves exigent circumstances; 9 and 10 ‘‘(ii) prior approval for the enforcement action 11 was obtained from the appropriate official. 12 ‘‘(B) If an enforcement action is initiated pursuant 13 to subparagraph (A) and the exigent circumstances per- 14 mitting the enforcement action cease, the enforcement ac- 15 tion shall be discontinued until such exigent circumstances 16 reemerge. 17 ‘‘(C) If an enforcement action is carried out in viola- 18 tion of this subsection— 19 ‘‘(i) no information resulting from the enforce- 20 ment action may be entered into the record or re- 21 ceived into evidence in a removal proceeding result- 22 ing from the enforcement action; and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 216 •S 3660 IS ‘‘(ii) the alien who is the subject of such re- 1 moval proceeding may file a motion for the imme- 2 diate termination of the removal proceeding. 3 ‘‘(3)(A) This subsection shall apply to any enforce- 4 ment action by officers or agents of the Department of 5 Homeland Security, including— 6 ‘‘(i) officers or agents of U.S. Immigration and 7 Customs Enforcement; 8 ‘‘(ii) officers or agents of U.S. Customs and 9 Border Protection; and 10 ‘‘(iii) any individual designated to perform im- 11 migration enforcement functions pursuant to sub- 12 section (g). 13 ‘‘(B) While carrying out an enforcement action at a 14 sensitive location, officers and agents referred to in sub- 15 paragraph (A) shall make every effort— 16 ‘‘(i) to limit the time spent at the sensitive loca- 17 tion; 18 ‘‘(ii) to limit the enforcement action at the sen- 19 sitive location to the person or persons for whom 20 prior approval was obtained; and 21 ‘‘(iii) to conduct themselves discreetly. 22 ‘‘(C) If, while carrying out an enforcement action 23 that is not initiated at or focused on a sensitive location, 24 officers or agents are led to a sensitive location, and no 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 217 •S 3660 IS exigent circumstance and prior approval with respect to 1 the sensitive location exists, such officers or agents shall— 2 ‘‘(i) cease before taking any further enforce- 3 ment action; 4 ‘‘(ii) conduct themselves in a discreet manner; 5 ‘‘(iii) maintain surveillance; and 6 ‘‘(iv) immediately consult their supervisor in 7 order to determine whether such enforcement action 8 should be discontinued. 9 ‘‘(D) The limitations under this paragraph shall not 10 apply to the transportation of an individual apprehended 11 at or near a land or sea border to a hospital or health 12 care provider for the purpose of providing medical care 13 to such individual. 14 ‘‘(4)(A) Each official specified in subparagraph (B) 15 shall ensure that the employees under his or her super- 16 vision receive annual training on compliance with— 17 ‘‘(i) the requirements under this subsection in 18 enforcement actions at or focused on sensitive loca- 19 tions and enforcement actions that lead officers or 20 agents to a sensitive location; and 21 ‘‘(ii) the requirements under section 239 of this 22 Act and section 384 of the Illegal Immigration Re- 23 form and Immigrant Responsibility Act of 1996 (8 24 U.S.C. 1367). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 218 •S 3660 IS ‘‘(B) The officials specified in this subparagraph 1 are— 2 ‘‘(i) the Chief Counsel of U.S. Immigration and 3 Customs Enforcement; 4 ‘‘(ii) the Field Office Directors of U.S. Immi- 5 gration and Customs Enforcement; 6 ‘‘(iii) each Special Agent in Charge of U.S. Im- 7 migration and Customs Enforcement; 8 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 9 and Border Protection; 10 ‘‘(v) the Director of Field Operations of U.S. 11 Customs and Border Protection; 12 ‘‘(vi) the Director of Air and Marine Operations 13 of U.S. Customs and Border Protection; 14 ‘‘(vii) the Internal Affairs Special Agent in 15 Charge of U.S. Customs and Border Protection; and 16 ‘‘(viii) the chief law enforcement officer of each 17 State or local law enforcement agency that enters 18 into a written agreement with the Department of 19 Homeland Security pursuant to subsection (g). 20 ‘‘(5) The Secretary of Homeland Security shall mod- 21 ify the Notice to Appear form (I–862)— 22 ‘‘(A) to provide the subjects of an enforcement 23 action with information, written in plain language, 24 summarizing the restrictions against enforcement 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 219 •S 3660 IS actions at sensitive locations set forth in this sub- 1 section and the remedies available to the alien if 2 such action violates such restrictions; 3 ‘‘(B) so that the information described in sub- 4 paragraph (A) is accessible to individuals with lim- 5 ited-English proficiency; and 6 ‘‘(C) so that subjects of an enforcement action 7 are not permitted to verify that the officers or 8 agents that carried out such action complied with 9 the restrictions set forth in this subsection. 10 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 11 toms Enforcement and the Commissioner of U.S. Customs 12 and Border Protection shall each submit an annual report 13 to the appropriate committees of Congress that includes 14 the information set forth in subparagraph (B) with respect 15 to the respective agency. 16 ‘‘(B) Each report submitted under subparagraph (A) 17 shall include, with respect to the submitting agency during 18 the reporting period— 19 ‘‘(i) the number of enforcement actions that 20 were carried out at, or focused on, a sensitive loca- 21 tion; 22 ‘‘(ii) the number of enforcement actions in 23 which officers or agents were subsequently led to a 24 sensitive location; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 220 •S 3660 IS ‘‘(iii) for each enforcement action described in 1 clause (i) or (ii)— 2 ‘‘(I) the date on which it occurred; 3 ‘‘(II) the specific site, city, county, and 4 State in which it occurred; 5 ‘‘(III) the components of the agency in- 6 volved in the enforcement action; 7 ‘‘(IV) a description of the enforcement ac- 8 tion, including the nature of the criminal activ- 9 ity of its intended target; 10 ‘‘(V) the number of individuals, if any, ar- 11 rested or taken into custody; 12 ‘‘(VI) the number of collateral arrests, if 13 any, and the reasons for each such arrest; 14 ‘‘(VII) a certification whether the location 15 administrator was contacted before, during, or 16 after the enforcement action; and 17 ‘‘(VIII) the percentage of all of the staff 18 members and supervisors reporting to the offi- 19 cials listed in paragraph (4)(B) who completed 20 the training required under paragraph (4)(A). 21 ‘‘(7) Nothing in the subsection may be construed— 22 ‘‘(A) to affect the authority of Federal, State, 23 or local law enforcement agencies— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 221 •S 3660 IS ‘‘(i) to enforce generally applicable Federal 1 or State criminal laws unrelated to immigra- 2 tion; or 3 ‘‘(ii) to protect residents from imminent 4 threats to public safety; or 5 ‘‘(B) to limit or override the protections pro- 6 vided in— 7 ‘‘(i) section 239; or 8 ‘‘(ii) section 384 of the Illegal Immigration 9 Reform and Immigrant Responsibility Act of 10 1996 (8 U.S.C. 1367).’’. 11 SEC. 411. GRANTS FOR RACIAL AND ETHNIC APPROACHES 12 TO COMMUNITY HEALTH. 13 (a) PURPOSE.—It is the purpose of this section to 14 award grants to assist communities in mobilizing and or- 15 ganizing resources in support of effective and sustainable 16 programs that will reduce or eliminate disparities in health 17 and health care experienced by racial and ethnic minority 18 individuals. 19 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 20 of Health and Human Services, acting through the Ad- 21 ministrator of the Health Resources and Services Admin- 22 istration (referred to in this section as the ‘‘Secretary’’), 23 shall award grants to eligible entities to assist in design- 24 ing, implementing, and evaluating culturally and linguis- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 222 •S 3660 IS tically appropriate, science-based, and community-driven 1 sustainable strategies to eliminate racial and ethnic health 2 and health care disparities. 3 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 4 grant under this section, an entity shall— 5 (1) represent a coalition— 6 (A) whose principal purpose is to develop 7 and implement interventions to reduce or elimi- 8 nate a health or health care disparity in a tar- 9 geted racial or ethnic minority group in the 10 community served by the coalition; and 11 (B) that includes— 12 (i) members selected from among— 13 (I) public health departments; 14 (II) community-based organiza- 15 tions; 16 (III) university and research or- 17 ganizations; 18 (IV) Indian tribes or tribal orga- 19 nizations (as such terms are defined 20 in section 4 of the Indian Self-Deter- 21 mination and Education Assistance 22 Act (25 U.S.C. 5304)), the Indian 23 Health Service, or any other organiza- 24 tion that serves Alaska Natives; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 223 •S 3660 IS (V) interested public or private 1 health care providers or organizations 2 as determined appropriate by the Sec- 3 retary; and 4 (ii) at least 1 member from a commu- 5 nity-based organization that represents the 6 targeted racial or ethnic minority group; 7 and 8 (2) submit to the Secretary an application at 9 such time, in such manner, and containing such in- 10 formation as the Secretary may require, which shall 11 include— 12 (A) a description of the targeted racial or 13 ethnic populations in the community to be 14 served under the grant; 15 (B) a description of at least 1 health dis- 16 parity that exists in the racial or ethnic tar- 17 geted populations, including health issues such 18 as infant mortality, breast and cervical cancer 19 screening and management, musculoskeletal 20 diseases and obesity, prostate cancer screening 21 and management, cardiovascular disease, diabe- 22 tes, child and adult immunization levels, oral 23 disease, or other health priority areas as des- 24 ignated by the Secretary; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 224 •S 3660 IS (C) a demonstration of a proven record of 1 accomplishment of the coalition members in 2 serving and working with the targeted commu- 3 nity. 4 (d) SUSTAINABILITY.—The Secretary shall give pri- 5 ority to an eligible entity under this section if the entity 6 agrees that, with respect to the costs to be incurred by 7 the entity in carrying out the activities for which the grant 8 was awarded, the entity (and each of the participating 9 partners in the coalition represented by the entity) will 10 maintain its expenditures of non-Federal funds for such 11 activities at a level that is not less than the level of such 12 expenditures during the fiscal year immediately preceding 13 the first fiscal year for which the grant is awarded. 14 (e) NONDUPLICATION.—Any funds provided to an eli- 15 gible entity through a grant under this section shall— 16 (1) supplement, not supplant, any other Federal 17 funds made available to the entity for the purposes 18 of this section; and 19 (2) not be used to duplicate the activities of any 20 other health disparity grant program under this Act, 21 including an amendment made by this Act. 22 (f) TECHNICAL ASSISTANCE.—The Secretary may, 23 either directly or by grant or contract, provide any entity 24 that receives a grant under this section with technical and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 225 •S 3660 IS other nonfinancial assistance necessary to meet the re- 1 quirements of this section. 2 (g) DISSEMINATION.—The Secretary shall encourage 3 and enable eligible entities receiving grants under this sec- 4 tion to share best practices, evaluation results, and reports 5 with communities not affiliated with such entities, by 6 using the Internet, conferences, and other pertinent infor- 7 mation regarding the projects funded by this section, in- 8 cluding through using outreach efforts of the Office of Mi- 9 nority Health and the Centers for Disease Control and 10 Prevention. 11 (h) ADMINISTRATIVE BURDENS.—The Secretary 12 shall make every effort to minimize duplicative or unneces- 13 sary administrative burdens on eligible entities receiving 14 grants under this section. 15 (i) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated such sums as may be 17 necessary to carry out this section. 18 SEC. 412. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 19 (a) ELIMINATION OF ISOLATION TEST FOR COST- 20 BASED AMBULANCE REIMBURSEMENT.— 21 (1) IN GENERAL.—Section 1834(l)(8) of the 22 Social Security Act (42 U.S.C. 1395m(l)(8)) is 23 amended— 24 (A) in subparagraph (B)— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 226 •S 3660 IS (i) by striking ‘‘owned and’’; and 1 (ii) by inserting ‘‘(including when 2 such services are provided by the entity 3 under an arrangement with the hospital)’’ 4 after ‘‘hospital’’; and 5 (B) by striking the comma at the end of 6 subparagraph (B) and all that follows and in- 7 serting a period. 8 (2) EFFECTIVE DATE.—The amendments made 9 by this subsection shall apply to services furnished 10 on or after January 1, 2019. 11 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 12 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 13 REQUIREMENT.— 14 (1) IN GENERAL.—Section 1820(c)(2) of the 15 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 16 amended— 17 (A) in subparagraph (B)(iii), by striking 18 ‘‘provides not more than’’ and inserting ‘‘sub- 19 ject to subparagraph (F), provides not more 20 than’’; and 21 (B) by adding at the end the following new 22 subparagraph: 23 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 24 LIMIT REQUIREMENT.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 227 •S 3660 IS ‘‘(i) IN GENERAL.—A State may elect 1 to treat a facility, with respect to the des- 2 ignation of the facility for a cost-reporting 3 period, as satisfying the requirement of 4 subparagraph (B)(iii) relating to a max- 5 imum number of acute care inpatient beds 6 if the facility elects, in accordance with a 7 method specified by the Secretary and be- 8 fore the beginning of the cost reporting pe- 9 riod, to meet the requirement under clause 10 (ii). 11 ‘‘(ii) ALTERNATE REQUIREMENT.— 12 The requirement under this clause, with 13 respect to a facility and a cost-reporting 14 period, is that the total number of inpa- 15 tient bed days described in subparagraph 16 (B)(iii) during such period will not exceed 17 7,300. For purposes of this subparagraph, 18 an individual who is an inpatient in a bed 19 in the facility for a single day shall be 20 counted as one inpatient bed day. 21 ‘‘(iii) WITHDRAWAL OF ELECTION.— 22 The option described in clause (i) shall not 23 apply to a facility for a cost-reporting pe- 24 riod if the facility (for any two consecutive 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 228 •S 3660 IS cost-reporting periods during the previous 1 5 cost-reporting periods) was treated under 2 such option and had a total number of in- 3 patient bed days for each of such two cost- 4 reporting periods that exceeded the num- 5 ber specified in such clause.’’. 6 (2) EFFECTIVE DATE.—The amendments made 7 by paragraph (1) shall apply to cost-reporting peri- 8 ods beginning on or after the date of the enactment 9 of this Act. 10 SEC. 413. ESTABLISHMENT OF RURAL COMMUNITY HOS- 11 PITAL (RCH) PROGRAM. 12 (a) IN GENERAL.—Section 1861 of the Social Secu- 13 rity Act (42 U.S.C. 1395x), as amended by section 14 205(b)(1), is amended by adding at the end of the fol- 15 lowing new subsection: 16 ‘‘Rural Community Hospital; Rural Community Hospital 17 Services 18 ‘‘(kkk)(1) The term ‘rural community hospital’ 19 means a hospital (as defined in subsection (e)) that— 20 ‘‘(A) is located in a rural area (as defined in 21 section 1886(d)(2)(D)) or treated as being so lo- 22 cated pursuant to section 1886(d)(8)(E); 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 229 •S 3660 IS ‘‘(B) subject to paragraph (2), has less than 51 1 acute care inpatient beds, as reported in its most re- 2 cent cost report; 3 ‘‘(C) makes available 24-hour emergency care 4 services; 5 ‘‘(D) subject to paragraph (3), has a provider 6 agreement in effect with the Secretary and is open 7 to the public as of January 1, 2010; and 8 ‘‘(E) applies to the Secretary for such designa- 9 tion. 10 ‘‘(2) For purposes of paragraph (1)(B), beds in a 11 psychiatric or rehabilitation unit of the hospital which is 12 a distinct part of the hospital shall not be counted. 13 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 14 hibit any of the following from qualifying as a rural com- 15 munity hospital: 16 ‘‘(A) A replacement facility (as defined by the 17 Secretary in regulations in effect on January 1, 18 2012) with the same service area (as defined by the 19 Secretary in regulations in effect on such date). 20 ‘‘(B) A facility obtaining a new provider num- 21 ber pursuant to a change of ownership. 22 ‘‘(C) A facility which has a binding written 23 agreement with an outside, unrelated party for the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 230 •S 3660 IS construction, reconstruction, lease, rental, or financ- 1 ing of a building as of January 1, 2012. 2 ‘‘(4) Nothing in this subsection shall be construed as 3 prohibiting a critical access hospital from qualifying as a 4 rural community hospital if the critical access hospital 5 meets the conditions otherwise applicable to hospitals 6 under subsection (e) and section 1866. 7 ‘‘(5) Nothing in this subsection shall be construed as 8 prohibiting a rural community hospital participating in 9 the demonstration program under section 410A of the 10 Medicare Prescription Drug, Improvement, and Mod- 11 ernization Act of 2003 (Public Law 108–173; 117 Stat. 12 2313) from qualifying as a rural community hospital if 13 the rural community hospital meets the conditions other- 14 wise applicable to hospitals under subsection (e) and sec- 15 tion 1866.’’. 16 (b) PAYMENT.— 17 (1) INPATIENT HOSPITAL SERVICES.—Section 18 1814 of the Social Security Act (42 U.S.C. 1395f) 19 is amended by adding at the end the following new 20 subsection: 21 ‘‘Payment for Inpatient Services Furnished in Rural 22 Community Hospitals 23 ‘‘(m) The amount of payment under this part for in- 24 patient hospital services furnished in a rural community 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 231 •S 3660 IS hospital, other than such services furnished in a psy- 1 chiatric or rehabilitation unit of the hospital which is a 2 distinct part, is, at the election of the hospital in the appli- 3 cation referred to in section 1861(kkk)(1)(E)— 4 ‘‘(1) 101 percent of the reasonable costs of pro- 5 viding such services, without regard to the amount 6 of the customary or other charge, or 7 ‘‘(2) the amount of payment provided for under 8 the prospective payment system for inpatient hos- 9 pital services under section 1886(d).’’. 10 (2) OUTPATIENT SERVICES.—Section 1834 of 11 such Act (42 U.S.C. 1395m) is amended by adding 12 at the end the following new subsection: 13 ‘‘(w) PAYMENT FOR OUTPATIENT SERVICES FUR- 14 NISHED IN RURAL COMMUNITY HOSPITALS.—The 15 amount of payment under this part for outpatient services 16 furnished in a rural community hospital is, at the election 17 of the hospital in the application referred to in section 18 1861(kkk)(1)(E)— 19 ‘‘(1) 101 percent of the reasonable costs of pro- 20 viding such services, without regard to the amount 21 of the customary or other charge and any limitation 22 under section 1861(v)(1)(U), or 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 232 •S 3660 IS ‘‘(2) the amount of payment provided for under 1 the prospective payment system for covered OPD 2 services under section 1833(t).’’. 3 (3) EXEMPTION FROM 30-PERCENT REDUCTION 4 IN REIMBURSEMENT FOR BAD DEBT.—Section 5 1861(v)(1)(T) of such Act (42 U.S.C. 6 1395x(v)(1)(T)) is amended by inserting ‘‘(other 7 than for a rural community hospital)’’ after ‘‘In de- 8 termining such reasonable costs for hospitals’’. 9 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 10 SERVICES.—Section 1834(w) of such Act (as added by 11 subsection (b)(2)) is amended— 12 (1) by redesignating paragraphs (1) and (2) as 13 subparagraphs (A) and (B), respectively; 14 (2) by inserting ‘‘(1)’’ after ‘‘(w)’’; and 15 (3) by adding at the end the following: 16 ‘‘(2) The amounts of beneficiary cost-sharing for out- 17 patient services furnished in a rural community hospital 18 under this part shall be as follows: 19 ‘‘(A) For items and services that would have 20 been paid under section 1833(t) if furnished by a 21 hospital, the amount of cost-sharing determined 22 under paragraph (8) of such section. 23 ‘‘(B) For items and services that would have 24 been paid under section 1833(h) if furnished by a 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 233 •S 3660 IS provider of services or supplier, no cost-sharing shall 1 apply. 2 ‘‘(C) For all other items and services, the 3 amount of cost-sharing that would apply to the item 4 or service under the methodology that would be used 5 to determine payment for such item or service if pro- 6 vided by a physician, provider of services, or sup- 7 plier, as the case may be.’’. 8 (d) CONFORMING AMENDMENTS.— 9 (1) PART A PAYMENT.—Section 1814(b) of 10 such Act (42 U.S.C. 1395f(b)) is amended in the 11 matter preceding paragraph (1) by inserting ‘‘other 12 than inpatient hospital services furnished by a rural 13 community hospital,’’ after ‘‘critical access hospital 14 services,’’. 15 (2) PART B PAYMENT.—Section 1833(a) of 16 such Act (42 U.S.C. 1395l(a)), as amended by sec- 17 tion 205(b)(3), is amended— 18 (A) in paragraph (2), in the matter before 19 subparagraph (A), by striking ‘‘and (I)’’ and in- 20 serting ‘‘(I), and (K)’’; 21 (B) by striking ‘‘and’’ at the end of para- 22 graph (9); 23 (C) by striking the period at the end of 24 paragraph (10) and inserting ‘‘; and’’; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 234 •S 3660 IS (D) by adding at the end the following: 1 ‘‘(11) in the case of outpatient services fur- 2 nished by a rural community hospital, the amounts 3 described in section 1834(w).’’. 4 (3) TECHNICAL AMENDMENTS.— 5 (A) CONSULTATION WITH STATE AGEN- 6 CIES.—Section 1863 of such Act (42 U.S.C. 7 1395z) is amended by striking ‘‘and (dd)(2)’’ 8 and inserting ‘‘(dd)(2), and (kkk)(1)’’. 9 (B) PROVIDER AGREEMENTS.—Section 10 1866(a)(2)(A) of such Act (42 U.S.C. 11 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 12 tion 1834(w)(2),’’ after ‘‘section 1833(b),’’. 13 (e) EFFECTIVE DATE.—The amendments made by 14 this section shall apply to items and services furnished on 15 or after October 1, 2019. 16 SEC. 414. MEDICARE REMOTE MONITORING PILOT 17 PROJECTS. 18 (a) PILOT PROJECTS.— 19 (1) IN GENERAL.—Not later than 9 months 20 after the date of enactment of this Act, the Sec- 21 retary of Health and Human Services (in this sec- 22 tion referred to as the ‘‘Secretary’’) shall conduct 23 pilot projects under title XVIII of the Social Secu- 24 rity Act for the purpose of providing incentives to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 235 •S 3660 IS home health agencies to utilize home monitoring and 1 communications technologies that— 2 (A) enhance health outcomes for Medicare 3 beneficiaries; and 4 (B) reduce expenditures under such title. 5 (2) SITE REQUIREMENTS.— 6 (A) URBAN AND RURAL.—The Secretary 7 shall conduct the pilot projects under this sec- 8 tion in both urban and rural areas. 9 (B) SITE IN A SMALL STATE.—The Sec- 10 retary shall conduct at least 3 of the pilot 11 projects in a State with a population of less 12 than 1,000,000. 13 (3) DEFINITION OF HOME HEALTH AGENCY.— 14 In this section, the term ‘‘home health agency’’ has 15 the meaning given that term in section 1861(o) of 16 the Social Security Act (42 U.S.C. 1395x(o)). 17 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 18 OF PROJECTS.—The Secretary shall specify the criteria 19 for identifying those Medicare beneficiaries who shall be 20 considered within the scope of the pilot projects under this 21 section for purposes of the application of subsection (c) 22 and for the assessment of the effectiveness of the home 23 health agency in achieving the objectives of this section. 24 Such criteria may provide for the inclusion in the projects 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 236 •S 3660 IS of Medicare beneficiaries who begin receiving home health 1 services under title XVIII of the Social Security Act after 2 the date of the implementation of the projects. 3 (c) INCENTIVES.— 4 (1) PERFORMANCE TARGETS.—The Secretary 5 shall establish for each home health agency partici- 6 pating in a pilot project under this section a per- 7 formance target using one of the following meth- 8 odologies, as determined appropriate by the Sec- 9 retary: 10 (A) ADJUSTED HISTORICAL PERFORMANCE 11 TARGET.—The Secretary shall establish for the 12 agency— 13 (i) a base expenditure amount equal 14 to the average total payments made to the 15 agency under parts A and B of title XVIII 16 of the Social Security Act for Medicare 17 beneficiaries determined to be within the 18 scope of the pilot project in a base period 19 determined by the Secretary; and 20 (ii) an annual per capita expenditure 21 target for such beneficiaries, reflecting the 22 base expenditure amount adjusted for risk 23 and adjusted growth rates. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 237 •S 3660 IS (B) COMPARATIVE PERFORMANCE TAR- 1 GET.—The Secretary shall establish for the 2 agency a comparative performance target equal 3 to the average total payments under such parts 4 A and B during the pilot project for comparable 5 individuals in the same geographic area that 6 are not determined to be within the scope of the 7 pilot project. 8 (2) INCENTIVE.—Subject to paragraph (3), the 9 Secretary shall pay to each participating home care 10 agency an incentive payment for each year under the 11 pilot project equal to a portion of the Medicare sav- 12 ings realized for such year relative to the perform- 13 ance target under paragraph (1). 14 (3) LIMITATION ON EXPENDITURES.—The Sec- 15 retary shall limit incentive payments under this sec- 16 tion in order to ensure that the aggregate expendi- 17 tures under title XVIII of the Social Security Act 18 (including incentive payments under this subsection) 19 do not exceed the amount that the Secretary esti- 20 mates would have been expended if the pilot projects 21 under this section had not been implemented. 22 (d) WAIVER AUTHORITY.—The Secretary may waive 23 such provisions of titles XI and XVIII of the Social Secu- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 238 •S 3660 IS rity Act as the Secretary determines to be appropriate for 1 the conduct of the pilot projects under this section. 2 (e) REPORT TO CONGRESS.—Not later than 5 years 3 after the date that the first pilot project under this section 4 is implemented, the Secretary shall submit to Congress a 5 report on the pilot projects. Such report shall contain a 6 detailed description of issues related to the expansion of 7 the projects under subsection (f) and recommendations for 8 such legislation and administrative actions as the Sec- 9 retary considers appropriate. 10 (f) EXPANSION.—If the Secretary determines that 11 any of the pilot projects under this section enhance health 12 outcomes for Medicare beneficiaries and reduce expendi- 13 tures under title XVIII of the Social Security Act, the Sec- 14 retary may initiate comparable projects in additional 15 areas. 16 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 17 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 18 tive payment under this section— 19 (1) shall be in addition to the payments that a 20 home health agency would otherwise receive under 21 title XVIII of the Social Security Act for the provi- 22 sion of home health services; and 23 (2) shall have no effect on the amount of such 24 payments. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 239 •S 3660 IS SEC. 415. RURAL HEALTH QUALITY ADVISORY COMMISSION 1 AND DEMONSTRATION PROJECTS. 2 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 3 SION.— 4 (1) ESTABLISHMENT.—Not later than 6 5 months after the date of the enactment of this sec- 6 tion, the Secretary of Health and Human Services 7 (in this section referred to as the ‘‘Secretary’’) shall 8 establish a commission to be known as the Rural 9 Health Quality Advisory Commission (in this section 10 referred to as the ‘‘Commission’’). 11 (2) DUTIES OF COMMISSION.— 12 (A) NATIONAL PLAN.—The Commission 13 shall develop, coordinate, and facilitate imple- 14 mentation of a national plan for rural health 15 quality improvement. The national plan shall— 16 (i) identify objectives for rural health 17 quality improvement; 18 (ii) identify strategies to eliminate 19 known gaps in rural health system capacity 20 and improve rural health quality; and 21 (iii) provide recommendations for 22 Federal programs to identify opportunities 23 for strengthening and aligning policies and 24 programs to improve rural health quality. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 240 •S 3660 IS (B) DEMONSTRATION PROJECTS.—The 1 Commission shall design demonstration projects 2 to recommend to the Secretary to test alter- 3 native models for rural health quality improve- 4 ment, including with respect to both personal 5 and population health. 6 (C) MONITORING.—The Commission shall 7 monitor progress toward the objectives identi- 8 fied pursuant to paragraph (1)(A). 9 (3) MEMBERSHIP.— 10 (A) NUMBER.—The Commission shall be 11 composed of 11 members appointed by the Sec- 12 retary. 13 (B) SELECTION.—The Secretary shall se- 14 lect the members of the Commission from 15 among individuals with significant rural health 16 care and health care quality expertise, including 17 expertise in clinical health care, health care 18 quality research, population or public health, or 19 purchaser organizations. 20 (4) CONTRACTING AUTHORITY.—Subject to the 21 availability of funds, the Commission may enter into 22 contracts and make other arrangements, as may be 23 necessary to carry out the duties described in para- 24 graph (2). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 241 •S 3660 IS (5) STAFF.—Upon the request of the Commis- 1 sion, the Secretary may detail, on a reimbursable 2 basis, any of the personnel of the Office of Rural 3 Health Policy of the Health Resources and Services 4 Administration, the Agency for Healthcare Quality 5 and Research, or the Centers for Medicare & Med- 6 icaid Services to the Commission to assist in car- 7 rying out this subsection. 8 (6) REPORTS TO CONGRESS.—Not later than 1 9 year after the establishment of the Commission, and 10 annually thereafter, the Commission shall submit a 11 report to the Congress on rural health quality. Each 12 such report shall include the following: 13 (A) An inventory of relevant programs and 14 recommendations for improved coordination and 15 integration of policy and programs. 16 (B) An assessment of achievement of the 17 objectives identified in the national plan devel- 18 oped under paragraph (2) and recommenda- 19 tions for realizing such objectives. 20 (C) Recommendations on Federal legisla- 21 tion, regulations, or administrative policies to 22 enhance rural health quality and outcomes. 23 (b) RURAL HEALTH QUALITY DEMONSTRATION 24 PROJECTS.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 242 •S 3660 IS (1) IN GENERAL.—Not later than 270 days 1 after the date of the enactment of this section, the 2 Secretary, in consultation with the Rural Health 3 Quality Advisory Commission, the Office of Rural 4 Health Policy of the Health Resources and Services 5 Administration, the Agency for Healthcare Research 6 and Quality, and the Centers for Medicare & Med- 7 icaid Services, shall make grants to eligible entities 8 for a total of 5 demonstration projects to implement 9 and evaluate methods for improving the quality of 10 health care in rural communities. Each such dem- 11 onstration project shall include— 12 (A) alternative community models that— 13 (i) will achieve greater integration of 14 personal and population health services; 15 and 16 (ii) address safety, effectiveness, 17 patient- or community-centeredness, timeli- 18 ness, efficiency, and equity (the 6 aims 19 identified by the Institute of Medicine of 20 the National Academy of Sciences in its re- 21 port entitled ‘‘Crossing the Quality Chasm: 22 A New Health System for the 21st Cen- 23 tury’’ released on March 1, 2001); 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 243 •S 3660 IS (B) innovative approaches to the financing 1 and delivery of health services to achieve rural 2 health quality goals; and 3 (C) development of quality improvement 4 support structures to assist rural health sys- 5 tems and professionals (such as workforce sup- 6 port structures, quality monitoring and report- 7 ing, clinical care protocols, and information 8 technology applications). 9 (2) ELIGIBLE ENTITIES.—In this subsection, 10 the term ‘‘eligible entity’’ means a consortium 11 that— 12 (A) shall include— 13 (i) at least one health care provider or 14 health care delivery system located in a 15 rural area; and 16 (ii) at least one organization rep- 17 resenting multiple community stakeholders; 18 and 19 (B) may include other partners such as 20 rural research centers. 21 (3) CONSULTATION.—In developing the pro- 22 gram for awarding grants under this subsection, the 23 Secretary shall consult with the Administrator of the 24 Agency for Healthcare Research and Quality, rural 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 244 •S 3660 IS health care providers, rural health care researchers, 1 and private and nonprofit groups (including national 2 associations) which are undertaking similar efforts. 3 (4) EXPEDITED WAIVERS.—The Secretary shall 4 expedite the processing of any waiver that— 5 (A) is authorized under title XVIII or XIX 6 of the Social Security Act (42 U.S.C. 1395 et 7 seq.); and 8 (B) is necessary to carry out a demonstra- 9 tion project under this subsection. 10 (5) DEMONSTRATION PROJECT SITES.—The 11 Secretary shall ensure that the 5 demonstration 12 projects funded under this subsection are conducted 13 at a variety of sites representing the diversity of 14 rural communities in the United States. 15 (6) DURATION.—Each demonstration project 16 under this subsection shall be for a period of 4 17 years. 18 (7) INDEPENDENT EVALUATION.—The Sec- 19 retary shall enter into an arrangement with an enti- 20 ty that has experience working directly with rural 21 health systems for the conduct of an independent 22 evaluation of the program carried out under this 23 subsection. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 245 •S 3660 IS (8) REPORT.—Not later than 1 year after the 1 conclusion of all of the demonstration projects fund- 2 ed under this subsection, the Secretary shall submit 3 a report to the Congress on the results of such 4 projects. The report shall include— 5 (A) an evaluation of patient access to care, 6 patient outcomes, and an analysis of the cost 7 effectiveness of each such project; and 8 (B) recommendations on Federal legisla- 9 tion, regulations, or administrative policies to 10 enhance rural health quality and outcomes. 11 (c) APPROPRIATION.— 12 (1) IN GENERAL.—Out of funds in the Treas- 13 ury not otherwise appropriated, there are appro- 14 priated to the Secretary to carry out this section 15 $30,000,000 for the period of fiscal years 2019 16 through 2023. 17 (2) AVAILABILITY.— 18 (A) IN GENERAL.—Funds appropriated 19 under paragraph (1) shall remain available for 20 expenditure through fiscal year 2023. 21 (B) REPORT.—For purposes of carrying 22 out subsection (b)(8), funds appropriated under 23 paragraph (1) shall remain available for ex- 24 penditure through fiscal year 2024. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 246 •S 3660 IS (3) RESERVATION.—Of the amount appro- 1 priated under paragraph (1), the Secretary shall re- 2 serve— 3 (A) $5,000,000 to carry out subsection (a); 4 and 5 (B) $25,000,000 to carry out subsection 6 (b), of which— 7 (i) 2 percent shall be for the provision 8 of technical assistance to grant recipients; 9 and 10 (ii) 5 percent shall be for independent 11 evaluation under subsection (b)(7). 12 SEC. 416. RURAL HEALTH CARE SERVICES. 13 Section 330A of the Public Health Service Act (42 14 U.S.C. 254c) is amended to read as follows: 15 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 16 RURAL HEALTH NETWORK DEVELOPMENT, 17 DELTA RURAL DISPARITIES AND HEALTH 18 SYSTEMS DEVELOPMENT, AND SMALL RURAL 19 HEALTH CARE PROVIDER QUALITY IMPROVE- 20 MENT GRANT PROGRAMS. 21 ‘‘(a) PURPOSE.—The purpose of this section is to 22 provide for grants— 23 ‘‘(1) under subsection (b), to promote rural 24 health care services outreach; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 247 •S 3660 IS ‘‘(2) under subsection (c), to provide for the 1 planning and implementation of integrated health 2 care networks in rural areas; 3 ‘‘(3) under subsection (d), to assist rural com- 4 munities in the Delta Region to reduce health dis- 5 parities and to promote and enhance health system 6 development; and 7 ‘‘(4) under subsection (e), to provide for the 8 planning and implementation of small rural health 9 care provider quality improvement activities. 10 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 11 GRANTS.— 12 ‘‘(1) GRANTS.—The Director of the Office of 13 Rural Health Policy of the Health Resources and 14 Services Administration (referred to in this section 15 as the ‘Director’) may award grants to eligible enti- 16 ties to promote rural health care services outreach 17 by expanding the delivery of health care services to 18 include new and enhanced services in rural areas. 19 The Director may award the grants for periods of 20 not more than 3 years. 21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 22 grant under this subsection for a project, an enti- 23 ty— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 248 •S 3660 IS ‘‘(A) shall be a rural public or rural non- 1 profit private entity, a facility that qualifies as 2 a rural health clinic under title XVIII of the 3 Social Security Act, a public or nonprofit entity 4 existing exclusively to provide services to mi- 5 grant and seasonal farm workers in rural areas, 6 or a Tribal government whose grant-funded ac- 7 tivities will be conducted within federally recog- 8 nized Tribal areas; 9 ‘‘(B) shall represent a consortium com- 10 posed of members— 11 ‘‘(i) that include 3 or more independ- 12 ently owned health care entities; and 13 ‘‘(ii) that may be nonprofit or for- 14 profit entities; and 15 ‘‘(C) shall not previously have received a 16 grant under this subsection for the same or a 17 similar project, unless the entity is proposing to 18 expand the scope of the project or the area that 19 will be served through the project. 20 ‘‘(3) APPLICATIONS.—To be eligible to receive a 21 grant under this subsection, an eligible entity shall 22 prepare and submit to the Director an application at 23 such time, in such manner, and containing such in- 24 formation as the Director may require, including— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 249 •S 3660 IS ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) a description of the manner in which 4 the project funded under the grant will meet 5 the health care needs of rural populations in 6 the local community or region to be served; 7 ‘‘(C) a plan for quantifying how health 8 care needs will be met through identification of 9 the target population and benchmarks of service 10 delivery or health status, such as— 11 ‘‘(i) quantifiable measurements of 12 health status improvement for projects fo- 13 cusing on health promotion; or 14 ‘‘(ii) benchmarks of increased access 15 to primary care, including tracking factors 16 such as the number and type of primary 17 care visits, identification of a medical 18 home, or other general measures of such 19 access; 20 ‘‘(D) a description of how the local com- 21 munity or region to be served will be involved 22 in the development and ongoing operations of 23 the project; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 250 •S 3660 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 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT 10 GRANTS.— 11 ‘‘(1) GRANTS.— 12 ‘‘(A) IN GENERAL.—The Director may 13 award rural health network development grants 14 to eligible entities to promote, through planning 15 and implementation, the development of inte- 16 grated health care networks that have combined 17 the functions of the entities participating in the 18 networks in order to— 19 ‘‘(i) achieve efficiencies and economies 20 of scale; 21 ‘‘(ii) expand access to, coordinate, and 22 improve the quality of the health care de- 23 livery system through development of orga- 24 nizational efficiencies; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 251 •S 3660 IS ‘‘(iii) implement health information 1 technology to achieve efficiencies, reduce 2 medical errors, and improve quality; 3 ‘‘(iv) coordinate care and manage 4 chronic illness; and 5 ‘‘(v) strengthen the rural health care 6 system as a whole in such a manner as to 7 show a quantifiable return on investment 8 to the participants in the network. 9 ‘‘(B) GRANT PERIODS.—The Director may 10 award such a rural health network development 11 grant— 12 ‘‘(i) for a period of 3 years for imple- 13 mentation activities; or 14 ‘‘(ii) for a period of 1 year for plan- 15 ning activities to assist in the initial devel- 16 opment of an integrated health care net- 17 work, if the proposed participants in the 18 network do not have a history of collabo- 19 rative efforts and a 3-year grant would be 20 inappropriate. 21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 22 grant under this subsection, an entity— 23 ‘‘(A) shall be a rural public or rural non- 24 profit private entity, a facility that qualifies as 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 252 •S 3660 IS a rural health clinic under title XVIII of the 1 Social Security Act, a public or nonprofit entity 2 existing exclusively to provide services to mi- 3 grant and seasonal farm workers in rural areas, 4 or a Tribal government whose grant-funded ac- 5 tivities will be conducted within federally recog- 6 nized Tribal areas; 7 ‘‘(B) shall represent a network composed 8 of participants— 9 ‘‘(i) that include 3 or more independ- 10 ently owned health care entities; and 11 ‘‘(ii) that may be nonprofit or for- 12 profit entities; and 13 ‘‘(C) shall not previously have received a 14 grant under this subsection (other than a 1- 15 year grant for planning activities) for the same 16 or a similar project. 17 ‘‘(3) APPLICATIONS.—To be eligible to receive a 18 grant under this subsection, an eligible entity, in 19 consultation with the appropriate State office of 20 rural health or another appropriate State entity, 21 shall prepare and submit to the Director an applica- 22 tion at such time, in such manner, and containing 23 such information as the Director may require, in- 24 cluding— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 253 •S 3660 IS ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) an explanation of the reasons why 4 Federal assistance is required to carry out the 5 project; 6 ‘‘(C) a description of— 7 ‘‘(i) the history of collaborative activi- 8 ties carried out by the participants in the 9 network; 10 ‘‘(ii) the degree to which the partici- 11 pants are ready to integrate their func- 12 tions; and 13 ‘‘(iii) how the local community or re- 14 gion to be served will benefit from and be 15 involved in the activities carried out by the 16 network; 17 ‘‘(D) a description of how the local com- 18 munity or region to be served will experience in- 19 creased access to quality health care services 20 across the continuum of care as a result of the 21 integration activities carried out by the net- 22 work, including a description of— 23 ‘‘(i) return on investment for the com- 24 munity and the network members; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 254 •S 3660 IS ‘‘(ii) other quantifiable performance 1 measures that show the benefit of the net- 2 work activities; 3 ‘‘(E) a plan for sustaining the project after 4 Federal support for the project has ended; 5 ‘‘(F) a description of how the project will 6 be evaluated; 7 ‘‘(G) the administrative capacity to submit 8 annual performance data electronically as speci- 9 fied by the Director; and 10 ‘‘(H) other such information as the Direc- 11 tor determines to be appropriate. 12 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 13 TEMS DEVELOPMENT GRANTS.— 14 ‘‘(1) GRANTS.—The Director may award grants 15 to eligible entities to support reduction of health dis- 16 parities, improve access to health care, and enhance 17 rural health system development in the Delta Re- 18 gion. 19 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 20 grant under this subsection, an entity shall be a 21 rural public or rural nonprofit private entity, a facil- 22 ity that qualifies as a rural health clinic under title 23 XVIII of the Social Security Act, a public or non- 24 profit entity existing exclusively to provide services 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 255 •S 3660 IS to migrant and seasonal farm workers in rural 1 areas, or a Tribal government whose grant-funded 2 activities will be conducted within federally recog- 3 nized Tribal areas. 4 ‘‘(3) APPLICATIONS.—To be eligible to receive a 5 grant under this subsection, an eligible entity shall 6 prepare and submit to the Director an application at 7 such time, in such manner, and containing such in- 8 formation as the Director may require, including— 9 ‘‘(A) a description of the project that the 10 eligible entity will carry out using the funds 11 provided under the grant; 12 ‘‘(B) an explanation of the reasons why 13 Federal assistance is required to carry out the 14 project; 15 ‘‘(C) a description of the manner in which 16 the project funded under the grant will meet 17 the health care needs of the Delta Region; 18 ‘‘(D) a description of how the local com- 19 munity or region to be served will experience in- 20 creased access to quality health care services as 21 a result of the activities carried out by the enti- 22 ty; 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 256 •S 3660 IS ‘‘(E) a description of how health dispari- 1 ties will be reduced or the health system will be 2 improved; 3 ‘‘(F) a plan for sustaining the project after 4 Federal support for the project has ended; 5 ‘‘(G) a description of how the project will 6 be evaluated including process and outcome 7 measures related to the quality of care provided 8 or how the health care system improves its per- 9 formance; 10 ‘‘(H) a description of how the grantee will 11 develop an advisory group made up of rep- 12 resentatives of the communities to be served to 13 provide guidance to the grantee to best meet 14 community need; and 15 ‘‘(I) other such information as the Director 16 determines to be appropriate. 17 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 18 ITY IMPROVEMENT GRANTS.— 19 ‘‘(1) GRANTS.—The Director may award grants 20 to provide for the planning and implementation of 21 small rural health care provider quality improvement 22 activities. The Director may award the grants for 23 periods of 1 to 3 years. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 257 •S 3660 IS ‘‘(2) ELIGIBILITY.—To be eligible for a grant 1 under this subsection, an entity— 2 ‘‘(A) shall be— 3 ‘‘(i) a rural public or rural nonprofit 4 private health care provider or provider of 5 health care services, such as a rural health 6 clinic; or 7 ‘‘(ii) another rural provider or net- 8 work of small rural providers identified by 9 the Director as a key source of local care; 10 and 11 ‘‘(B) shall not previously have received a 12 grant under this subsection for the same or a 13 similar project. 14 ‘‘(3) PREFERENCE.—In awarding grants under 15 this subsection, the Director shall give preference to 16 facilities that qualify as rural health clinics under 17 title XVIII of the Social Security Act. 18 ‘‘(4) APPLICATIONS.—To be eligible to receive a 19 grant under this subsection, an eligible entity shall 20 prepare and submit to the Director an application at 21 such time, in such manner, and containing such in- 22 formation as the Director may require, including— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 258 •S 3660 IS ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) an explanation of the reasons why 4 Federal assistance is required to carry out the 5 project; 6 ‘‘(C) a description of the manner in which 7 the project funded under the grant will assure 8 continuous quality improvement in the provision 9 of services by the entity; 10 ‘‘(D) a description of how the local com- 11 munity or region to be served will experience in- 12 creased access to quality health care services as 13 a result of the activities carried out by the enti- 14 ty; 15 ‘‘(E) a plan for sustaining the project after 16 Federal support for the project has ended; 17 ‘‘(F) a description of how the project will 18 be evaluated including process and outcome 19 measures related to the quality of care pro- 20 vided; and 21 ‘‘(G) other such information as the Direc- 22 tor determines to be appropriate. 23 ‘‘(f) GENERAL REQUIREMENTS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 259 •S 3660 IS ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 1 that receives a grant under this section may not use 2 funds provided through the grant— 3 ‘‘(A) to build or acquire real property; or 4 ‘‘(B) for construction. 5 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 6 The Director shall coordinate activities carried out 7 under grant programs described in this section, to 8 the extent practicable, with Federal and State agen- 9 cies and nonprofit organizations that are operating 10 similar grant programs, to maximize the effect of 11 public dollars in funding meritorious proposals. 12 ‘‘(g) REPORT.—Not later than September 30, 2020, 13 the Secretary shall prepare and submit to the appropriate 14 committees of Congress a report on the progress and ac- 15 complishments of the grant programs described in sub- 16 sections (b), (c), (d), and (e). 17 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec- 18 tion, the term ‘Delta Region’ has the meaning given to 19 the term ‘region’ in section 382A of the Consolidated 20 Farm and Rural Development Act (7 U.S.C. 2009aa). 21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 $40,000,000 for fiscal year 2019, and such sums as may 24 be necessary for each of fiscal years 2020 through 2023.’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 260 •S 3660 IS SEC. 417. COMMUNITY HEALTH CENTER COLLABORATIVE 1 ACCESS EXPANSION. 2 Section 330(r)(4) of the Public Health Service Act 3 (42 U.S.C. 254b(r)(4)) is amended— 4 (1) in subparagraph (A), by striking ‘‘primary 5 health care services’’ each place it appears and in- 6 serting ‘‘primary health care and other mental, den- 7 tal, and physical health services’’; and 8 (2) in subparagraph (B)— 9 (A) in clause (i), by striking ‘‘; and’’ and 10 inserting ‘‘;’’; 11 (B) in clause (ii), by striking the period 12 and inserting ‘‘; and’’; and 13 (C) by adding at the end the following: 14 ‘‘(iii) in the case of a rural health 15 clinic described in such subparagraph— 16 ‘‘(I) that such clinic provides, to 17 the extent possible, enabling services, 18 such as transportation and language 19 assistance (including translation and 20 interpretation); and 21 ‘‘(II) that the primary health 22 care and other services described in 23 such subparagraph are subject to full 24 reimbursement according to the pro- 25 spective payment system for Federally 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 261 •S 3660 IS qualified health center services under 1 section 1834(o) of the Social Security 2 Act.’’. 3 SEC. 418. FACILITATING THE PROVISION OF TELEHEALTH 4 SERVICES ACROSS STATE LINES. 5 (a) IN GENERAL.—For purposes of expediting the 6 provision of telehealth services, for which payment is made 7 under the Medicare Program, across State lines, the Sec- 8 retary of Health and Human Services shall, in consulta- 9 tion with representatives of States, physicians, health care 10 practitioners, and patient advocates, encourage and facili- 11 tate the adoption of provisions allowing for multistate 12 practitioner practice across State lines. 13 (b) DEFINITIONS.—In subsection (a): 14 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 15 health service’’ has the meaning given that term in 16 subparagraph (F) of section 1834(m)(4) of the So- 17 cial Security Act (42 U.S.C. 1395m(m)(4)). 18 (2) PHYSICIAN, PRACTITIONER.—The terms 19 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 20 given those terms in subparagraphs (D) and (E), re- 21 spectively, of such section. 22 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 23 Program’’ means the program of health insurance 24 administered by the Secretary of Health and Human 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 262 •S 3660 IS Services under title XVIII of the Social Security Act 1 (42 U.S.C. 1395 et seq.). 2 SEC. 419. SCORING OF PREVENTIVE HEALTH SAVINGS. 3 Section 202 of the Congressional Budget and Im- 4 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 5 ed by adding at the end the following: 6 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 7 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 8 Upon a request by the chairman or ranking minority 9 member of the Committee on the Budget of the Sen- 10 ate, or by the chairman or ranking minority member 11 of the Committee on the Budget of the House of 12 Representatives, the Director shall determine if a 13 proposed measure would result in reductions in 14 budget outlays in budgetary outyears through the 15 use of preventive health and preventive health serv- 16 ices. 17 ‘‘(2) PROJECTIONS.—If the Director determines 18 that a measure would result in substantial reduc- 19 tions in budget outlays as described in paragraph 20 (1), the Director— 21 ‘‘(A) shall include, in any projection pre- 22 pared by the Director, a description and esti- 23 mate of the reductions in budget outlays in the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 263 •S 3660 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 ‘budgetary outyears’ means 10 the 2 consecutive 10-year periods beginning 11 with the first fiscal year that is 10 years after 12 the budget year provided for in the most re- 13 cently agreed to concurrent resolution on the 14 budget; and 15 ‘‘(B) the term ‘preventive health’ means an 16 action that focuses on the health of the public, 17 individuals, and defined populations in order to 18 protect, promote, and maintain health, wellness, 19 and functional ability, and prevent disease, dis- 20 ability, and premature death that is dem- 21 onstrated by credible and publicly available epi- 22 demiological projection models, incorporating 23 clinical trials or observational studies in hu- 24 mans, to avoid future health care costs.’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 264 •S 3660 IS SEC. 420. SENSE OF CONGRESS ON MAINTENANCE OF EF- 1 FORT PROVISIONS REGARDING CHILDREN’S 2 HEALTH. 3 It is the sense of the Congress that— 4 (1) the maintenance of effort provisions added 5 to sections 1902 and 2105(d) of the Social Security 6 Act by sections 2001(b) and 2101(b) of the Patient 7 Protection and Affordable Care Act were intended to 8 maintain the eligibility standards for the Medicaid 9 program under title XIX of the Social Security Act 10 and Children’s Health Insurance Program under 11 title XXI of such Act until the American Health 12 Benefit Exchanges in the States are fully oper- 13 ational; 14 (2) it is imperative that the maintenance of ef- 15 fort provisions are enforced to the strict standard in- 16 tended by the Congress through September 30, 17 2027; 18 (3) waiving the maintenance of effort provisions 19 should not be permitted; 20 (4) the maintenance of effort provisions ensure 21 the continued success of the Medicaid program and 22 Children’s Health Insurance Program and were in- 23 tended to specifically protect vulnerable and disabled 24 adults, children, and senior citizens, many of whom 25 are also members of communities of color; and 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 265 •S 3660 IS (5) the maintenance of effort provisions must 1 be strictly enforced and proposals to weaken the 2 maintenance of effort provisions must not be consid- 3 ered. 4 SEC. 421. REPEAL OF REQUIREMENT FOR DOCUMENTA- 5 TION EVIDENCING CITIZENSHIP OR NATION- 6 ALITY UNDER THE MEDICAID PROGRAM. 7 (a) REPEAL.—Subsections (i)(22) and (x) of section 8 1903 of the Social Security Act (42 U.S.C. 1396b) are 9 each repealed. 10 (b) CONFORMING AMENDMENTS.— 11 (1) Section 1902 of the Social Security Act (42 12 U.S.C. 1396a) is amended— 13 (A) by amending paragraph (46) of sub- 14 section (a) to read as follows: 15 ‘‘(46) provide that information is requested and 16 exchanged for purposes of income and eligibility 17 verification in accordance with a State system which 18 meets the requirements of section 1137 of this 19 Act;’’; 20 (B) in subsection (e)(13)(A)(i)— 21 (i) in the matter preceding subclause 22 (I), by striking ‘‘sections 1902(a)(46)(B) 23 and 1137(d)’’ and inserting ‘‘section 24 1137(d)’’; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 266 •S 3660 IS (ii) in subclause (IV), by striking 1 ‘‘1902(a)(46)(B) or’’; and 2 (C) by striking subsection (ee). 3 (2) Section 1903 of the Social Security Act (42 4 U.S.C. 1396b) is amended— 5 (A) in subsection (i), by redesignating 6 paragraphs (23) through (26) as paragraphs 7 (22) through (25), respectively; and 8 (B) by redesignating subsections (y) and 9 (z) as subsections (x) and (y), respectively. 10 (3) Subsection (c) of section 6036 of the Deficit 11 Reduction Act of 2005 (42 U.S.C. 1396b note) is re- 12 pealed. 13 (c) EFFECTIVE DATE.—The repeals and amend- 14 ments made by this section shall take effect as if included 15 in the enactment of the Deficit Reduction Act of 2005. 16 SEC. 422. PROTECTION OF THE HHS OFFICES OF MINORITY 17 HEALTH. 18 (a) IN GENERAL.—Pursuant to section 1707A of the 19 Public Health Service Act (42 U.S.C. 300u–6a), the Of- 20 fices of Minority Health established within the Centers for 21 Disease Control and Prevention, the Health Resources 22 and Services Administration, the Substance Abuse and 23 Mental Health Services Administration, the Agency for 24 Healthcare Research and Quality, the Food and Drug Ad- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 267 •S 3660 IS ministration, and the Centers for Medicare & Medicaid 1 Services, are offices that, regardless of change in the 2 structure of the Department of Health and Human Serv- 3 ices, shall report to the Secretary of Health and Human 4 Services. 5 (b) SENSE OF CONGRESS.—It is the sense of the 6 Congress that any effort to eliminate or consolidate such 7 Offices of Minority Health undermines the progress 8 achieved so far. 9 SEC. 423. OFFICE OF MINORITY HEALTH IN VETERANS 10 HEALTH ADMINISTRATION OF DEPARTMENT 11 OF VETERANS AFFAIRS. 12 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 13 I of chapter 73 of title 38, United States Code, is amended 14 by adding at the end the following new section: 15 ‘‘§ 7310. Office of Minority Health 16 ‘‘(a) ESTABLISHMENT.—There is established in the 17 Department within the Office of the Under Secretary for 18 Health an office to be known as the ‘Office of Minority 19 Health’ (in this section referred to as the ‘Office’). 20 ‘‘(b) HEAD.—The Director of the Office of Minority 21 Health shall be the head of the Office. The Director of 22 the Office of Minority Health shall be appointed by the 23 Under Secretary for Health from among individuals quali- 24 fied to perform the duties of the position. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 268 •S 3660 IS ‘‘(c) FUNCTIONS.—The functions of the Office are as 1 follows: 2 ‘‘(1) To establish short-range and long-range 3 goals and objectives and coordinate all other activi- 4 ties within the Veterans Health Administration that 5 relate to disease prevention, health promotion, health 6 care services delivery, and health care research con- 7 cerning veterans who are members of a racial or eth- 8 nic minority group. 9 ‘‘(2) To support research, demonstrations, and 10 evaluations to test new and innovative models for 11 the discharge of activities described in paragraph 12 (1). 13 ‘‘(3) To increase knowledge and understanding 14 of health risk factors for veterans who are members 15 of a racial or ethnic minority group. 16 ‘‘(4) To develop mechanisms that support bet- 17 ter health care information dissemination, education, 18 prevention, and services delivery to veterans from 19 disadvantaged backgrounds, including veterans who 20 are members of a racial or ethnic minority group. 21 ‘‘(5) To enter into contracts or agreements with 22 appropriate public and nonprofit private entities to 23 develop and carry out programs to provide bilingual 24 or interpretive services to assist veterans who are 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 269 •S 3660 IS members of a racial or ethnic minority group and 1 who lack proficiency in speaking the English lan- 2 guage in accessing and receiving health care services 3 through the Veterans Health Administration. 4 ‘‘(6) To carry out programs to improve access 5 to health care services through the Veterans Health 6 Administration for veterans with limited proficiency 7 in speaking the English language, including the de- 8 velopment and evaluation of demonstration and pilot 9 projects for that purpose. 10 ‘‘(7) To advise the Under Secretary for Health 11 on matters relating to the development, implementa- 12 tion, and evaluation of health professions education 13 in decreasing disparities in health care outcomes be- 14 tween veterans who are members of a racial or eth- 15 nic minority group and other veterans, including cul- 16 tural competency as a method of eliminating such 17 health disparities. 18 ‘‘(8) To perform such other functions and du- 19 ties as the Secretary or the Under Secretary for 20 Health considers appropriate. 21 ‘‘(d) DEFINITIONS.—In this section: 22 ‘‘(1) The term ‘racial or ethnic minority group’ 23 means any of the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 270 •S 3660 IS ‘‘(A) American Indians (including Alaska 1 Natives, Eskimos, and Aleuts). 2 ‘‘(B) Asian Americans. 3 ‘‘(C) Native Hawaiians and other Pacific 4 Islanders. 5 ‘‘(D) Blacks. 6 ‘‘(E) Hispanics. 7 ‘‘(2) The term ‘Hispanic’ means individuals 8 whose origin is Mexican, Puerto Rican, Cuban, Cen- 9 tral or South American, or any other Spanish-speak- 10 ing country.’’. 11 (b) CLERICAL AMENDMENT.—The table of sections 12 at the beginning of such chapter is amended by inserting 13 after the item relating to section 7309A the following new 14 item: 15 ‘‘7310. Office of Minority Health.’’. SEC. 424. INDIAN DEFINED IN TITLE I OF PPACA. 16 (a) DEFINITION OF INDIAN.—Section 1304 of the 17 Patient Protection and Affordable Care Act (42 U.S.C. 18 18024) is amended by adding at the end the following: 19 ‘‘(f) INDIAN.— 20 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 21 dian’ means any individual— 22 ‘‘(A) described in paragraph (13) or (28) 23 of section 4 of the Indian Health Care Improve- 24 ment Act (25 U.S.C. 1603); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 271 •S 3660 IS ‘‘(B) who is eligible for health services pro- 1 vided by the Indian Health Service under sec- 2 tion 809 of the Indian Health Care Improve- 3 ment Act (25 U.S.C. 1679); 4 ‘‘(C) who is of Indian descent and belongs 5 to the Indian community served by the local fa- 6 cilities and program of the Indian Health Serv- 7 ice; or 8 ‘‘(D) who is described in paragraph (2). 9 ‘‘(2) INCLUSIONS.—An individual is described 10 in this paragraph if the individual is any of the fol- 11 lowing: 12 ‘‘(A) A member of a federally recognized 13 Indian Tribe. 14 ‘‘(B) A resident of an urban center who 15 meets any of the following criteria: 16 ‘‘(i) Membership in a Tribe, band, or 17 other organized group of Indians, including 18 those Tribes, bands, or groups terminated 19 since 1940 and those recognized as of the 20 date of enactment of the Health Equity 21 and Accountability Act of 2018 or later by 22 the State in which they reside, or being a 23 descendant, in the first or second degree, 24 of any such member. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 272 •S 3660 IS ‘‘(ii) Is an Eskimo or Aleut or other 1 Alaska Native. 2 ‘‘(iii) Is considered by the Secretary of 3 the Interior to be an Indian for any pur- 4 pose. 5 ‘‘(iv) Is determined to be an Indian 6 under regulations promulgated by the Sec- 7 retary. 8 ‘‘(C) An individual who is considered by 9 the Secretary of the Interior to be an Indian for 10 any purpose. 11 ‘‘(D) An individual who is considered by 12 the Secretary to be an Indian for purposes of 13 eligibility for Indian health care services, includ- 14 ing as a California Indian, Eskimo, Aleut, or 15 other Alaska Native.’’. 16 (b) CONFORMING AMENDMENTS.— 17 (1) AFFORDABLE CHOICES HEALTH BENEFIT 18 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 19 tection and Affordable Care Act (42 U.S.C. 20 18031(c)(6)(D)) is amended by striking ‘‘(as defined 21 in section 4 of the Indian Health Care Improvement 22 Act)’’. 23 (2) REDUCED COST-SHARING FOR INDIVIDUALS 24 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 273 •S 3660 IS 1402(d) of the Patient Protection and Affordable 1 Care Act (42 U.S.C. 18071(d)) is amended— 2 (A) in paragraph (1), in the matter pre- 3 ceding subparagraph (A), by striking ‘‘(as de- 4 fined in section 4(d) of the Indian Self-Deter- 5 mination and Education Assistance Act (25 6 U.S.C. 450b(d))’’; and 7 (B) in paragraph (2), in the matter pre- 8 ceding subparagraph (A), by striking ‘‘(as so 9 defined)’’. 10 (3) EXEMPTION FROM PENALTY FOR NOT 11 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 12 Section 5000A(e) of the Internal Revenue Code of 13 1986 is amended by striking paragraph (3) and in- 14 serting the following: 15 ‘‘(3) INDIANS.—Any applicable individual who 16 is an Indian (as defined in section 1304(f) of the 17 Patient Protection and Affordable Care Act).’’. 18 SEC. 425. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 19 ACCESS FOR LOW-INCOME PATIENTS. 20 (a) IN GENERAL.—Not later than January 1, 2019, 21 the Comptroller General of the United States shall con- 22 duct a study on how amendments made by the Patient 23 Protection and Affordable Care Act (Public Law 111– 24 148) and the Health Care and Education Reconciliation 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 274 •S 3660 IS Act of 2010 (Public Law 111–152) to titles XVIII and 1 XIX of the Social Security Act (42 U.S.C. 1395 et seq., 2 1396 et seq.) relating to disproportionate share hospital 3 adjustment payments under Medicare and Medicaid (and 4 subsequent amendments made with respect to such pay- 5 ments) affect the timely access to health care services for 6 low-income patients. Such study shall— 7 (1) evaluate and examine whether States elect- 8 ing to make medical assistance available under sec- 9 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 10 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 11 States making such an election through a waiver of 12 the State plan) to individuals described in such sec- 13 tion mitigate the need for payments to dispropor- 14 tionate share hospitals under section 1886(d)(5)(F) 15 of the Social Security Act (42 U.S.C. 16 1395ww(d)(5)(F)) and section 1923 of such Act (42 17 U.S.C. 1396r–4), including the impact of such 18 States electing to make medical assistance available 19 to such individuals on— 20 (A) the number of individuals in the 21 United States who are without health insurance 22 and the distribution of such individuals in rela- 23 tion to areas primarily served by dispropor- 24 tionate share hospitals; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 275 •S 3660 IS (B) the low-income utilization rate of such 1 hospitals and the resulting fiscal sustainability 2 of such hospitals; 3 (2) evaluate the appropriate level and distribu- 4 tion of such payments among such disproportionate 5 share hospitals for purposes of— 6 (A) sufficiently accounting for the level of 7 uncompensated care provided by such hospitals 8 to low-income patients; and 9 (B) providing timely access to health serv- 10 ices for individuals in medically underserved 11 areas; and 12 (3) assess, with respect to such disproportionate 13 share hospitals— 14 (A) the role played by such hospitals in 15 providing critical access to emergency, inpa- 16 tient, and outpatient health services, as well as 17 the location of such hospitals in relation to 18 medically underserved areas; and 19 (B) the extent to which such hospitals sat- 20 isfy the requirements established for charitable 21 hospital organizations under section 501(r) of 22 the Internal Revenue Code of 1986 with respect 23 to community health needs assessments, finan- 24 cial assistance policy requirements, limitations 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 276 •S 3660 IS on charges, and billing and collection require- 1 ments. 2 (b) REPORTS.— 3 (1) REPORT TO CONGRESS.—Not later than 4 180 days after the date on which the study under 5 subsection (a) is completed, the Comptroller General 6 of the United States shall submit to the Committee 7 on Energy and Commerce of the House of Rep- 8 resentatives and the Committee on Finance of the 9 Senate a report that contains— 10 (A) the results of the study; 11 (B) recommendations to Congress for any 12 legislative changes to the payments to dis- 13 proportionate share hospitals under section 14 1886(d)(5)(F) of the Social Security Act (42 15 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 16 such Act (42 U.S.C. 1396r–4) that are needed 17 to ensure access to health services for low-in- 18 come patients that— 19 (i) are based on the number of indi- 20 viduals without health insurance, the 21 amount of uncompensated care provided by 22 such hospitals, and the impact of reduced 23 payment levels on low-income communities; 24 and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 277 •S 3660 IS (ii) takes into account any reports 1 submitted by the Secretary of the Treas- 2 ury, in consultation with the Secretary of 3 Health and Human Services, to Congres- 4 sional committees regarding the costs in- 5 curred by charitable hospital organizations 6 for charity care, bad debt, nonreimbursed 7 expenses for services provided to individ- 8 uals under the Medicare program under 9 title XVIII of the Social Security Act and 10 the Medicaid program under title XIX of 11 such Act, and any community benefit ac- 12 tivities provided by such organizations. 13 (2) REPORT TO THE SECRETARY OF HEALTH 14 AND HUMAN SERVICES.—Not later than 180 days 15 after the date on which the study under subsection 16 (a) is completed, the Comptroller General of the 17 United States shall submit to the Secretary of 18 Health and Human Services a report that con- 19 tains— 20 (A) the results of the study; and 21 (B) any recommendations for purposes of 22 assisting in the development of the methodology 23 for the adjustment of payments to dispropor- 24 tionate share hospitals, as required under sec- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 278 •S 3660 IS tion 1886(r) of the Social Security Act (42 1 U.S.C. 1395ww(r)) and the reduction of such 2 payments under section 1923(f)(7) of such Act 3 (42 U.S.C. 1396r–4(f)(7)), taking into account 4 the reports referred to in paragraph (1)(B)(ii). 5 SEC. 426. ASSISTANT SECRETARY OF THE INDIAN HEALTH 6 SERVICE. 7 (a) REFERENCES.—Any reference in a law, regula- 8 tion, document, paper, or other record of the United 9 States to the Director of the Indian Health Service shall 10 be deemed to be a reference to the Assistant Secretary 11 of the Indian Health Service. 12 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 13 United States Code, is amended in the matter relating to 14 the Assistant Secretaries of Health and Human Services 15 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 16 the Assistant Secretary of the Indian Health Service’’. 17 (c) CONFORMING AMENDMENT.—Section 5316 of 18 title 5, United States Code, is amended by striking ‘‘Direc- 19 tor, Indian Health Service, Department of Health and 20 Human Services.’’. 21 SEC. 427. REAUTHORIZATION OF THE NATIVE HAWAIIAN 22 HEALTH CARE IMPROVEMENT ACT. 23 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 24 Section 6(h)(1) of the Native Hawaiian Health Care Im- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 279 •S 3660 IS provement Act (42 U.S.C. 11705(h)(1)) is amended by 1 striking ‘‘may be necessary for fiscal years 1993 through 2 2019’’ and inserting ‘‘are necessary’’. 3 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 4 LOKAHI.—Section 7(b) of the Native Hawaiian Health 5 Care Improvement Act (42 U.S.C. 11706(b)) is amended 6 by striking ‘‘may be necessary for fiscal years 1993 7 through 2019’’ and inserting ‘‘are necessary’’. 8 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 9 Section 10(c) of the Native Hawaiian Health Care Im- 10 provement Act (42 U.S.C. 11709(c)) is amended by strik- 11 ing ‘‘may be necessary for fiscal years 1993 through 12 2019’’ and inserting ‘‘are necessary’’. 13 SEC. 428. AVAILABILITY OF NON-ENGLISH LANGUAGE 14 SPEAKING PROVIDERS. 15 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 16 tient Protection and Affordable Care Act (42 U.S.C. 17 18031(c)(1)(B)) is amended by inserting before the semi- 18 colon the following: ‘‘and the ability of such provider to 19 provide care in a language other than English either 20 through the provider speaking such language or by the 21 provider having a qualified interpreter for an individual 22 with limited-English proficiency (as defined in section 23 3400 of such Act) who speaks such language available 24 during office hours’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 280 •S 3660 IS (b) EFFECTIVE DATE.—The amendment made by 1 subsection (a) shall not apply to any plan beginning on 2 or prior to the date that is 1 year after the date of the 3 enactment of this Act. 4 SEC. 429. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 5 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 6 1311(c)(1)(C) of the Patient Protection and Affordable 7 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 8 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 9 (2) by adding at the end the following new 10 clauses: 11 ‘‘(ii) not later than January 1, 2020, in- 12 crease the percentage of essential community 13 providers as described in clause (i) included in 14 its network by 10 percent annually (based on 15 the level in the plan for 2016) until 90 percent 16 of all federally-qualified health centers and 75 17 percent of all other such essential community 18 providers in the contract service area are in-net- 19 work; and 20 ‘‘(iii) include at least one essential commu- 21 nity provider in each of the essential community 22 provider categories described in section 23 156.235(a)(2)(ii)(B) of title 45, Code of Fed- 24 eral Regulations (as in effect on the date of en- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 281 •S 3660 IS actment of the Health Equity and Account- 1 ability Act of 2018) in each county in the serv- 2 ice area, where available;’’. 3 (b) REPORTING REQUIREMENTS.—Section 4 1311(e)(3) of the Patient Protection and Affordable Care 5 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 6 end the following new subparagraph: 7 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 8 PROVIDERS.—The Secretary shall require quali- 9 fied health plans to submit annually to the Sec- 10 retary data on the percentage of essential com- 11 munity providers as described in clause (ii) of 12 subsection (c)(1)(C), by county, that contract 13 with each qualified health plan offered in that 14 county and the percentage of such essential 15 community providers, by category as described 16 in clause (iii) of such subsection, that contract 17 with each qualified health plan offered in that 18 county. Such data shall be made available to 19 the general public.’’. 20 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 21 APPLIED UNDER MEDICARE AND MEDICAID.— 22 (1) MEDICARE.—Section 1852(d)(1) of the So- 23 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 24 amended— 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 282 •S 3660 IS (A) by striking ‘‘and’’ at the end of sub- 1 paragraph (D); 2 (B) by striking the period at the end of 3 subparagraph (E) and inserting ‘‘; and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(F) the plan meets the requirements of 7 clauses (ii) and (iii) of section 1311(c)(1)(C) of 8 the Patient Protection and Affordable Care Act 9 (relating to inclusion in networks of essential 10 community providers).’’. 11 (2) MEDICAID.—Section 1932(b)(5) of the So- 12 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 13 amended— 14 (A) by striking ‘‘and’’ at the end of sub- 15 paragraph (A); 16 (B) by striking the period at the end of 17 subparagraph (B) and inserting ‘‘; and’’; and 18 (C) by adding at the end the following new 19 subparagraph: 20 ‘‘(C) meets the requirements of clauses (ii) 21 and (iii) of section 1311(c)(1)(C) of the Patient 22 Protection and Affordable Care Act (relating to 23 inclusion in networks of essential community 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 283 •S 3660 IS providers) with respect to services offered in the 1 service area involved.’’. 2 SEC. 430. PROVIDER NETWORK ADEQUACY IN COMMU- 3 NITIES OF COLOR. 4 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 5 tient Protection and Affordable Care Act (42 U.S.C. 6 18031(c)(1)(B)), as amended by section 428(a), is further 7 amended— 8 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 9 (2) by adding at the end the following the fol- 10 lowing new clauses: 11 ‘‘(ii) meet such network adequacy 12 standards as the Secretary may establish 13 with regard to— 14 ‘‘(I) appointment wait time; 15 ‘‘(II) travel time and distance to 16 health care provider facilities and pro- 17 viders by public and private transit; 18 ‘‘(III) hours of operation to ac- 19 commodate individuals who cannot 20 come to provider appointments during 21 standard business hours; and 22 ‘‘(IV) other network adequacy 23 standards to ensure that care through 24 these plans is accessible to diverse 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 284 •S 3660 IS communities, including individuals 1 with limited-English proficiency as de- 2 fined in section 3400 of such Act; and 3 ‘‘(iii) provide coverage for services for 4 enrollees through out-of-network providers 5 at no additional cost to the enrollees in 6 cases where in-network providers are un- 7 able to comply with the standards estab- 8 lished under subclause (III) or (IV) of 9 clause (ii) for such services and the out-of- 10 network providers can deliver such services 11 in compliance with such standards. 12 ‘‘(b) EFFECTIVE DATE.—The amendments made by 13 subsection (a) shall not apply to plans beginning on or 14 prior to the date that is 1 year after the date of the enact- 15 ment of this Act.’’. 16 SEC. 431. IMPROVING ACCESS TO DENTAL CARE. 17 (a) REPORTS TO CONGRESS.— 18 (1) GAO REPORTS.—Not later than 1 year 19 after the date of the enactment of this Act, the 20 Comptroller General of the United States shall sub- 21 mit to Congress— 22 (A) a report on the Alaska Dental Health 23 Aide Therapists program and the Dental Ther- 24 apist and Advanced Dental Therapist programs 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 285 •S 3660 IS in Minnesota, to assess the effectiveness of den- 1 tal therapists in— 2 (i) improving access to timely dental 3 care among communities of color; 4 (ii) providing high quality care; and 5 (iii) providing culturally competent 6 care; and 7 (B) a report on State variations in the use 8 of dental hygienists and the effectiveness of ex- 9 panding the scope of practice for dental hygien- 10 ists in— 11 (i) improving access to timely dental 12 care among communities of color; 13 (ii) providing high quality care; and 14 (iii) providing culturally competent 15 care. 16 (2) HRSA REPORT ON DENTAL SHORTAGE 17 AREAS.—Not later than 1 year after the date of the 18 enactment of this Act, the Secretary of Health and 19 Human Services, acting through the Administrator 20 of the Health Resources and Services Administra- 21 tion, shall submit to Congress a report which details 22 geographic dental access shortages and the pre- 23 paredness of dental providers to offer culturally and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 286 •S 3660 IS linguistically appropriate, affordable, accessible, and 1 timely services. 2 (b) EXPANSION OF DENTAL HEALTH AID THERA- 3 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 4 Indian Health Care Improvement Act (25 U.S.C. 5 1616l(d)) is amended— 6 (1) in paragraph (2), by striking ‘‘Subject to’’ 7 and all that follows and inserting ‘‘Subject to para- 8 graph (3), in establishing a national program under 9 paragraph (1), the Secretary shall not reduce the 10 amounts provided for the Community Health Aide 11 Program described in subsections (a) and (b).’’; 12 (2) by striking paragraph (3); and 13 (3) by redesignating paragraph (4) as para- 14 graph (3). 15 (c) COVERAGE OF DENTAL SERVICES UNDER THE 16 MEDICARE PROGRAM.— 17 (1) COVERAGE.—Section 1861(s)(2) of the So- 18 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 19 ed— 20 (A) in subparagraph (FF), by striking 21 ‘‘and’’ at the end; 22 (B) in subparagraph (GG), by adding 23 ‘‘and’’ after the semicolon at the end; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 287 •S 3660 IS (C) by adding at the end the following new 1 subparagraph: 2 ‘‘(HH) oral health services (as defined in sub- 3 section (kkk));’’. 4 (2) ORAL HEALTH SERVICES DEFINED.—Sec- 5 tion 1861 of the Social Security Act (42 U.S.C. 6 1395x), as amended by sections 205(b) and 413(a), 7 is amended by adding at the end the following new 8 subsection: 9 ‘‘Oral Health Services 10 ‘‘(kkk)(1) The term ‘oral health services’ means serv- 11 ices (as defined by the Secretary) that are necessary to 12 prevent disease and promote oral health, restore oral 13 structures to health and function, and treat emergency 14 conditions. 15 ‘‘(2) For purposes of paragraph (1), such term shall 16 include mobile and portable oral health services (as de- 17 fined by the Secretary) that— 18 ‘‘(A) are provided for the purpose of over- 19 coming mobility, transportation, and access barriers 20 for individuals; and 21 ‘‘(B) satisfy the standards and certification re- 22 quirements established under section 1902(a)(82)(B) 23 for the State in which the services are provided.’’. 24 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 288 •S 3660 IS (3) PAYMENT AND COINSURANCE.—Section 1 1833(a)(1) of the Social Security Act (42 U.S.C. 2 1395l(a)(1)) is amended— 3 (A) by striking ‘‘and’’ before ‘‘(BB)’’; and 4 (B) by inserting before the semicolon at 5 the end the following: ‘‘, and (CC) with respect 6 to oral health services (as defined in section 7 1861(kkk)), the amount paid shall be (i) in the 8 case of such services that are preventive, 100 9 percent of the lesser of the actual charge for 10 the services or the amount determined under 11 the payment basis determined under section 12 1848, and (ii) in the case of all other such serv- 13 ices, 80 percent of the lesser of the actual 14 charge for the services or the amount deter- 15 mined under the payment basis determined 16 under section 1848’’. 17 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 18 ULE.—Section 1848(j)(3) of the Social Security Act 19 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 20 ‘‘(2)(HH),’’ after ‘‘risk assessment),’’. 21 (5) DENTURES.—Section 1861(s)(8) of the So- 22 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 23 ed— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 289 •S 3660 IS (A) by striking ‘‘(other than dental)’’ and 1 inserting ‘‘(including dentures)’’; and 2 (B) by striking ‘‘internal body’’. 3 (6) REPEAL OF GROUND FOR EXCLUSION.— 4 Section 1862(a) of the Social Security Act (42 5 U.S.C. 1395y) is amended by striking paragraph 6 (12). 7 (7) EFFECTIVE DATE.—The amendments made 8 by this section shall apply to services furnished on 9 or after January 1, 2019. 10 (d) COVERAGE OF DENTAL SERVICES UNDER THE 11 MEDICAID PROGRAM.— 12 (1) IN GENERAL.—Section 1905 of the Social 13 Security Act (42 U.S.C. 1396d) is amended— 14 (A) in subsection (a)(10), by striking ‘‘den- 15 tal services’’ and inserting ‘‘oral health services 16 (as defined in subsection (ee)(1))’’; and 17 (B) by adding at the end the following new 18 subsection: 19 ‘‘(ee)(1) Subject to paragraphs (2) and (3), for pur- 20 poses of this title, the term ‘oral health services’ means 21 services (as defined by the Secretary) that are necessary 22 to prevent disease and promote oral health, restore oral 23 structures to health and function, and treat emergency 24 conditions. These services shall include, in the case of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 290 •S 3660 IS pregnant or postpartum women, such services as are nec- 1 essary to address oral health conditions that exist or are 2 exacerbated by pregnancy or childbirth or which, if left 3 untreated, could adversely affect fetal or child develop- 4 ment. 5 ‘‘(2) For purposes of paragraph (1), such term shall 6 include— 7 ‘‘(A) dentures; and 8 ‘‘(B) mobile and portable oral health services 9 (as defined by the Secretary) that— 10 ‘‘(i) are provided for the purpose of over- 11 coming mobility, transportation, and access bar- 12 riers for individuals; and 13 ‘‘(ii) satisfy the standards and certification 14 requirements established under section 15 1902(a)(84)(C) for the State in which the serv- 16 ices are provided. 17 ‘‘(3) For purposes of paragraph (1), such term shall 18 not include dental care or services provided to individuals 19 under the age of 21 under subsection (r)(3).’’. 20 (2) CONFORMING AMENDMENTS.— 21 (A) STATE PLAN REQUIREMENTS.—Section 22 1902(a) of the Social Security Act (42 U.S.C. 23 1396a(a)) is amended— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 291 •S 3660 IS (i) in paragraph (10)(A), in the mat- 1 ter preceding clause (i), by inserting 2 ‘‘(10),’’ after ‘‘(5),’’; 3 (ii) in paragraph (82), by striking 4 ‘‘and’’ at the end; 5 (iii) in paragraph (83), by striking the 6 period at the end and inserting ‘‘; and’’; 7 and 8 (iv) by inserting after paragraph (83) 9 the following: 10 ‘‘(84) provide for— 11 ‘‘(A) informing, in writing, all individuals 12 who have been determined to be eligible for 13 medical assistance of the availability of oral 14 health services (as defined in section 1905(ee)); 15 ‘‘(B) conducting targeted outreach to preg- 16 nant women who have been determined to be el- 17 igible for medical assistance about the avail- 18 ability of medical assistance for such dental 19 services and the importance of receiving dental 20 care while pregnant; and 21 ‘‘(C) establishing and maintaining stand- 22 ards for and certification of mobile and portable 23 oral health services (as described in subsections 24 (r)(3)(C) and (ee)(2)(B) of section 1905).’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 292 •S 3660 IS (B) DEFINITION OF MEDICAL ASSIST- 1 ANCE.—Section 1905(a)(12) of the Social Secu- 2 rity Act (42 U.S.C. 1396d(a)(12)) is amended 3 by striking ‘‘, dentures,’’. 4 (3) MOBILE AND PORTABLE ORAL HEALTH 5 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 6 Social Security Act (42 U.S.C. 1396d(r)(3)) is 7 amended— 8 (A) in subparagraph (A)(ii), by striking ‘‘; 9 and’’ and inserting a semicolon; 10 (B) in subparagraph (B), by striking the 11 period at the end and inserting ‘‘; and’’; and 12 (C) by adding at the end the following new 13 subparagraph: 14 ‘‘(C) which shall include mobile and port- 15 able oral health services (as defined by the Sec- 16 retary) that— 17 ‘‘(i) are provided for the purpose of 18 overcoming mobility, transportation, or ac- 19 cess barriers for children; and 20 ‘‘(ii) satisfy the standards and certifi- 21 cation requirements established under sec- 22 tion 1902(a)(82)(C) for the State in which 23 the services are provided.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 293 •S 3660 IS (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 1 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 2 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 3 amended— 4 (1) in paragraph (1)— 5 (A) in subparagraph (J), by striking ‘‘oral 6 and’’; and 7 (B) by adding at the end the following: 8 ‘‘(K) Oral health services for children and 9 adults.’’; and 10 (2) by adding at the end the following: 11 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 12 of paragraph (1)(K), the term ‘oral health services’ 13 means services (as defined by the Secretary), that 14 are necessary to prevent any oral disease and pro- 15 mote oral health, restore oral structures to health 16 and function, and treat emergency oral conditions.’’. 17 (f) DEMONSTRATION PROGRAM ON TRAINING AND 18 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 19 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 20 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 21 MUNITIES.— 22 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 23 The Secretary of Veterans Affairs may carry out a 24 demonstration program to establish programs to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 294 •S 3660 IS train and employ alternative dental health care pro- 1 viders in order to increase access to dental health 2 care services for veterans who are entitled to such 3 services from the Department of Veterans Affairs 4 and reside in rural and other underserved commu- 5 nities. 6 (2) TELEHEALTH.—For purposes of alternative 7 dental health care providers and other dental care 8 providers who are licensed to provide clinical care, 9 dental services provided under the demonstration 10 program under this subsection may be administered 11 by such providers through telehealth-enabled collabo- 12 ration and supervision when appropriate and fea- 13 sible. 14 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 15 VIDERS DEFINED.—In this subsection, the term ‘‘al- 16 ternative dental health care providers’’ has the 17 meaning given that term in section 340G–1(a)(2) of 18 the Public Health Service Act (42 U.S.C. 256g– 19 1(a)(2)). 20 (4) AUTHORIZATION OF APPROPRIATIONS.— 21 There are authorized to be appropriated such sums 22 as are necessary to carry out the demonstration pro- 23 gram under this subsection. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 295 •S 3660 IS (g) DEMONSTRATION PROGRAM ON TRAINING AND 1 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 2 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 3 MEMBERS OF THE ARMED FORCES AND DEPENDENTS 4 LACKING READY ACCESS TO SUCH SERVICES.— 5 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 6 The Secretary of Defense may carry out a dem- 7 onstration program to establish programs to train 8 and employ alternative dental health care providers 9 in order to increase access to dental health care 10 services for members of the Armed Forces and their 11 dependents who lack ready access to such services, 12 including the following: 13 (A) Members and dependents who reside in 14 rural areas or areas otherwise underserved by 15 dental health care providers. 16 (B) Members of the National Guard and 17 Reserves in active status who are potentially 18 deployable. 19 (2) TELEHEALTH.—For purposes of alternative 20 dental health care providers and other dental care 21 providers who are licensed to provide clinical care, 22 dental services provided under the demonstration 23 program under this subsection may be administered 24 by such providers through telehealth-enabled collabo- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 296 •S 3660 IS ration and supervision when appropriate and fea- 1 sible. 2 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 3 VIDERS DEFINED.—In this subsection, the term ‘‘al- 4 ternative dental health care providers’’ has the 5 meaning given that term in section 340G–1(a)(2) of 6 the Public Health Service Act (42 U.S.C. 256g– 7 1(a)(2)). 8 (4) AUTHORIZATION OF APPROPRIATIONS.— 9 There are authorized to be appropriated such sums 10 as are necessary to carry out the demonstration pro- 11 gram under this subsection. 12 (h) DEMONSTRATION PROGRAM ON TRAINING AND 13 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 14 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 15 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 16 PRISONS.— 17 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 18 The Attorney General, acting through the Director 19 of the Bureau of Prisons, may carry out a dem- 20 onstration program to establish programs to train 21 and employ alternative dental health care providers 22 in order to increase access to dental health services 23 for prisoners within the custody of the Bureau of 24 Prisons. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 297 •S 3660 IS (2) TELEHEALTH.—For purposes of alternative 1 dental health care providers and other dental care 2 providers who are licensed to provide clinical care, 3 dental services provided under the demonstration 4 program under this subsection may be administered 5 by such providers through telehealth-enabled collabo- 6 ration and supervision when appropriate and fea- 7 sible. 8 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 9 VIDERS DEFINED.—In this subsection and sub- 10 section (i), the term ‘‘alternative dental health care 11 providers’’ has the meaning given that term in sec- 12 tion 340G–1(a)(2) of the Public Health Service Act 13 (42 U.S.C. 256g–1(a)(2)). 14 (4) AUTHORIZATION OF APPROPRIATIONS.— 15 There are authorized to be appropriated such sums 16 as are necessary to carry out the demonstration pro- 17 gram under this subsection. 18 (i) DEMONSTRATION PROGRAM ON TRAINING AND 19 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 20 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 21 UNDER THE INDIAN HEALTH SERVICE.— 22 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 23 The Secretary of Health and Human Services, act- 24 ing through the Indian Health Service, may carry 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 298 •S 3660 IS out a demonstration program to establish programs 1 to train and employ alternative dental health care 2 providers in order to help eliminate oral health dis- 3 parities and increase access to dental services 4 through health programs operated by the Indian 5 Health Service, Indian tribes, tribal organizations, 6 and urban Indian organizations (as the preceding 3 7 terms are defined in section 4 of the Indian Health 8 Care Improvement Act (25 U.S.C. 1603)). 9 (2) TELEHEALTH.—For purposes of alternative 10 dental health care providers and other dental care 11 providers who are licensed to provide clinical care, 12 dental services provided under the demonstration 13 program under this subsection may be administered 14 by such providers through telehealth-enabled collabo- 15 ration and supervision when appropriate and fea- 16 sible. 17 (3) AUTHORIZATION OF APPROPRIATIONS.— 18 There are authorized to be appropriated such sums 19 as are necessary to carry out the demonstration pro- 20 gram under this subsection. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 299 •S 3660 IS Subtitle C—Advancing Health Eq- 1 uity Through Payment and De- 2 livery Reform 3 SEC. 441. SENSE OF CONGRESS. 4 It is the Sense of Congress that— 5 (1) the sustainability of the health care system 6 in the United States hinges on restructuring how 7 health care is paid for, shifting away from paying 8 for the volume of services provided to the value the 9 services provide; 10 (2) high value care is care that provides higher 11 quality care more efficiently, achieving greater 12 health improvement and better health outcomes at 13 lower cost (per patient and overall); 14 (3) a high value health care system must deliver 15 timely, accessible, well-coordinated, high-quality, cul- 16 turally centered, and language-appropriate care to 17 everyone; 18 (4) eliminating health disparities and achieving 19 health equity must be central to efforts to achieve a 20 high value health care system; 21 (5) eliminating such disparities and achieving 22 such equity will require tailored interventions and 23 targeted investments to address inequities in health 24 and health care to make sure that health care deliv- 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 300 •S 3660 IS ery and payment efforts are responsive to and inclu- 1 sive of the needs of communities of color and other 2 communities experiencing disparities; and 3 (6) new models of value-based payment and 4 care delivery should consider the holistic needs of 5 the patient population, including social determinants 6 of health and behavioral health needs. 7 SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 8 QUALITY PAYMENT PROGRAM. 9 (a) INTEGRATING ACHIEVING HEALTH EQUITY 10 ACROSS MEASURES AND ACTIVITIES.— 11 (1) IN GENERAL.—The Centers for Medicare & 12 Medicaid Services Quality Payment Program (in this 13 section referred to as the ‘‘Quality Payment Pro- 14 gram’’), developed through implementation of the 15 provisions of and amendments made by the Medicare 16 Access and CHIP Reauthorization Act of 2015 17 (Public Law 114–10) relating to improving quality 18 and payment under title XVIII of the Social Secu- 19 rity Act, shall explicitly integrate ‘‘achieving health 20 equity’’ across all measures and activities under the 21 Quality Payment Program, including under the 22 Merit-based Incentive Payment System under sec- 23 tion 1848(q) of such Act (42 U.S.C. 1395w–4(q)) or 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 301 •S 3660 IS alternative payment models in accordance with this 1 section. 2 (2) IDENTIFICATION OF LIMITED-ENGLISH PRO- 3 FICIENT INDIVIDUALS AS UNDERSERVED GROUP.— 4 The Administrator of the Centers for Medicare & 5 Medicaid Services (in this section referred to as the 6 ‘‘Administrator’’) shall identify individuals with lim- 7 ited-English proficiency as a specific underserved 8 group within the Quality Payment Program and give 9 high weight under the Quality Payment Program to 10 measures and activities relating to providing lan- 11 guage services for non-English speakers. A clinician 12 or other professional may demonstrate performance 13 on measures and activities with respect to this cat- 14 egory by developing language assistance plans, pro- 15 viding oral interpretation services, and providing 16 translated documents for the population served or el- 17 igible to be served. 18 (b) STRATIFIED DATA.— 19 (1) IN GENERAL.—The Administrator shall in- 20 clude an explicit reference under the Quality Pay- 21 ment Program indicating that data stratification 22 and reporting is one way of working to achieve 23 health equity. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 302 •S 3660 IS (2) STRATIFICATION OF DATA.—The Adminis- 1 trator shall require that a clinician or other profes- 2 sional, in reporting measures relating to achieving 3 health quality under this the Quality Payment Pro- 4 gram, stratify clinical quality measures by disparity 5 variables, including race, ethnicity, preferred lan- 6 guage, disability status, sexual orientation, gender 7 identity, and psychological and behavioral status. A 8 clinician or other professional may use existing de- 9 mographic data collection fields in certified elec- 10 tronic health record technology (as defined in section 11 1848(o)(4) of the Social Security Act (42 U.S.C. 12 1395w–4(o)(4))) to carry out such data stratifica- 13 tion under the preceding sentence. Such stratified 14 data may assist clinicians and other professionals in 15 the identification of disparities and distinguish ef- 16 forts to improve quality from efforts to reduce dis- 17 parities, which may not correlate without dedicated 18 work. 19 (3) REQUIREMENT OF ADOPTION OF CERT.—All 20 entities, clinicians, or other professionals partici- 21 pating in the Quality Payment Program shall be re- 22 quired to adopt 2015 certified electronic health 23 record technology (as so defined) as a condition of 24 participating in the Quality Payment Program. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 303 •S 3660 IS (c) QUALITY IMPROVEMENT ACTIVITIES.—The Ad- 1 ministrator, upon yearly review of the Quality Payment 2 Program, shall add quality improvement activities that im- 3 plement the Culturally and Linguistically Accessible 4 Standards (CLAS) standards as Improvement Activities 5 under the Quality Payment Program. 6 SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE- 7 DUCING DELIVERY AND PAYMENT MODELS. 8 (a) IN GENERAL.—The Center for Medicare and 9 Medicaid Innovation established under section 1115A of 10 the Social Security Act (42 U.S.C. 1315a) (in this section 11 referred to as the ‘‘CMI’’) shall establish a dedicated fund 12 to identify, test, evaluate, and scale delivery and payment 13 models under the applicable titles (as defined in subsection 14 (a)(4)(B) of such section) that target health disparities 15 among racial and ethnic minorities, including models that 16 support high-value non-medical services that address so- 17 cially determined barriers to health, including English pro- 18 ficiency status, low health literacy, and case management, 19 transportation, and enrollment assistance needs, which 20 will help to reduce disparities and impact the overall cost 21 of care. 22 (b) PILOT PROGRAMS.—The CMI shall prioritize the 23 testing of models under such section 1115A that include 24 partnerships with entities, including community based or- 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 304 •S 3660 IS ganizations or other non-profit entities, to help address 1 socially determined barriers to health and health care. 2 (c) ALTERNATIVES.—Any model tested by the CMI 3 under such 1115A shall include measures to assess and 4 track the impact of the model on health disparities, using 5 existing measures such as the Healthcare Disparities and 6 Cultural Competency Measures endorsed by the entity 7 with a contract under section 1890(a) of the Social Secu- 8 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 9 ethnicity, English proficiency, gender identity, sexual ori- 10 entation, and disability status. 11 SEC. 444. SUPPORTING SAFETY NET AND COMMUNITY- 12 BASED PROVIDERS TO COMPETE IN VALUE- 13 BASED PAYMENT SYSTEMS. 14 (a) IN GENERAL.—Any pay-for-performance or alter- 15 native payment model that is developed and tested by the 16 Center for Medicare and Medicaid Innovation established 17 under section 1115A of the Social Security Act (42 U.S.C. 18 1315a), or any other agency of the Department of Health 19 and Human Services with respect to the programs under 20 titles XVIII, XIX, or XXI of such Act, shall be assessed 21 for potential impact on safety net, community based, and 22 critical access providers, including Federally qualified 23 health centers. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 305 •S 3660 IS (b) NEW MODELS.—The rollout of any such models 1 shall include training and additional up front resources for 2 community based and safety net providers to enable those 3 providers to participate in the model. 4 Subtitle D—Health Empowerment 5 Zones 6 SEC. 451. SHORT TITLE. 7 This subtitle may be cited as the ‘‘Health Empower- 8 ment Zone Act of 2018’’. 9 SEC. 452. FINDINGS. 10 Congress finds the following: 11 (1) Numerous studies and reports, including 12 the 2015 National Healthcare Quality and Dispari- 13 ties Report of the Agency for Healthcare Research 14 and Quality and the 2002 report of the Institute of 15 Medicine entitled ‘‘Unequal Treatment: Confronting 16 Racial and Ethnic Disparities in Health Care’’, doc- 17 ument the extensiveness to which health disparities 18 exist across the country. 19 (2) These studies have found that, on average, 20 racial and ethnic minorities are disproportionately 21 afflicted with chronic and acute conditions—such as 22 cancer, diabetes, musculoskeletal disease, obesity, 23 and hypertension—and suffer worse health out- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 306 •S 3660 IS comes, worse health status, and higher mortality 1 rates than their White counterparts. 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 and health literacy, employment, race, 8 ethnicity, immigration status, geography, and lan- 9 guage preference—that directly and indirectly affect 10 the health, health care, and wellness of individuals 11 and communities. 12 (4) Integrally involving and fully supporting the 13 communities most affected by health inequities in 14 the assessment, planning, launch, and evaluation of 15 health disparity elimination efforts are among the 16 leading recommendations made to adequately ad- 17 dress and ultimately reduce health disparities. 18 (5) Recommendations also include supporting 19 the efforts of community stakeholders from a broad 20 cross section—including local businesses, local de- 21 partments of commerce, education, labor, urban 22 planning, and transportation, and community-based 23 and other nonprofit organizations, including national 24 and regional intermediaries with demonstrated ca- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 307 •S 3660 IS pacity to serve low-income urban communities—to 1 find areas of common ground around health dis- 2 parity elimination and collaborate to improve the 3 overall health and wellness of a community and its 4 residents. 5 SEC. 453. DESIGNATION OF HEALTH EMPOWERMENT 6 ZONES. 7 (a) IN GENERAL.—The Secretary may, at the request 8 of an eligible community partnership described in sub- 9 section (b)(1), designate an eligible area described in sub- 10 section (b)(2) as a health empowerment zone for the pur- 11 pose of eligibility for a grant under section 455. 12 (b) ELIGIBILITY CRITERIA.— 13 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 14 community partnership is eligible to submit a re- 15 quest under this section if the partnership— 16 (A) demonstrates widespread public sup- 17 port from key individuals and entities in the eli- 18 gible area, including members of the target 19 community, State and local governments, non- 20 profit organizations including national and re- 21 gional intermediaries with demonstrated capac- 22 ity to serve low-income urban communities, and 23 community and industry leaders, for designa- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 308 •S 3660 IS tion of the eligible area as a health empower- 1 ment zone; and 2 (B) includes representatives of— 3 (i) a broad cross section of stake- 4 holders and residents from communities in 5 the eligible area experiencing dispropor- 6 tionate disparities in health status and 7 health care; and 8 (ii) organizations, facilities, and insti- 9 tutions that have a history of working 10 within and serving such communities. 11 (2) ELIGIBLE AREA.—An area is eligible to be 12 designated as a health empowerment zone under this 13 section if one or more communities in the area expe- 14 rience disproportionate disparities in health status 15 and health care. In determining whether a commu- 16 nity experiences such disparities, the Secretary shall 17 consider data collected by the Department of Health 18 and Human Services focusing on the following areas: 19 (A) Access to affordable, high-quality 20 health services. 21 (B) The prevalence of disproportionate 22 rates of certain illnesses or diseases including 23 the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 309 •S 3660 IS (i) Arthritis, osteoporosis, chronic 1 back conditions, and other musculoskeletal 2 diseases. 3 (ii) Cancer. 4 (iii) Chronic kidney disease. 5 (iv) Diabetes. 6 (v) Injury (intentional and uninten- 7 tional). 8 (vi) Violence (intimate and non- 9 intimate). 10 (vii) Maternal and paternal illnesses 11 and diseases. 12 (viii) Infant mortality. 13 (ix) Mental illness and other disabil- 14 ities. 15 (x) Substance use disorder treatment 16 and prevention, including underage drink- 17 ing. 18 (xi) Nutrition, obesity, and overweight 19 conditions. 20 (xii) Heart disease. 21 (xiii) Hypertension. 22 (xiv) Cerebrovascular disease or 23 stroke. 24 (xv) Tuberculosis. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 310 •S 3660 IS (xvi) HIV/AIDS and other sexually 1 transmitted infections. 2 (xvii) Viral hepatitis. 3 (xviii) Asthma. 4 (xix) Tooth decay and other oral 5 health issues. 6 (C) Within the community, the historical 7 and persistent presence of conditions that have 8 been found to contribute to health disparities 9 including any such conditions respecting any of 10 the following: 11 (i) Poverty. 12 (ii) Educational status and the quality 13 of community schools. 14 (iii) Income. 15 (iv) Access to high-quality affordable 16 health care. 17 (v) Work and work environment. 18 (vi) Environmental conditions in the 19 community, including with respect to clean 20 water, clean air, and the presence or ab- 21 sence of pollutants. 22 (vii) Language and English pro- 23 ficiency. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 311 •S 3660 IS (viii) Access to affordable healthy 1 food. 2 (ix) Access to ethnically and culturally 3 diverse health and human service providers 4 and practitioners. 5 (x) Access to culturally and linguis- 6 tically competent health and human serv- 7 ices and health and human service pro- 8 viders. 9 (xi) Health-supporting infrastructure. 10 (xii) Health insurance that is ade- 11 quate and affordable. 12 (xiii) Race, racism, and bigotry (con- 13 scious and unconscious). 14 (xiv) Sexual orientation. 15 (xv) Health literacy. 16 (xvi) Place of residence (such as 17 urban areas, rural areas, and reservations 18 of Indian tribes). 19 (xvii) Stress. 20 (c) PROCEDURE.— 21 (1) REQUEST.—A request under subsection (a) 22 shall— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 312 •S 3660 IS (A) describe the bounds of the area to be 1 designated as a health empowerment zone and 2 the process used to select those bounds; 3 (B) demonstrate that the partnership sub- 4 mitting the request is an eligible community 5 partnership described in subsection (b)(1); 6 (C) demonstrate that the area is an eligible 7 area described in subsection (b)(2); 8 (D) include a comprehensive assessment of 9 disparities in health status and health care ex- 10 perience by one or more communities in the 11 area; 12 (E) set forth— 13 (i) a vision and a set of values for the 14 area; and 15 (ii) a comprehensive and holistic set of 16 goals to be achieved in the area through 17 designation as a health empowerment zone; 18 and 19 (F) include a strategic plan and an action 20 plan for achieving the goals described in sub- 21 paragraph (E)(ii). 22 (2) APPROVAL.—Not later than 60 days after 23 the receipt of a request for designation of an area 24 as a health empowerment zone under this section, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 313 •S 3660 IS the Secretary shall approve or disapprove the re- 1 quest. 2 (d) MINIMUM NUMBER.—The Secretary— 3 (1) shall designate not more than 110 health 4 empowerment zones under this section; and 5 (2) shall designate at least one health empower- 6 ment zone in each of the several States, the District 7 of Columbia, and each territory or possession of the 8 United States. 9 SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 10 At the request of any organization or entity seeking 11 to submit a request under section 453(a), the Secretary 12 shall provide technical assistance, and may award a grant, 13 to assist such organization or entity— 14 (1) to form an eligible community partnership 15 described in section 453(b)(1); 16 (2) to complete a health assessment, including 17 an assessment of health disparities under section 18 453(c)(1)(D); or 19 (3) to prepare and submit a request, including 20 a strategic plan, in accordance with section 453. 21 SEC. 455. BENEFITS OF DESIGNATION. 22 (a) PRIORITY.—In awarding a grant under sub- 23 section (b), a Federal official shall give priority to any ap- 24 plicant that— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 314 •S 3660 IS (1) meets the eligibility criteria for the grant; 1 (2) proposes to use the grant for activities in a 2 health empowerment zone; and 3 (3) demonstrates that such activities will di- 4 rectly and significantly further the goals of the stra- 5 tegic plan approved for such zone under section 453. 6 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 7 STRATEGIC PLAN.— 8 (1) IN GENERAL.—Upon designating an eligible 9 area as a health empowerment zone at the request 10 of an eligible community partnership, the Secretary 11 shall, subject to the availability of appropriations, 12 make a grant to the community partnership for im- 13 plementation of the strategic plan for such zone. 14 (2) GRANT PERIOD.—A grant under paragraph 15 (1) for a health empowerment zone shall be for a pe- 16 riod of 2 years and may be renewed, except that the 17 total period of grants under paragraph (1) for such 18 zone may not exceed 10 years. 19 (3) LIMITATION.—In awarding grants under 20 this subsection, the Secretary shall not give less pri- 21 ority to an applicant or reduce the amount of a 22 grant because the Secretary rendered technical as- 23 sistance or made a grant to the same applicant 24 under section 454. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 315 •S 3660 IS (4) REPORTING.—The Secretary shall establish 1 metrics for measuring the progress of grantees 2 under this subsection and, based on such metrics, 3 require each such grantee to report to the Secretary 4 not less than every 6 months on the progress in im- 5 plementing the strategic plan for the health em- 6 powerment zone. 7 SEC. 456. DEFINITION OF SECRETARY. 8 In this subtitle, the term ‘‘Secretary’’ means the Sec- 9 retary of Health and Human Services, acting through the 10 Administrator of the Health Resources and Services Ad- 11 ministration and the Deputy Assistant Secretary for Mi- 12 nority Health, and in cooperation with the Director of the 13 Office of Community Services and the Director of the Na- 14 tional Institute on Minority Health and Health Dispari- 15 ties. 16 SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 17 To carry out this subtitle, there is authorized to be 18 appropriated $100,000,000 for fiscal year 2019. 19 Subtitle E—At-Risk Community 20 Coverage 21 SEC. 461. MEDICAID COVERAGE FOR CITIZENS OF FREELY 22 ASSOCIATED STATES. 23 (a) IN GENERAL.—Section 402(b)(2) of the Personal 24 Responsibility and Work Opportunity Reconciliation Act 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 316 •S 3660 IS of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 1 the end the following new subparagraph: 2 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 3 OF FREELY ASSOCIATED STATES.—With respect 4 to eligibility for benefits for the designated Fed- 5 eral program described in paragraph (3)(C), 6 section 401(a) and paragraph (1) shall not 7 apply to any individual who lawfully resides in 8 1 of the 50 States or the District of Columbia 9 in accordance with the Compacts of Free Asso- 10 ciation between the Government of the United 11 States and the Governments of the Federated 12 States of Micronesia, the Republic of the Mar- 13 shall Islands, and the Republic of Palau and 14 shall not apply, at the option of the Governors 15 of Puerto Rico, the Virgin Islands, Guam, the 16 Northern Mariana Islands, or American Samoa, 17 respectively, as communicated to the Secretary 18 of Health and Human Services in writing, to 19 any individual who lawfully resides in the re- 20 spective territory in accordance with such Com- 21 pacts.’’. 22 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 23 Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend- 24 ed— 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 317 •S 3660 IS (1) in paragraph (1), by striking ‘‘or’’ at the 1 end; 2 (2) in paragraph (2), by striking the period at 3 the end and inserting ‘‘; or’’; and 4 (3) by adding at the end the following new 5 paragraph: 6 ‘‘(3) an individual described in section 7 402(b)(2)(G), but only with respect to the des- 8 ignated Federal program described in section 9 402(b)(3)(C).’’. 10 (c) DEFINITION OF QUALIFIED ALIEN.—Section 11 431(b) of such Act (8 U.S.C. 1641(b)) is amended— 12 (1) in paragraph (6), by striking ‘‘; or’’ at the 13 end and inserting a comma; 14 (2) in paragraph (7), by striking the period at 15 the end and inserting ‘‘, or’’; and 16 (3) by adding at the end the following new 17 paragraph: 18 ‘‘(8) an individual who lawfully resides in the 19 United States in accordance with a Compact of Free 20 Association referred to in section 402(b)(2)(G), but 21 only with respect to the designated Federal program 22 described in section 402(b)(3)(C) (relating to the 23 Medicaid program).’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 318 •S 3660 IS (d) EFFECTIVE DATE.—The amendments made by 1 this section take effect on October 1, 2018. 2 SEC. 462. AT-RISK YOUTH MEDICAID PROTECTION. 3 (a) IN GENERAL.—Section 1902 of the Social Secu- 4 rity Act (42 U.S.C. 1396a), as amended by section 5 431(d)(2), is further amended— 6 (1) in subsection (a)— 7 (A) by striking ‘‘and’’ at the end of para- 8 graph (83); 9 (B) by striking the period at the end of 10 paragraph (84) and inserting ‘‘; and’’; and 11 (C) by inserting after paragraph (84) the 12 following new paragraph: 13 ‘‘(85) provide that— 14 ‘‘(A) the State shall not terminate eligi- 15 bility for medical assistance under a State plan 16 for an individual who is an eligible juvenile (as 17 defined in subsection (nn)(2)) because the juve- 18 nile is an inmate of a public institution (as de- 19 fined in subsection (nn)(3)), but may suspend 20 coverage during the period the juvenile is such 21 an inmate; 22 ‘‘(B) the State shall restore coverage for 23 such medical assistance to such an individual 24 upon the individual’s release from any such 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 319 •S 3660 IS public institution, without requiring a new ap- 1 plication from the individual, unless (and until 2 such date as) there is a determination that the 3 individual no longer meets the eligibility re- 4 quirements for such medical assistance; and 5 ‘‘(C) the State shall process any applica- 6 tion for medical assistance submitted by, or on 7 behalf of, a juvenile who is an inmate of a pub- 8 lic institution notwithstanding that the juvenile 9 is such an inmate.’’; and 10 (2) by adding at the end the following new sub- 11 section: 12 ‘‘(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC IN- 13 STITUTION.—For purposes of subsection (a)(84) and this 14 subsection: 15 ‘‘(1) JUVENILE.—The term ‘juvenile’ means an 16 individual who is— 17 ‘‘(A) under 21 years of age; or 18 ‘‘(B) is described in subsection 19 (a)(10)(A)(i)(IX). 20 ‘‘(2) ELIGIBLE JUVENILE.—The term ‘eligible 21 juvenile’ means a juvenile who is an inmate of a 22 public institution and was eligible for medical assist- 23 ance under the State plan immediately before be- 24 coming an inmate of such a public institution or who 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 320 •S 3660 IS becomes eligible for such medical assistance while an 1 inmate of a public institution. 2 ‘‘(3) INMATE OF A PUBLIC INSTITUTION.—The 3 term ‘inmate of a public institution’ has the meaning 4 given such term for purposes of applying the sub- 5 division (A) following paragraph (30) of section 6 1905(a), taking into account the exception in such 7 subdivision for a patient of a medical institution.’’. 8 (b) NO CHANGE IN EXCLUSION FROM MEDICAL AS- 9 SISTANCE FOR INMATES OF PUBLIC INSTITUTIONS.— 10 Nothing in this section shall be construed as changing the 11 exclusion from medical assistance under the subdivision 12 (A) following paragraph (30) of section 1905(a) of the So- 13 cial Security Act (42 U.S.C. 1396d(a)), including any ap- 14 plicable restrictions on a State submitting claims for Fed- 15 eral financial participation under title XIX of such Act 16 for such assistance. 17 (c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BE- 18 FORE ADJUDICATION OR SENTENCING.—Nothing in this 19 section shall be construed to mandate, encourage, or sug- 20 gest that a State suspend or terminate coverage for indi- 21 viduals before they have been adjudicated or sentenced. 22 (d) EFFECTIVE DATE.— 23 (1) IN GENERAL.—Except as provided in para- 24 graph (2), the amendments made by subsection (a) 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 321 •S 3660 IS shall apply to eligibility for medical assistance under 1 a State plan under title XIX of the Social Security 2 Act of juveniles who become inmates of public insti- 3 tutions on or after the date that is 1 year after the 4 date of the enactment of this Act. 5 (2) RULE FOR CHANGES REQUIRING STATE 6 LEGISLATION.—In the case of a State plan for med- 7 ical assistance under title XIX of the Social Security 8 Act which the Secretary of Health and Human Serv- 9 ices determines requires State legislation (other than 10 legislation appropriating funds) in order for the plan 11 to meet the additional requirements imposed by the 12 amendments made by subsection (a), the State plan 13 shall not be regarded as failing to comply with the 14 requirements of such title solely on the basis of its 15 failure to meet these additional requirements before 16 the first day of the first calendar quarter beginning 17 after the close of the first regular session of the 18 State legislature that begins after the date of the en- 19 actment of this Act. For purposes of the previous 20 sentence, in the case of a State that has a 2-year 21 legislative session, each year of such session shall be 22 deemed to be a separate regular session of the State 23 legislature. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 322 •S 3660 IS TITLE V—IMPROVING HEALTH 1 OUTCOMES FOR WOMEN, 2 CHILDREN, AND FAMILIES 3 Subtitle A—In General 4 SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDER- 5 SERVED COMMUNITIES. 6 Part Q of title III of the Public Health Service Act 7 (42 U.S.C. 280g et seq.) is amended by adding at the end 8 the following: 9 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER- 10 SERVED COMMUNITIES. 11 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 12 laboration with the Administrator of the Health Resources 13 and Services Administration and other Federal officials 14 determined appropriate by the Secretary, is authorized to 15 award grants to eligible entities— 16 ‘‘(1) to promote health for underserved commu- 17 nities, with preference given to projects that benefit 18 racial and ethnic minority women, racial and ethnic 19 minority children, adolescents, and lesbian, gay, bi- 20 sexual, transgender, queer, or questioning commu- 21 nities; and 22 ‘‘(2) to strengthen health outreach initiatives in 23 medically underserved communities, including lin- 24 guistically isolated populations. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 323 •S 3660 IS ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 1 subsection (a) may be used to support the activities of 2 community health workers, including such activities— 3 ‘‘(1) to educate and provide outreach regarding 4 enrollment in health insurance including the State 5 Children’s Health Insurance Program under title 6 XXI of the Social Security Act, Medicare under title 7 XVIII of such Act, and Medicaid under title XIX of 8 such Act; 9 ‘‘(2) to educate and provide outreach in a com- 10 munity setting regarding health problems prevalent 11 among underserved communities, and especially 12 among racial and ethnic minority women, racial and 13 ethnic minority children, adolescents, and lesbian, 14 gay, bisexual, transgender, queer, or questioning 15 communities; 16 ‘‘(3) to educate and provide experiential learn- 17 ing opportunities and target risk factors and healthy 18 behaviors that impede or contribute to achieving 19 positive health outcomes, including— 20 ‘‘(A) healthy nutrition; 21 ‘‘(B) physical activity; 22 ‘‘(C) overweight or obesity; 23 ‘‘(D) tobacco use; 24 ‘‘(E) alcohol and substance use; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 324 •S 3660 IS ‘‘(F) injury and violence; 1 ‘‘(G) sexual health; 2 ‘‘(H) mental health; 3 ‘‘(I) musculoskeletal health and arthritis; 4 ‘‘(J) dental and oral health; 5 ‘‘(K) understanding informed consent; and 6 ‘‘(L) stigma; 7 ‘‘(4) to promote community wellness and aware- 8 ness; and 9 ‘‘(5) to educate and refer target populations to 10 appropriate health care agencies and community- 11 based programs and organizations in order to in- 12 crease access to quality health care services, includ- 13 ing preventive health services. 14 ‘‘(c) APPLICATION.— 15 ‘‘(1) IN GENERAL.—Each eligible entity that 16 desires to receive a grant under subsection (a) shall 17 submit an application to the Secretary, at such time, 18 in such manner, and accompanied by such additional 19 information as the Secretary may require. 20 ‘‘(2) CONTENTS.—Each application submitted 21 pursuant to paragraph (1) shall— 22 ‘‘(A) describe the activities for which as- 23 sistance under this section is sought; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 325 •S 3660 IS ‘‘(B) contain an assurance that, with re- 1 spect to each community health worker pro- 2 gram receiving funds under the grant awarded, 3 such program provides in-language training and 4 supervision to community health workers to en- 5 able such workers to provide authorized pro- 6 gram activities in (at least) the most commonly 7 used languages within a particular geographic 8 region; 9 ‘‘(C) contain an assurance that the appli- 10 cant will evaluate the effectiveness of commu- 11 nity health worker programs receiving funds 12 under the grant; 13 ‘‘(D) contain an assurance that each com- 14 munity health worker program receiving funds 15 under the grant will provide culturally com- 16 petent services in the linguistic context most 17 appropriate for the individuals served by the 18 program; 19 ‘‘(E) contain a plan to document and dis- 20 seminate project descriptions and results to 21 other States and organizations as identified by 22 the Secretary; and 23 ‘‘(F) describe plans to enhance the capac- 24 ity of individuals to utilize health services and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 326 •S 3660 IS health-related social services under Federal, 1 State, and local programs by— 2 ‘‘(i) assisting individuals in estab- 3 lishing eligibility under the programs and 4 in receiving the services or other benefits 5 of the programs; and 6 ‘‘(ii) providing other services, as the 7 Secretary determines to be appropriate, 8 which may include transportation and 9 translation services. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Secretary shall give priority to those appli- 12 cants— 13 ‘‘(1) who propose to target geographic areas 14 that— 15 ‘‘(A)(i) have a high percentage of residents 16 who are uninsured or underinsured (if the tar- 17 geted geographic area is located in a State that 18 has elected to make medical assistance available 19 under section 1902(a)(10)(A)(i)(VIII) of the 20 Social Security Act to individuals described in 21 such section); 22 ‘‘(ii) have a high percentage of under- 23 insured residents in a particular geographic 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 327 •S 3660 IS area (if the targeted geographic area is located 1 in a State that has not so elected); or 2 ‘‘(iii) have a high number of households ex- 3 periencing extreme poverty; and 4 ‘‘(B) have a high percentage of families for 5 whom English is not their primary language or 6 including smaller limited-English-proficient 7 communities within the region that are not oth- 8 erwise reached by linguistically appropriate 9 health services; 10 ‘‘(2) with experience in providing health or 11 health-related social services to individuals who are 12 underserved with respect to such services; and 13 ‘‘(3) with documented community activity and 14 experience with community health workers. 15 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 16 TIONS.—The Secretary shall encourage community health 17 worker programs receiving funds under this section to col- 18 laborate with academic institutions, including minority- 19 serving institutions. Nothing in this section shall be con- 20 strued to require such collaboration. 21 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 22 NESS.—The Secretary shall establish guidelines for ensur- 23 ing the quality of the training and supervision of commu- 24 nity health workers under the programs funded under this 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 328 •S 3660 IS section and for ensuring the cost effectiveness of such pro- 1 grams. 2 ‘‘(g) MONITORING.—The Secretary shall monitor 3 community health worker programs identified in approved 4 applications and shall determine whether such programs 5 are in compliance with the guidelines established under 6 subsection (f). 7 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 8 provide technical assistance to community health worker 9 programs identified in approved applications with respect 10 to planning, developing, and operating programs under the 11 grant. 12 ‘‘(i) REPORT TO CONGRESS.— 13 ‘‘(1) IN GENERAL.—Not later than 4 years 14 after the date on which the Secretary first awards 15 grants under subsection (a), the Secretary shall sub- 16 mit to Congress a report regarding the grant 17 project. 18 ‘‘(2) CONTENTS.—The report required under 19 paragraph (1) shall include the following: 20 ‘‘(A) A description of the programs for 21 which grant funds were used. 22 ‘‘(B) The number of individuals served. 23 ‘‘(C) An evaluation of— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 329 •S 3660 IS ‘‘(i) the effectiveness of these pro- 1 grams; 2 ‘‘(ii) the cost of these programs; and 3 ‘‘(iii) the impact of these programs on 4 the health outcomes of the community resi- 5 dents. 6 ‘‘(D) Recommendations for sustaining the 7 community health worker programs developed 8 or assisted under this section. 9 ‘‘(E) Recommendations regarding training 10 to enhance career opportunities for community 11 health workers. 12 ‘‘(j) DEFINITIONS.—In this section: 13 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 14 ‘community health worker’ means an individual who 15 promotes health or nutrition within the community 16 in which the individual resides— 17 ‘‘(A) by serving as a liaison between com- 18 munities and health care agencies; 19 ‘‘(B) by providing guidance and social as- 20 sistance to community residents; 21 ‘‘(C) by enhancing community residents’ 22 ability to effectively communicate with health 23 care providers; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 330 •S 3660 IS ‘‘(D) by providing culturally and linguis- 1 tically appropriate health or nutrition edu- 2 cation; 3 ‘‘(E) by advocating for individual and com- 4 munity health, including dental, oral, mental, 5 and environmental health, or nutrition needs; 6 ‘‘(F) by taking into consideration the 7 needs of the communities served, including the 8 prevalence rates of risk factors that impede 9 achieving positive healthy outcomes among 10 women and children, especially among racial 11 and ethnic minority women and children; and 12 ‘‘(G) by providing referral and followup 13 services. 14 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 15 nity setting’ means a home or a community organi- 16 zation that serves a population. 17 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 18 tity’ means— 19 ‘‘(A) a unit of State, territorial, local, or 20 Tribal government (including a federally recog- 21 nized Tribe or Alaska Native village); or 22 ‘‘(B) a community-based organization. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 331 •S 3660 IS ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 1 The term ‘medically underserved community’ means 2 a community— 3 ‘‘(A) that has a substantial number of in- 4 dividuals who are members of a medically un- 5 derserved population, as defined by section 6 330(b)(3); 7 ‘‘(B) a significant portion of which is a 8 health professional shortage area as designated 9 under section 332; and 10 ‘‘(C) that includes populations that are lin- 11 guistically isolated, such as geographic areas 12 with a shortage of health professionals able to 13 provide linguistically appropriate services. 14 ‘‘(5) SUPPORT.—The term ‘support’ means the 15 provision of training, supervision, and materials 16 needed to effectively deliver the services described in 17 subsection (b), reimbursement for services, and 18 other benefits. 19 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 $15,000,000 for each of fiscal years 2019 through 2023.’’. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 332 •S 3660 IS SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 1 TRITION ASSISTANCE FOR CHILDREN, PREG- 2 NANT PERSONS, AND LAWFULLY PRESENT IN- 3 DIVIDUALS. 4 (a) MEDICAID.—Section 1903(v) of the Social Secu- 5 rity Act (42 U.S.C. 1396b(v)) is amended by striking 6 paragraph (4) and inserting the following new paragraph: 7 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 8 403, and 421 of the Personal Responsibility and Work Op- 9 portunity Reconciliation Act of 1996 and paragraph (1), 10 payment shall be made to a State under this section for 11 medical assistance furnished to an alien under this title 12 (including an alien described in such paragraph) who 13 meets any of the following conditions: 14 ‘‘(i) The alien is otherwise eligible for such as- 15 sistance under the State plan approved under this 16 title (other than the requirement of the receipt of 17 aid or assistance under title IV, supplemental secu- 18 rity income benefits under title XVI, or a State sup- 19 plementary payment) within either or both of the 20 following eligibility categories: 21 ‘‘(I) Children under 21 years of age, in- 22 cluding any optional targeted low-income child 23 (as such term is defined in section 24 1905(u)(2)(B)). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 333 •S 3660 IS ‘‘(II) Pregnant persons during pregnancy 1 and during the 60-day period beginning on the 2 last day of the pregnancy. 3 ‘‘(ii) The alien is lawfully present in the United 4 States. 5 ‘‘(B) No debt shall accrue under an affidavit of sup- 6 port against any sponsor of an alien who meets the condi- 7 tions specified in subparagraph (A) on the basis of the 8 provision of medical assistance to such alien under this 9 paragraph and the cost of such assistance shall not be con- 10 sidered as an unreimbursed cost.’’. 11 (b) SCHIP.—Subparagraph (N) of section 12 2107(e)(1) of the Social Security Act (42 U.S.C. 13 1397gg(e)(1)) is amended to read as follows: 14 ‘‘(N) Paragraph (4) of section 1903(v) (re- 15 lating to coverage of categories of children, 16 pregnant persons, and other lawfully present in- 17 dividuals).’’. 18 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 19 withstanding sections 401(a), 402(a), and 403(a) of the 20 Personal Responsibility and Work Opportunity Reconcili- 21 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 22 and section 6(f) of the Food and Nutrition Act of 2008 23 (7 U.S.C. 2015(f)), persons who are lawfully present in 24 the United States shall be not be ineligible for benefits 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 334 •S 3660 IS under the supplemental nutrition assistance program on 1 the basis of their immigration status or date of entry into 2 the United States. 3 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 4 Section 421(d)(3) of the Personal Responsibility and 5 Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 6 1631(d)(3)) is amended by striking ‘‘to the extent that 7 a qualified alien is eligible under section 402(a)(2)(J)’’ 8 and inserting, ‘‘to the extent that a child is a member of 9 a household under the supplemental nutrition assistance 10 program’’. 11 (e) ENSURING PROPER SCREENING.—Section 12 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 13 U.S.C. 2020(e)(2)(B)) is amended— 14 (1) by redesignating clauses (vi) and (vii) as 15 clauses (vii) and (viii); and 16 (2) by inserting after clause (v) the following: 17 ‘‘(vi) shall provide a method for imple- 18 menting section 421 of the Personal Re- 19 sponsibility and Work Opportunity Rec- 20 onciliation Act of 1996 (8 U.S.C. 1631) 21 that does not require any unnecessary in- 22 formation from persons who may be ex- 23 empt from that provision;’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 335 •S 3660 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 ‘‘for—’’ and 5 all that follows and inserting ‘‘for assistance under 6 any State program funded under part A of title IV 7 of the Social Security Act (42 U.S.C. 601 et seq.).’’; 8 (2) in subsection (b)— 9 (A) by striking ‘‘(1) PROGRAM OF TEM- 10 PORARY ASSISTANCE FOR NEEDY FAMILIES.—’’; 11 and 12 (B) by striking paragraph (2); and 13 (3) in subsection (e), by striking ‘‘it—’’ and all 14 that follows and inserting ‘‘the term in section 15 419(5) of the Social Security Act (42 U.S.C. 16 619(5)) when referring to assistance provided under 17 a State program funded under paragraph A of title 18 IV of the Social Security Act (42 U.S.C. 601 et 19 seq.).’’. 20 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 21 AND AWARENESS. 22 (a) IN GENERAL.—The Secretary shall establish and 23 implement a birth defects prevention and public awareness 24 program, consisting of the activities described in sub- 25 sections (c) and (d). 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 336 •S 3660 IS (b) DEFINITIONS.—In this section: 1 (1) MATERNAL.—The term ‘‘maternal’’ refers 2 to persons who are pregnant or breastfeeding of all 3 gender identities. 4 (2) PREGNANCY AND BREASTFEEDING INFOR- 5 MATION SERVICES.—The term ‘‘pregnancy and 6 breastfeeding information services’’ includes only— 7 (A) information services to provide accu- 8 rate, evidence-based, clinical information re- 9 garding maternal exposures during pregnancy 10 that may be associated with birth defects or 11 other health risks, such as exposures to medica- 12 tions, chemicals, infections, foodborne patho- 13 gens, illnesses, nutrition, or lifestyle factors; 14 (B) information services to provide accu- 15 rate, evidence-based, clinical information re- 16 garding maternal exposures during breast- 17 feeding that may be associated with health risks 18 to a breast-fed infant, such as exposures to 19 medications, chemicals, infections, foodborne 20 pathogens, illnesses, nutrition, or lifestyle fac- 21 tors; 22 (C) the provision of accurate, evidence- 23 based information weighing risks of exposures 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 337 •S 3660 IS during breastfeeding against the benefits of 1 breastfeeding; and 2 (D) the provision of information described 3 in subparagraph (A), (B), or (C) through coun- 4 selors, Websites, fact sheets, telephonic or elec- 5 tronic communication, community outreach ef- 6 forts, or other appropriate means. 7 (3) SECRETARY.—The term ‘‘Secretary’’ means 8 the Secretary of Health and Human Services, acting 9 through the Director of the Centers for Disease 10 Control and Prevention. 11 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 12 subsection (a), the Secretary shall conduct or support a 13 nationwide media campaign to increase awareness among 14 health care providers and at-risk populations about preg- 15 nancy and breastfeeding information services. 16 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 17 INFORMATION SERVICES.— 18 (1) IN GENERAL.—In carrying out subsection 19 (a), the Secretary shall award grants to State or re- 20 gional agencies or organizations for any of the fol- 21 lowing: 22 (A) INFORMATION SERVICES.—The provi- 23 sion of, or campaigns to increase awareness 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 338 •S 3660 IS about, pregnancy and breastfeeding information 1 services. 2 (B) SURVEILLANCE AND RESEARCH.—The 3 conduct or support of— 4 (i) surveillance of or research on— 5 (I) maternal exposures and ma- 6 ternal health conditions that may in- 7 fluence the risk of birth defects, pre- 8 maturity, or other adverse pregnancy 9 outcomes; and 10 (II) maternal exposures that may 11 influence health risks to a breastfed 12 infant; or 13 (ii) networking to facilitate surveil- 14 lance or research described in this sub- 15 paragraph. 16 (2) PREFERENCE FOR CERTAIN STATES.—The 17 Secretary, in making any grant under this sub- 18 section, shall give preference to States, otherwise 19 equally qualified, that have a pregnancy and 20 breastfeeding information service in place. 21 (3) MATCHING FUNDS.—The Secretary may 22 only award a grant under this subsection to a State 23 or regional agency or organization that agrees, with 24 respect to the costs to be incurred in carrying out 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 339 •S 3660 IS the grant activities, to make available (directly or 1 through donations from public or private entities) 2 non-Federal funds toward such costs in an amount 3 equal to not less than 25 percent of the amount of 4 the grant. 5 (4) COORDINATION.—The Secretary shall en- 6 sure that activities funded through a grant under 7 this subsection are coordinated, to the maximum ex- 8 tent practicable, with other birth defects prevention 9 and environmental health activities of the Federal 10 Government, including with respect to pediatric envi- 11 ronmental health specialty units and children’s envi- 12 ronmental health centers. 13 (e) EVALUATION.—In furtherance of the program 14 under subsection (a), the Secretary shall provide for an 15 evaluation of pregnancy and breastfeeding information 16 services to identify efficient and effective models of— 17 (1) providing information; 18 (2) raising awareness and increasing knowledge 19 about birth defects prevention measures and tar- 20 geting education to at-risk groups; 21 (3) modifying risk behaviors; or 22 (4) other outcome measures as determined ap- 23 propriate by the Secretary. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 340 •S 3660 IS (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 $5,000,000 for fiscal year 2019, $6,000,000 for fiscal year 3 2020, $7,000,000 for fiscal year 2021, $8,000,000 for fis- 4 cal year 2022, and $9,000,000 for fiscal year 2023. 5 SEC. 505. PREVENTING MATERNAL DEATHS. 6 (a) PROGRAM AUTHORIZED.— 7 (1) IN GENERAL.—The Secretary of Health and 8 Human Services, acting through the Director of the 9 Centers for Disease Control and Prevention, shall 10 establish a grant program under which the Secretary 11 may make grants to States for the purpose of— 12 (A) carrying out the activities described in 13 subsection (b)(1); 14 (B) establishing and sustaining a State 15 maternal mortality review committee, in accord- 16 ance with subsection (b)(2); 17 (C) ensuring that the State department of 18 health carries out the activities described in 19 subsection (b)(3); 20 (D) disseminating the case abstraction 21 form developed under subsection (c); and 22 (E) providing for the public disclosure of 23 information, in accordance with subsection (d). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 341 •S 3660 IS (2) CRITERIA.—The Secretary shall establish 1 criteria for determining eligibility for, and the 2 amount of a grant awarded to, a State under para- 3 graph (1). Such criteria shall provide that in the 4 case of a State that receives a grant under para- 5 graph (1) for a fiscal year and is determined by the 6 Secretary to have not used such grant in accordance 7 with this section, such State may not be eligible for 8 such a grant for any subsequent fiscal year. 9 (b) USE OF FUNDS.— 10 (1) REVIEW OF PREGNANCY-RELATED AND 11 PREGNANCY-ASSOCIATED DEATHS.—With respect to 12 a State that receives a grant under subsection 13 (a)(1), the following shall apply: 14 (A) PROCESS FOR MANDATORY REPORTING 15 OF PREGNANCY-RELATED AND PREGNANCY-AS- 16 SOCIATED DEATHS.— 17 (i) IN GENERAL.—The State, through 18 the State maternal mortality review com- 19 mittee established under subsection (a)(1), 20 shall develop a process that provides for 21 mandatory and confidential case reporting 22 to the State department of health by indi- 23 viduals and entities described in clause (ii) 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 342 •S 3660 IS with respect to pregnancy-related and 1 pregnancy-associated deaths. 2 (ii) INDIVIDUALS AND ENTITIES DE- 3 SCRIBED.—Individuals and entities de- 4 scribed in this clause include each of the 5 following: 6 (I) Health care professionals. 7 (II) Medical examiners. 8 (III) Medical coroners. 9 (IV) Hospitals. 10 (V) Birth centers. 11 (VI) Other health care facilities. 12 (VII) Other individuals respon- 13 sible for completing death records. 14 (VIII) Other appropriate individ- 15 uals or entities specified by the Sec- 16 retary. 17 (B) PROCESS FOR VOLUNTARY REPORTING 18 OF PREGNANCY-RELATED AND PREGNANCY-AS- 19 SOCIATED DEATHS.—The State, through the 20 State maternal mortality review committee es- 21 tablished under subsection (a)(1), shall develop 22 a process that provides for voluntary and con- 23 fidential case reporting to the State department 24 of health by family members of the deceased 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 343 •S 3660 IS and other individuals on possible pregnancy-re- 1 lated and pregnancy-associated deaths. Such 2 process shall include— 3 (i) making publicly available on the 4 website of the State department of health 5 a telephone number, Internet web link, and 6 email address for such reporting; and 7 (ii) publicizing to local professional or- 8 ganizations, community organizations, and 9 social services agencies the availability of 10 the telephone number, Internet web link, 11 and email address made available under 12 clause (i). 13 (C) IDENTIFICATION OF PREGNANCY-RE- 14 LATED AND PREGNANCY-ASSOCIATED DEATHS 15 BY STATE VITAL STATISTICS UNIT.—The State, 16 through the vital statistics unit of the State, 17 shall annually identify pregnancy-related and 18 pregnancy-associated deaths occurring in such 19 State in the year involved by— 20 (i) matching each death record of a 21 person in such year to a live birth certifi- 22 cate or an infant death record for the pur- 23 pose of identifying deaths of persons that 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 344 •S 3660 IS occurred during pregnancy and within one 1 year after the end of a pregnancy; 2 (ii) identifying each death of a person 3 reported during such year as having an un- 4 derlying or contributing cause of death re- 5 lated to pregnancy, regardless of the time 6 that has passed between the end of the 7 pregnancy and the death; 8 (iii) collecting data from medical ex- 9 aminer and coroner reports; and 10 (iv) using any other method the State 11 may devise to identify maternal deaths 12 such as reviewing a random sample of re- 13 ported deaths of persons who could have 14 been pregnant to ascertain cases of preg- 15 nancy-related and pregnancy-associated 16 deaths that are not discernable from a re- 17 view of death records alone. 18 For purposes of effectively collecting and ob- 19 taining data on pregnancy-related and preg- 20 nancy-associated deaths, the State shall adopt 21 the most recent standardized birth and death 22 records, as issued by the National Center for 23 Vital Health Statistics, including the rec- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 345 •S 3660 IS ommended checkbox section for pregnancy on 1 each death record. 2 (D) CASE INVESTIGATION AND DEVELOP- 3 MENT OF CASE SUMMARIES.— 4 (i) IN GENERAL.—Following the re- 5 ceipt of reports by the State department of 6 health pursuant to subparagraph (A) or 7 (B) and the collection of cases of preg- 8 nancy-related and pregnancy-associated 9 deaths by the vital statistics unit of the 10 State under subparagraph (C), the State, 11 through the State maternal mortality re- 12 view committee established under sub- 13 section (a)(1), shall investigate each case, 14 using the case abstraction form described 15 in subsection (c), and prepare a de-identi- 16 fied case summary for each case, which 17 shall be reviewed by the committee and in- 18 cluded in applicable reports. The State de- 19 partment of health or vital statistics unit 20 of the State, as the case may be, shall pro- 21 vide the State maternal mortality review 22 committee with access to the information 23 collected pursuant to subparagraph (A) or 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 346 •S 3660 IS (B), or under subparagraph (C), as nec- 1 essary to carry out this subparagraph. 2 (ii) MANDATORY DATA AND INFORMA- 3 TION.—Each case investigation under this 4 subparagraph shall, subject to availability, 5 include data and information obtained 6 through— 7 (I) medical examiner and autopsy 8 reports of the person involved; 9 (II) medical records of the per- 10 son, including such records related to 11 health care prior to pregnancy, pre- 12 natal and postnatal care, labor and 13 delivery care, emergency room care, 14 hospital discharge records, and any 15 care delivered up until the time of 16 death of the person; 17 (III) oral and written interviews 18 of individuals directly involved in the 19 maternal care of the person during 20 and immediately following the preg- 21 nancy of the person, including health 22 care, mental health, and social service 23 providers, as applicable; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 347 •S 3660 IS (IV) socioeconomic and other rel- 1 evant background information about 2 the person; 3 (V) any information collected 4 under subparagraph (C)(i); and 5 (VI) any other information on 6 the cause of death of the person, such 7 as social services and child welfare re- 8 ports. 9 (iii) DISCRETIONARY DATA AND IN- 10 FORMATION.—Each case investigation 11 under this subparagraph may include data 12 and information obtained through oral or 13 written interviews of the family of the per- 14 son. 15 (2) STATE MATERNAL MORTALITY REVIEW 16 COMMITTEES.— 17 (A) MANDATORY ACTIVITIES.—A State 18 maternal mortality review committee established 19 under subsection (a)(1) shall carry out the fol- 20 lowing activities: 21 (i) Develop the processes described in 22 subparagraphs (A) and (B) of paragraph 23 (1). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 348 •S 3660 IS (ii) Review the data and information 1 collected by the vital statistics unit of the 2 State under paragraph (1)(C) regarding 3 pregnancy-related and pregnancy-associ- 4 ated deaths to identify trends, patterns, 5 and disparities in adverse outcomes and 6 address medical, non-medical, and system- 7 related factors that may have contributed 8 to such pregnancy-related and pregnancy- 9 associated deaths and disparities. 10 (iii) Carry out the activities described 11 in paragraph (1)(D). 12 (iv) Develop recommendations, based 13 on the case summaries prepared under 14 paragraph (1)(D) and the data and infor- 15 mation collected under paragraph (1)(C), 16 to improve maternal care, social and health 17 services, and public health policy and insti- 18 tutions, including improving access to ma- 19 ternal care and social and health services 20 and identifying disparities in maternal care 21 and outcomes. 22 (B) DISCRETIONARY ACTIVITIES.— 23 (i) IN GENERAL.—A State maternal 24 mortality review committee established 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 349 •S 3660 IS under subsection (a)(1) may, while subject 1 to confidentiality requirements, present 2 findings and recommendations based on 3 the case summaries prepared under para- 4 graph (1)(D) directly to a health care facil- 5 ity or its local or State professional organi- 6 zation for the purpose of— 7 (I) instituting policy changes, 8 educational activities, and improve- 9 ments in the quality of care provided 10 by the facility; and 11 (II) exploring and forming re- 12 gional collaborations. 13 (ii) INVESTIGATION OF CASES OF SE- 14 VERE MATERNAL MORBIDITY.—A State 15 maternal mortality review committee may 16 investigate cases of severe maternal mor- 17 bidity and any such investigation may in- 18 clude data and information obtained 19 through— 20 (I) identified patient registries; 21 or 22 (II) oral or written interviews of 23 the person concerned and the family 24 of such person. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 350 •S 3660 IS (C) COMPOSITION OF STATE MATERNAL 1 MORTALITY REVIEW COMMITTEES.— 2 (i) IN GENERAL.—A State maternal 3 mortality review committee established 4 under subsection (a)(1) shall be multidisci- 5 plinary and diverse. Membership on the 6 State maternal mortality review committee 7 shall be reviewed annually by the State de- 8 partment of health to ensure that member- 9 ship representation requirements are being 10 fulfilled in accordance with this subpara- 11 graph. 12 (ii) REQUIRED MEMBERSHIP.—Each 13 State maternal mortality review committee 14 shall include— 15 (I) representatives from medical 16 specialties providing care to pregnant 17 and postpartum patients, including 18 obstetricians (including generalists 19 and maternal fetal medicine special- 20 ists) and family practice physicians; 21 (II) certified nurse midwives, cer- 22 tified midwives, and advanced practice 23 nurses; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 351 •S 3660 IS (III) hospital-based registered 1 nurses; 2 (IV) representatives of the ma- 3 ternal and child health department of 4 the State department of health; 5 (V) social service providers or so- 6 cial workers, including those with ex- 7 perience working with communities di- 8 verse with respect to race, ethnicity, 9 and limited-English proficiency; 10 (VI) chief medical examiners or 11 designees; 12 (VII) facility representatives, 13 such as from hospitals or birth cen- 14 ters; 15 (VIII) patient advocates, commu- 16 nity maternal health organizations, 17 and minority advocacy groups that 18 represent those diverse racial and eth- 19 nic communities within the State that 20 are the most affected by pregnancy- 21 related or pregnancy-associated deaths 22 and by a lack of access to maternal 23 health care services; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 352 •S 3660 IS (IX) representatives of the de- 1 partments of health or public health 2 of major cities in the State. 3 (iii) DISCRETIONARY MEMBERSHIP.— 4 Each State maternal mortality review com- 5 mittee may also include representatives 6 from other relevant academic, health, so- 7 cial service, or policy professions or com- 8 munity organizations on an ongoing basis, 9 or as needed, as determined beneficial by 10 the committee, including— 11 (I) anesthesiologists; 12 (II) emergency physicians; 13 (III) pathologists; 14 (IV) epidemiologists; 15 (V) intensivists; 16 (VI) nutritionists; 17 (VII) mental health professionals; 18 (VIII) substance use disorder 19 treatment specialists; 20 (IX) representatives of relevant 21 patient and provider advocacy groups; 22 (X) academics; 23 (XI) paramedics; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 353 •S 3660 IS (XII) risk management special- 1 ists. 2 (iv) STAFF.—Staff of each State ma- 3 ternal mortality review committee shall in- 4 clude— 5 (I) vital health statisticians, ma- 6 ternal child health statisticians, or 7 epidemiologists; 8 (II) a coordinator of the State 9 maternal mortality review committee, 10 to be designated by the State; and 11 (III) administrative staff. 12 (D) OPTION FOR STATES TO ESTABLISH 13 REGIONAL MATERNAL MORTALITY REVIEW COM- 14 MITTEES.—States may choose to partner with 15 one or more neighboring States to carry out the 16 activities required of a State maternal mortality 17 review committee under this section. In such a 18 case, with respect to the States in such a part- 19 nership, any requirement under this section re- 20 lating to the reporting of information related to 21 such activities shall be deemed to be fulfilled by 22 each such State if a single such report is sub- 23 mitted for the partnership. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 354 •S 3660 IS (E) TREATMENT AS PUBLIC HEALTH AU- 1 THORITY FOR PURPOSES OF HIPAA.—For pur- 2 poses of applying HIPAA privacy and security 3 law (as defined in section 3009(a)(2) of the 4 Public Health Service Act (42 U.S.C. 300jj– 5 19)), each State maternal mortality review com- 6 mittee and regional maternal mortality review 7 committee established under subsection (a)(1) 8 or subsection (b)(2)(D), as the case may be, 9 shall be deemed to be a public health authority 10 described in section 164.501 (and referenced in 11 section 164.512(b)(1)(i)) of title 45, Code of 12 Federal Regulations (or any successor regula- 13 tion), carrying out public health activities and 14 purposes described in such section 15 164.512(b)(1)(i) (or any such successor regula- 16 tion). 17 (3) STATE DEPARTMENT OF HEALTH ACTIVI- 18 TIES.—With respect to a State that receives a grant 19 under subsection (a)(1), the State department of 20 health shall— 21 (A) in consultation with the State maternal 22 mortality review committee and in conjunction 23 with relevant professional organizations and pa- 24 tient advocacy organizations, develop a plan for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 355 •S 3660 IS ongoing health care provider education, based 1 on the findings and recommendations of the 2 committee, in order to improve the quality of 3 maternal care; and 4 (B) take steps to widely disseminate the 5 findings and recommendations of the State ma- 6 ternal mortality review committee and imple- 7 ment the recommendations of the committee. 8 (c) CASE ABSTRACTION FORM.— 9 (1) DISSEMINATION.—The Director of the Cen- 10 ters for Disease Control and Prevention shall dis- 11 seminate a uniform case abstraction form to States 12 and State maternal mortality review committees for 13 the purpose of— 14 (A) ensuring that the data and information 15 collected and reviewed by such committees can 16 be pooled for review by the Department of 17 Health and Human Services and its agencies; 18 and 19 (B) preserving the uniformity of the infor- 20 mation collected for Federal public health pur- 21 poses. 22 (2) PERMISSIBLE STATE MODIFICATION.—Each 23 State may modify the form developed under para- 24 graph (1) for implementation and use by such State 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 356 •S 3660 IS or by the State maternal mortality review committee 1 of such State by including on such form additional 2 information to be collected, but may not alter the 3 standard questions on such form, in order to ensure 4 that the information can be collected and reviewed 5 centrally at the Federal level. 6 (d) PUBLIC DISCLOSURE OF INFORMATION.— 7 (1) IN GENERAL.—For fiscal year 2019, or a 8 subsequent fiscal year, each State receiving a grant 9 under this section for such year shall, subject to 10 paragraph (3), provide for the public disclosure, and 11 submission to the information clearinghouse estab- 12 lished under paragraph (2), of the information in- 13 cluded in the report of the State under subsection 14 (f)(1) for such year. 15 (2) INFORMATION CLEARINGHOUSE.—The Sec- 16 retary shall establish an information clearinghouse, 17 to be administered by the Director of the Centers for 18 Disease Control and Prevention, that will maintain 19 findings and recommendations submitted pursuant 20 to paragraph (1) and provide such findings and rec- 21 ommendations for public review and research pur- 22 poses by State departments of health, State mater- 23 nal mortality review committees, health providers 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 357 •S 3660 IS and institutions, and national patient and provider 1 advocacy groups. 2 (3) CONFIDENTIALITY OF INFORMATION.—In 3 no case may any individually identifiable health in- 4 formation be provided to the public, or submitted to 5 the information clearinghouse, under this subsection. 6 (e) CONFIDENTIALITY OF PROCEEDINGS OF STATE 7 MATERNAL MORTALITY REVIEW COMMITTEES.— 8 (1) IN GENERAL.—All proceedings and activi- 9 ties of a State maternal mortality review committee 10 established under subsection (a)(1), opinions of 11 members of such a committee formed as a result of 12 such proceedings and activities, and records ob- 13 tained, created, or maintained pursuant to this sec- 14 tion, including records of interviews, written reports, 15 and statements procured by the Department of 16 Health and Human Services or by any other person, 17 agency, or organization acting jointly with the De- 18 partment, in connection with morbidity and mor- 19 tality reviews under this section, shall be confidential 20 and may not be subject to discovery, subpoena, or 21 introduction into evidence in any civil, criminal, leg- 22 islative, or other proceeding. Such records shall not 23 be open to public inspection. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 358 •S 3660 IS (2) TESTIMONY OF MEMBERS OF COM- 1 MITTEE.— 2 (A) IN GENERAL.—Members of a State 3 maternal mortality review committee established 4 under subsection (a)(1) may not be questioned 5 in any civil, criminal, legislative, or other pro- 6 ceeding regarding information presented in, or 7 opinions formed as a result of, a meeting or 8 communication of the committee. 9 (B) CLARIFICATION.—Nothing in this sub- 10 section may be construed to prevent a member 11 of a State maternal mortality review committee 12 established under subsection (a)(1) from testi- 13 fying regarding information that was obtained 14 independent of such member’s participation on 15 the committee, or public information. 16 (3) AVAILABILITY OF INFORMATION FOR RE- 17 SEARCH PURPOSES.—Nothing in this subsection may 18 prohibit a State maternal mortality review com- 19 mittee established under subsection (a)(1) or the De- 20 partment of Health and Human Services from pub- 21 lishing statistical compilations and research reports 22 that— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 359 •S 3660 IS (A) are based on confidential information, 1 relating to morbidity and mortality reviews 2 under this section; and 3 (B) do not contain identifying information 4 or any other information that could be used to 5 ultimately identify the individuals concerned. 6 (f) REPORTS.— 7 (1) STATE REPORTS.—Not later than one year 8 after the end of fiscal year 2019, and each subse- 9 quent fiscal year, each State maternal mortality re- 10 view committee established under subsection (a)(1) 11 and receiving a grant under this section for such 12 year, shall submit to the Director of the Centers for 13 Disease Control and Prevention a report on the find- 14 ings and recommendations of such committee and 15 information on the implementation of such rec- 16 ommendations during such year. 17 (2) ANNUAL REPORTS TO CONGRESS.—Not 18 later than 60 days after the deadline for State re- 19 ports under paragraph (1) for fiscal year 2019, and 20 each subsequent fiscal year, the Secretary of Health 21 and Human Services shall submit to Congress a re- 22 port on— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 360 •S 3660 IS (A) the findings, recommendations, and 1 implementation information submitted by any 2 State pursuant to paragraph (1); and 3 (B) the status of pregnancy-related and 4 pregnancy-associated deaths in the United 5 States, including recommendations on methods 6 to prevent such deaths in the United States. 7 (g) DEFINITIONS.—In this section: 8 (1) PREGNANCY-ASSOCIATED DEATH.—The 9 term ‘‘pregnancy-associated death’’ means the death 10 of a person while pregnant or during the one-year 11 period following the date of the end of pregnancy, ir- 12 respective of the cause of such death. 13 (2) PREGNANCY-RELATED DEATH.—The term 14 ‘‘pregnancy-related death’’ means the death of a per- 15 son while pregnant or during the one-year period fol- 16 lowing the date of the end of pregnancy, irrespective 17 of the duration of the pregnancy, from any cause re- 18 lated to, or aggravated by, the pregnancy or its 19 management, excluding any accidental or incidental 20 cause. 21 (3) SEVERE MATERNAL MORBIDITY.—The term 22 ‘‘severe maternal morbidity’’ means the physical and 23 psychological conditions that result from, or are ag- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 361 •S 3660 IS gravated by, pregnancy and have an adverse effect 1 on the health of a person. 2 (4) STATE.—The term ‘‘State’’ means each of 3 the 50 States, the District of Columbia, and each of 4 the territories. 5 (5) VITAL STATISTICS UNIT.—The term ‘‘vital 6 statistics unit’’ means the entity that is responsible 7 for maintaining vital records for a State, including 8 official records of live births, deaths, fetal deaths, 9 marriages, divorces, and annulments. 10 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 11 authorized to be appropriated to carry out this section 12 $7,000,000 for each of fiscal years 2019 through 2023. 13 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 14 HEALTH OUTCOMES. 15 Part B of title III of the Public Health Service Act 16 is amended by inserting after section 317V (as added by 17 section 110), the following: 18 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNAL 19 HEALTH OUTCOMES. 20 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta- 21 tion with relevant national stakeholder organizations, such 22 as national medical specialty organizations, national ma- 23 ternal child health organizations, national patient advo- 24 cacy organizations, and national health disparity organiza- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 362 •S 3660 IS tions, carry out the following activities to eliminate dis- 1 parities in maternal health outcomes: 2 ‘‘(1) Conduct research into the determinants 3 and the distribution of disparities in maternal care, 4 health risks, and health outcomes, and improve the 5 capacity of the performance measurement infrastruc- 6 ture to measure such disparities. 7 ‘‘(2) Expand access to health care services, re- 8 sources, and information that have been dem- 9 onstrated to improve the quality and outcomes of 10 maternity care for vulnerable populations. 11 ‘‘(3) Establish a demonstration project to com- 12 pare the effectiveness of interventions to reduce dis- 13 parities in maternity services and outcomes and to 14 implement and assess effective interventions. 15 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 16 ONSTRATION PROJECT.—The demonstration project 17 under subsection (a)(3) shall be conducted in no more 18 than 8 States, which shall be selected by the Secretary 19 based on— 20 ‘‘(1) applications submitted by States, which 21 specify which regions and populations the State in- 22 volved will serve under the demonstration project; 23 ‘‘(2) criteria designed by the Secretary to en- 24 sure that, as a whole, the demonstration project is, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 363 •S 3660 IS to the greatest extent possible, representative of the 1 demographic and geographic composition of commu- 2 nities most affected by disparities; 3 ‘‘(3) criteria designed by the Secretary to en- 4 sure that a variety of models are tested through the 5 demonstration project and that such models include 6 interventions that have an existing evidence base for 7 effectiveness; and 8 ‘‘(4) criteria designed by the Secretary to en- 9 sure that the demonstration projects and models will 10 be carried out in consultation with local and regional 11 provider organizations, such as community health 12 centers, hospital systems, and medical societies rep- 13 resenting providers of maternity services. 14 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 15 The demonstration project under subsection (a)(3) shall 16 begin on January 1, 2019, and end on December 31, 17 2022. 18 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 19 The Secretary may make grants to States and health care 20 providers participating in the demonstration project under 21 subsection (a)(3) for the purpose of collecting data nec- 22 essary for the evaluation and monitoring of such project. 23 ‘‘(e) REPORTS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 364 •S 3660 IS ‘‘(1) STATE REPORTS.—Each State that par- 1 ticipates in the demonstration project under sub- 2 section (a)(3) shall report to the Secretary, in a 3 time, form, and manner specified by the Secretary, 4 the data necessary to— 5 ‘‘(A) monitor the— 6 ‘‘(i) outcomes of the project; 7 ‘‘(ii) costs of the project; and 8 ‘‘(iii) quality of maternity care pro- 9 vided under the project; and 10 ‘‘(B) evaluate the rationale for the selec- 11 tion of the items and services included in any 12 bundled payment made by the State under the 13 project. 14 ‘‘(2) FINAL REPORT.—Not later than December 15 31, 2022, the Secretary shall submit to Congress a 16 report on the results of the demonstration project 17 under subsection (a)(3).’’. 18 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 19 UNEXPECTED INFANT DEATH AND SUDDEN 20 UNEXPLAINED DEATH IN CHILDHOOD. 21 (a) ESTABLISHMENT.—The Secretary of Health and 22 Human Services, acting through the Administrator of the 23 Health Resources and Services Administration and in con- 24 sultation with the Director of the Centers for Disease Con- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 365 •S 3660 IS trol and Prevention and the Director of the National Insti- 1 tutes of Health (in this section referred to as the ‘‘Sec- 2 retary’’), shall establish and implement a culturally and 3 linguistically competent public health awareness and edu- 4 cation campaign to provide information that is focused on 5 decreasing the risk factors for sudden unexpected infant 6 death and sudden unexplained death in childhood, includ- 7 ing educating individuals about safe sleep environments, 8 sleep positions, and reducing exposure to smoking during 9 pregnancy and after birth. 10 (b) TARGETED POPULATIONS.—The campaign under 11 subsection (a) shall be designed to reduce health dispari- 12 ties through the targeting of populations with high rates 13 of sudden unexpected infant death and sudden unex- 14 plained death in childhood. 15 (c) CONSULTATION.—In establishing and imple- 16 menting the campaign under subsection (a), the Secretary 17 shall consult with national organizations representing 18 health care providers, including nurses and physicians, 19 parents, child care providers, children’s advocacy and safe- 20 ty organizations, maternal and child health programs, nu- 21 trition professionals focusing on women, infants, and chil- 22 dren, and other individuals and groups determined nec- 23 essary by the Secretary for such establishment and imple- 24 mentation. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 366 •S 3660 IS (d) GRANTS.— 1 (1) IN GENERAL.—In carrying out the cam- 2 paign under subsection (a), the Secretary shall 3 award grants to national organizations, State and 4 local health departments, and community-based or- 5 ganizations for the conduct of education and out- 6 reach programs for nurses, parents, child care pro- 7 viders, public health agencies, and community orga- 8 nizations. 9 (2) APPLICATION.—To be eligible to receive a 10 grant under paragraph (1), an entity shall submit to 11 the Secretary an application at such time, in such 12 manner, and containing such information as the Sec- 13 retary may require. 14 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 15 authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of fiscal years 17 2019 through 2023. 18 SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 19 NANCIES. 20 Title III of the Public Health Service Act (42 U.S.C. 21 241 et seq.) is amended by adding at the end the fol- 22 lowing: 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 367 •S 3660 IS ‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 1 SERVICES 2 ‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 3 THE ACCESS OF MARGINALIZED YOUTH TO 4 SEXUAL HEALTH SERVICES. 5 ‘‘(a) GRANTS.—The Secretary may award grants on 6 a competitive basis to eligible entities to support the access 7 of marginalized youth to sexual health services. 8 ‘‘(b) USE OF FUNDS.—An eligible entity that is 9 awarded a grant under subsection (a) may use the funds 10 to— 11 ‘‘(1) provide medically accurate and complete 12 and age-, developmentally, and culturally appro- 13 priate sexual health information to marginalized 14 youth, including information on how to access sexual 15 health services; 16 ‘‘(2) promote effective communication regarding 17 sexual health among marginalized youth; 18 ‘‘(3) promote and support better health, edu- 19 cation, and economic opportunities for school-age 20 parents; and 21 ‘‘(4) train individuals who work with 22 marginalized youth to promote— 23 ‘‘(A) the prevention of unintended preg- 24 nancy; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 368 •S 3660 IS ‘‘(B) the prevention of sexually transmitted 1 infections, including the human immuno- 2 deficiency virus (HIV); 3 ‘‘(C) healthy relationships; and 4 ‘‘(D) the development of safe and sup- 5 portive environments. 6 ‘‘(c) APPLICATION.—To be awarded a grant under 7 subsection (a), an eligible entity shall submit an applica- 8 tion to the Secretary at such time, in such manner, and 9 containing such information as the Secretary may require. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Secretary shall give priority to eligible enti- 12 ties— 13 ‘‘(1) with a history of supporting the access of 14 marginalized youth to sexuality education or sexual 15 health services; and 16 ‘‘(2) that plan to serve marginalized youth that 17 are not served by Federal adolescent programs for 18 the prevention of pregnancy, HIV, and other sexu- 19 ally transmitted infections. 20 ‘‘(e) REQUIREMENTS.—The Secretary may not award 21 a grant under subsection (a) to an eligible entity unless— 22 ‘‘(1) such eligible entity has formed a partner- 23 ship with a community organization; and 24 ‘‘(2) such eligible entity agrees— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 369 •S 3660 IS ‘‘(A) to employ a scientifically effective 1 strategy; 2 ‘‘(B) that all information provided to 3 marginalized youth will be— 4 ‘‘(i) age- and developmentally appro- 5 priate; 6 ‘‘(ii) medically accurate and complete; 7 ‘‘(iii) scientifically based; and 8 ‘‘(iv) provided in the language and 9 cultural context that is most appropriate 10 for the individuals served by the eligible 11 entity; and 12 ‘‘(C) that for each year the eligible entity 13 receives grant funds under subsection (a), the 14 eligible entity will submit to the Secretary an 15 annual report that includes— 16 ‘‘(i) the use of grant funds by the eli- 17 gible entity; 18 ‘‘(ii) how the use of grant funds has 19 increased the access of marginalized youth 20 to sexual health services; and 21 ‘‘(iii) such other information as the 22 Secretary may require. 23 ‘‘(f) PUBLICATION AND EVALUATIONS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 370 •S 3660 IS ‘‘(1) EVALUATIONS.—Not less than once every 1 two years after the date of the enactment of this 2 part, the Secretary shall evaluate the effectiveness of 3 whichever of the following is greater: 4 ‘‘(A) Eight grants awarded under sub- 5 section (a). 6 ‘‘(B) Ten percent of the grants awarded 7 under subsection (a). 8 ‘‘(2) PUBLICATION.—The Secretary shall make 9 available to the public— 10 ‘‘(A) the evaluations required under para- 11 graph (1); and 12 ‘‘(B) the reports required under subsection 13 (e)(2)(C). 14 ‘‘(g) LIMITATIONS.—No funds made available to an 15 eligible entity under this section may be used by such enti- 16 ty to provide access to sexual health services that— 17 ‘‘(1) withhold sexual health-promoting or life- 18 saving information; 19 ‘‘(2) are medically inaccurate or have been sci- 20 entifically shown to be ineffective; 21 ‘‘(3) promote gender stereotypes; 22 ‘‘(4) are insensitive or unresponsive to the 23 needs of young people, including— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 371 •S 3660 IS ‘‘(A) youth with varying gender identities, 1 gender expressions, and sexual orientations; 2 ‘‘(B) sexually active youth; 3 ‘‘(C) pregnant or parenting youth; 4 ‘‘(D) survivors of sexual abuse or assault; 5 and 6 ‘‘(E) youth of all physical, developmental, 7 and mental abilities; or 8 ‘‘(5) are inconsistent with the ethical impera- 9 tives of medicine and public health. 10 ‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal- 11 ance of funds made available under section 510(d) of the 12 Social Security Act (42 U.S.C. 710(d)) (as in effect on 13 the day before the date of the enactment of this part) are 14 hereby transferred and made available to the Secretary to 15 carry out this section. The amounts transferred and made 16 available to carry out this section shall remain available 17 until expended. 18 ‘‘(i) DEFINITIONS.—In this section: 19 ‘‘(1) COMMUNITY ORGANIZATION.—The term 20 ‘community organization’ includes a State or local 21 health or education agency, public school, youth-fo- 22 cused organization that is faith-based and commu- 23 nity-based, juvenile justice entity, or other organiza- 24 tion that provides confidential and appropriate sexu- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 372 •S 3660 IS ality education or sexual health services to 1 marginalized youth. 2 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en- 3 tity’ includes a State or local health or education 4 agency, public school, nonprofit organization, hos- 5 pital, or an Indian Tribe or Tribal organization (as 6 such terms are defined in section 4 of the Indian 7 Self-Determination and Education Assistance Act 8 (25 U.S.C. 5304)). 9 ‘‘(3) MARGINALIZED YOUTH.—The term 10 ‘marginalized youth’ means a person under the age 11 of 26 that is disadvantaged by underlying structural 12 barriers and social inequity. 13 ‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 14 The term ‘medically accurate and complete’, when 15 used with respect to information, means information 16 that— 17 ‘‘(A) is supported by research and recog- 18 nized as accurate, objective, and complete by 19 leading medical, psychological, psychiatric, or 20 public health organizations and agencies; and 21 ‘‘(B) does not withhold any information re- 22 lating to the effectiveness and benefits of cor- 23 rect and consistent use of condoms or other 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 373 •S 3660 IS contraceptives and pregnancy prevention meth- 1 ods. 2 ‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 3 The term ‘scientifically effective strategy’ means a 4 strategy that— 5 ‘‘(A) is widely recognized by leading med- 6 ical and public health agencies as effective in 7 promoting sexual health awareness and healthy 8 behavior; and 9 ‘‘(B) either— 10 ‘‘(i) has been demonstrated to be ef- 11 fective on the basis of rigorous scientific 12 research; or 13 ‘‘(ii) incorporates characteristics of ef- 14 fective programs. 15 ‘‘(6) SEXUAL HEALTH SERVICES.—The term 16 ‘sexual health services’ includes— 17 ‘‘(A) sexual health information, education, 18 and counseling; 19 ‘‘(B) contraception; 20 ‘‘(C) emergency contraception; 21 ‘‘(D) condoms and other barrier methods 22 to prevent pregnancy or sexually transmitted in- 23 fections; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 374 •S 3660 IS ‘‘(E) routine gynecological care, including 1 human papillomavirus (HPV) vaccines and can- 2 cer screenings; 3 ‘‘(F) pre-exposure prophylaxis or post-ex- 4 posure prophylaxis; 5 ‘‘(G) mental health services; 6 ‘‘(H) sexual assault survivor services; and 7 ‘‘(I) other prevention, care, or treatment.’’. 8 SEC. 509. GESTATIONAL DIABETES. 9 Part B of title III of the Public Health Service Act 10 (42 U.S.C. 243 et seq.) is amended by adding after section 11 317H the following: 12 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 13 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 14 TIONAL DIABETES.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, in consultation with the Di- 18 abetes Mellitus Interagency Coordinating Committee 19 established under section 429 and representatives of 20 appropriate national health organizations, shall de- 21 velop a multisite gestational diabetes research 22 project within the diabetes program of the Centers 23 for Disease Control and Prevention to expand and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 375 •S 3660 IS enhance surveillance data and public health research 1 on gestational diabetes. 2 ‘‘(2) AREAS TO BE ADDRESSED.—The research 3 project developed under paragraph (1) shall ad- 4 dress— 5 ‘‘(A) procedures to establish accurate and 6 efficient systems for the collection of gestational 7 diabetes data within each State and common- 8 wealth, territory, or possession of the United 9 States; 10 ‘‘(B) the progress of collaborative activities 11 with the National Vital Statistics System, the 12 National Center for Health Statistics, and 13 State health departments with respect to the 14 standard birth certificate, in order to improve 15 surveillance of gestational diabetes; 16 ‘‘(C) postpartum methods of tracking indi- 17 viduals with gestational diabetes after delivery 18 as well as targeted interventions proven to 19 lower the incidence of type 2 diabetes in that 20 population; 21 ‘‘(D) variations in the distribution of diag- 22 nosed and undiagnosed gestational diabetes, 23 and of impaired fasting glucose tolerance and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 376 •S 3660 IS impaired fasting glucose, within and among 1 groups of pregnant individuals; and 2 ‘‘(E) factors and culturally sensitive inter- 3 ventions that influence risks and reduce the in- 4 cidence of gestational diabetes and related com- 5 plications during childbirth, including cultural, 6 behavioral, racial, ethnic, geographic, demo- 7 graphic, socioeconomic, and genetic factors. 8 ‘‘(3) REPORT.—Not later than 2 years after the 9 date of the enactment of this section, and annually 10 thereafter, the Secretary shall generate a report on 11 the findings and recommendations of the research 12 project including prevalence of gestational diabetes 13 in the multisite area and disseminate the report to 14 the appropriate Federal and non-Federal agencies. 15 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 16 SEARCH.— 17 ‘‘(1) IN GENERAL.—The Secretary shall expand 18 and intensify public health research regarding gesta- 19 tional diabetes. Such research may include— 20 ‘‘(A) developing and testing novel ap- 21 proaches for improving postpartum diabetes 22 testing or screening and for preventing type 2 23 diabetes in individuals who can become preg- 24 nant with a history of gestational diabetes; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 377 •S 3660 IS ‘‘(B) conducting public health research to 1 further understanding of the epidemiologic, 2 socioenvironmental, behavioral, translation, and 3 biomedical factors and health systems that in- 4 fluence the risk of gestational diabetes and the 5 development of type 2 diabetes in individuals 6 who can become pregnant with a history of ges- 7 tational diabetes. 8 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 9 There is authorized to be appropriated to carry out 10 this subsection $5,000,000 for each of fiscal years 11 2019 through 2023. 12 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 13 RATE OF GESTATIONAL DIABETES.— 14 ‘‘(1) IN GENERAL.—The Secretary, acting 15 through the Director of the Centers for Disease 16 Control and Prevention, shall award grants, on a 17 competitive basis, to eligible entities for demonstra- 18 tion projects that implement evidence-based inter- 19 ventions to reduce the incidence of gestational diabe- 20 tes, the recurrence of gestational diabetes in subse- 21 quent pregnancies, and the development of type 2 di- 22 abetes in individuals who can become pregnant with 23 a history of gestational diabetes. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 378 •S 3660 IS ‘‘(2) PRIORITY.—In making grants under this 1 subsection, the Secretary shall give priority to 2 projects focusing on— 3 ‘‘(A) helping individuals who can become 4 pregnant who have 1 or more risk factors for 5 developing gestational diabetes; 6 ‘‘(B) working with individuals who can be- 7 come pregnant with a history of gestational dia- 8 betes during a previous pregnancy; 9 ‘‘(C) providing postpartum care for indi- 10 viduals who can become pregnant with gesta- 11 tional diabetes; 12 ‘‘(D) tracking cases where individuals who 13 can become pregnant with a history of gesta- 14 tional diabetes developed type 2 diabetes; 15 ‘‘(E) educating mothers with a history of 16 gestational diabetes about the increased risk of 17 their child developing diabetes; 18 ‘‘(F) working to prevent gestational diabe- 19 tes and prevent or delay the development of 20 type 2 diabetes in individuals who can become 21 pregnant with a history of gestational diabetes; 22 and 23 ‘‘(G) achieving outcomes designed to assess 24 the efficacy and cost-effectiveness of interven- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 379 •S 3660 IS tions that can inform decisions on long-term 1 sustainability, including third-party reimburse- 2 ment. 3 ‘‘(3) APPLICATION.—An eligible entity desiring 4 to receive a grant under this subsection shall submit 5 to the Secretary— 6 ‘‘(A) an application at such time, in such 7 manner, and containing such information as the 8 Secretary may require; and 9 ‘‘(B) a plan to— 10 ‘‘(i) lower the rate of gestational dia- 11 betes during pregnancy; or 12 ‘‘(ii) develop methods of tracking indi- 13 viduals who can become pregnant with a 14 history of gestational diabetes and develop 15 effective interventions to lower the inci- 16 dence of the recurrence of gestational dia- 17 betes in subsequent pregnancies and the 18 development of type 2 diabetes. 19 ‘‘(4) USES OF FUNDS.—An eligible entity re- 20 ceiving a grant under this subsection shall use the 21 grant funds to carry out demonstration projects de- 22 scribed in paragraph (1), including— 23 ‘‘(A) expanding community-based health 24 promotion education, activities, and incentives 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 380 •S 3660 IS focused on the prevention of gestational diabe- 1 tes and development of type 2 diabetes in indi- 2 viduals who can become pregnant with a history 3 of gestational diabetes; 4 ‘‘(B) aiding State- and Tribal-based diabe- 5 tes prevention and control programs to collect, 6 analyze, disseminate, and report surveillance 7 data on individuals who can become pregnant 8 with, and at risk for, gestational diabetes, the 9 recurrence of gestational diabetes in subsequent 10 pregnancies, and, for individuals who can be- 11 come pregnant with a history of gestational dia- 12 betes, the development of type 2 diabetes; and 13 ‘‘(C) training and encouraging health care 14 providers— 15 ‘‘(i) to promote risk assessment, high- 16 quality care, and self-management for ges- 17 tational diabetes and the recurrence of ges- 18 tational diabetes in subsequent preg- 19 nancies; and 20 ‘‘(ii) to prevent the development of 21 type 2 diabetes in individuals who can be- 22 come pregnant with a history of gesta- 23 tional diabetes, and its complications in the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 381 •S 3660 IS practice settings of the health care pro- 1 viders. 2 ‘‘(5) REPORT.—Not later than 4 years after the 3 date of the enactment of this section, the Secretary 4 shall prepare and submit to the Congress a report 5 concerning the results of the demonstration projects 6 conducted through the grants awarded under this 7 subsection. 8 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 9 this subsection, the term ‘eligible entity’ means a 10 nonprofit organization (such as a nonprofit academic 11 center or community health center) or a State, Trib- 12 al, or local health agency. 13 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 14 There is authorized to be appropriated to carry out 15 this subsection $5,000,000 for each of fiscal years 16 2019 through 2023. 17 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 18 TIONAL DIABETES.—The Secretary, acting through the 19 Director of the Centers for Disease Control and Preven- 20 tion, shall work with the State- and Tribal-based diabetes 21 prevention and control programs assisted by the Centers 22 to encourage postpartum followup after gestational diabe- 23 tes, as medically appropriate, for the purpose of reducing 24 the incidence of gestational diabetes, the recurrence of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 382 •S 3660 IS gestational diabetes in subsequent pregnancies, the devel- 1 opment of type 2 diabetes in individuals with a history 2 of gestational diabetes, and related complications.’’. 3 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 4 INFORMATION PROGRAMS. 5 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 6 CATION PROGRAM.— 7 (1) IN GENERAL.—The Secretary, acting 8 through the Director of the Centers for Disease 9 Control and Prevention, shall develop and dissemi- 10 nate to the public medically accurate and complete 11 information on emergency contraception. 12 (2) DISSEMINATION.—The Secretary may dis- 13 seminate medically accurate and complete informa- 14 tion under paragraph (1) directly or through ar- 15 rangements with nonprofit organizations, community 16 health workers including promotoras, consumer 17 groups, institutions of higher education, clinics, the 18 media, and Federal, State, and local agencies. 19 (3) INFORMATION.—The information dissemi- 20 nated under paragraph (1) shall— 21 (A) include, at a minimum, a description 22 of emergency contraception and an explanation 23 of the use, safety, efficacy, and availability of 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 383 •S 3660 IS such contraception and options for no-copay ac- 1 cess through insurance; and 2 (B) be pilot tested for consumer com- 3 prehension, cultural and linguistic appropriate- 4 ness, and acceptance of the messages across 5 geographically, racially, ethnically, and linguis- 6 tically diverse populations. 7 (b) EMERGENCY CONTRACEPTION INFORMATION 8 PROGRAM FOR HEALTH CARE PROVIDERS.— 9 (1) IN GENERAL.—The Secretary, acting 10 through the Administrator of the Health Resources 11 and Services Administration and in consultation 12 with major medical and public health organizations, 13 shall develop and disseminate to health care pro- 14 viders information on emergency contraception. 15 (2) INFORMATION.—The information dissemi- 16 nated under paragraph (1) shall include, at a min- 17 imum— 18 (A) information describing the use, safety, 19 efficacy, availability of emergency contraception, 20 and options for no-copay access through insur- 21 ance; 22 (B) a recommendation regarding the use of 23 such contraception; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 384 •S 3660 IS (C) information explaining how to obtain 1 copies of the information developed under sub- 2 section (a) for distribution to the patients of 3 the providers. 4 (c) DEFINITIONS.—In this section: 5 (1) EMERGENCY CONTRACEPTION.—The term 6 ‘‘emergency contraception’’ means a drug or device 7 (as the terms are defined in section 201 of the Fed- 8 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 9 or a drug regimen that— 10 (A) is used postcoitally; 11 (B) prevents pregnancy primarily by pre- 12 venting or delaying ovulation, and does not ter- 13 minate an established pregnancy; and 14 (C) is approved by the Food and Drug Ad- 15 ministration. 16 (2) HEALTH CARE PROVIDER.—The term 17 ‘‘health care provider’’ means an individual who is li- 18 censed or certified under State law to provide health 19 care services and who is operating within the scope 20 of such license. Such term shall include a phar- 21 macist. 22 (3) INSTITUTION OF HIGHER EDUCATION.—The 23 term ‘‘institution of higher education’’ has the same 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 385 •S 3660 IS meaning given such term in section 101(a) of the 1 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 2 (4) MEDICALLY ACCURATE AND COMPLETE.— 3 The term ‘‘medically accurate and complete’’ means, 4 with respect to information, activities, or services 5 verified or supported by the weight of research con- 6 ducted in compliance with accepted scientific meth- 7 ods and— 8 (A) published in peer-reviewed journals, 9 where applicable; or 10 (B) comprising information that leading 11 professional organizations and agencies with 12 relevant expertise in the field recognize as accu- 13 rate, objective, and complete. 14 (5) SECRETARY.—The term ‘‘Secretary’’ means 15 the Secretary of Health and Human Services. 16 (d) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 such sums as may be necessary for each of the fiscal years 19 2019 through 2023. 20 SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 21 (a) PURPOSES; FINDING; SENSE OF CONGRESS.— 22 (1) PURPOSES.—The purposes of this section 23 are to provide young people with comprehensive sex 24 education programs that— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 386 •S 3660 IS (A) promote and uphold the rights of 1 young people to information in order to make 2 healthy decisions about their sexual health; 3 (B) provide the information and skills all 4 young people need to make informed, respon- 5 sible, and healthy decisions in order to become 6 sexually healthy adults and have healthy rela- 7 tionships; 8 (C) provide information about the preven- 9 tion of unintended pregnancy, sexually trans- 10 mitted infections, including HIV, dating vio- 11 lence, sexual assault, bullying, and harassment; 12 and 13 (D) provide resources and information on 14 topics ranging from gender stereotyping and 15 gender roles and stigma and socio-cultural in- 16 fluences surrounding sex and sexuality. 17 (2) FINDING ON REQUIRED RESOURCES.—In 18 order to provide the comprehensive sex education de- 19 scribed in paragraph (1), Congress finds that in- 20 creased resources are required for sex education pro- 21 grams that— 22 (A) substantially incorporate elements of 23 evidence-based programs or characteristics of 24 effective programs; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 387 •S 3660 IS (B) cover a broad range of topics, includ- 1 ing medically accurate and complete informa- 2 tion that is age and developmentally appro- 3 priate about all the aspects of sex, sexual 4 health, and sexuality; 5 (C) are gender and gender identity-sen- 6 sitive, emphasizing the importance of equality 7 and the social environment for achieving sexual 8 and reproductive health and overall well-being; 9 (D) promote educational achievement, crit- 10 ical thinking, decisionmaking, self-esteem, and 11 self-efficacy; 12 (E) help develop healthy attitudes and in- 13 sights necessary for understanding relationships 14 between oneself and others and society; 15 (F) foster leadership skills and community 16 engagement by— 17 (i) promoting principles of fairness, 18 human dignity, and respect; and 19 (ii) engaging young people as partners 20 in their communities; and 21 (G) are culturally and linguistically appro- 22 priate, reflecting the diverse circumstances and 23 realities of young people. 24 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 388 •S 3660 IS (3) SENSE OF CONGRESS.—It is the sense of 1 Congress that— 2 (A) federally funded sex education pro- 3 grams should aim to— 4 (i) provide information about a range 5 of human sexuality topics, including— 6 (I) human development, healthy 7 relationships, personal skills; 8 (II) sexual behavior including ab- 9 stinence; 10 (III) sexual health including pre- 11 venting unintended pregnancy; 12 (IV) sexually transmitted infec- 13 tions including HIV; and 14 (V) society and culture; 15 (ii) promote safe and healthy relation- 16 ships; 17 (iii) promote gender equity; 18 (iv) use, and be informed by, the best 19 scientific information available; 20 (v) be culturally appropriate and in- 21 clusive of youth with varying gender identi- 22 ties, gender expressions, and sexual ori- 23 entations; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 389 •S 3660 IS (vi) be built on characteristics of ef- 1 fective programs; 2 (vii) expand the existing body of re- 3 search on comprehensive sex education 4 programs through program evaluation; 5 (viii) expand training programs for 6 teachers of comprehensive sex education; 7 (ix) build on programs funded under 8 section 513 of the Social Security Act (42 9 U.S.C. 713) and the Office of Adolescent 10 Health’s Teen Pregnancy Prevention Pro- 11 gram, funded under title II of the Consoli- 12 dated Appropriations Act, 2010 (Public 13 Law 111–117; 123 Stat. 3253), and on 14 programs supported through the Centers 15 for Disease Control and Prevention (CDC); 16 and 17 (x) promote and uphold the rights of 18 young people to information in order to 19 make healthy and autonomous decisions 20 about their sexual health; and 21 (B) no Federal funds should be used for 22 health education programs that— 23 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 390 •S 3660 IS (i) withhold health-promoting or life- 1 saving information about sexuality-related 2 topics, including HIV; 3 (ii) are medically inaccurate or have 4 been scientifically shown to be ineffective; 5 (iii) promote gender or racial stereo- 6 types; 7 (iv) are insensitive and unresponsive 8 to the needs of sexually active young peo- 9 ple; 10 (v) are insensitive and unresponsive to 11 the needs of survivors of sexual violence; 12 (vi) are insensitive and unresponsive 13 to the needs of youth of all physical, devel- 14 opmental, and mental abilities; 15 (vii) are insensitive and unresponsive 16 to the needs of youth with varying gender 17 identities, gender expressions, and sexual 18 orientations; or 19 (viii) are inconsistent with the ethical 20 imperatives of medicine and public health. 21 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 22 FOR ADOLESCENTS.— 23 (1) PROGRAM AUTHORIZED.—The Secretary of 24 Health and Human Services, in coordination with 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 391 •S 3660 IS the Associate Commissioner of the Family and 1 Youth Services Bureau of the Administration on 2 Children, Youth, and Families of the Department of 3 Health and Human Services, the Director of the Of- 4 fice of Adolescent Health, the Director of the Divi- 5 sion of Adolescent and School Health within the 6 Centers for Disease Control and Prevention and the 7 Secretary of Education, shall award grants, on a 8 competitive basis, to eligible entities to enable such 9 eligible entities to carry out programs that provide 10 adolescents with comprehensive sex education, as de- 11 scribed in paragraph (6). 12 (2) DURATION.—Grants awarded under this 13 section shall be for a period of 5 years. 14 (3) ELIGIBLE ENTITY.—In this section, the 15 term ‘‘eligible entity’’ means a public or private enti- 16 ty that focuses on adolescent health and education 17 or has experience working with adolescents. 18 (4) APPLICATIONS.—An eligible entity desiring 19 a grant under this subsection shall submit an appli- 20 cation to the Secretary at such time, in such man- 21 ner, and containing such information as the Sec- 22 retary may require, including an assurance to par- 23 ticipate in the evaluation described in subsection (e). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 392 •S 3660 IS (5) PRIORITY.—In awarding grants under this 1 section, the Secretary shall give priority to eligible 2 entities that— 3 (A) are State or local public entities; 4 (B) are entities not currently receiving 5 funds under— 6 (i) section 513 of the Social Security 7 Act (42 U.S.C. 713); 8 (ii) the Office of Adolescent Health’s 9 Teen Pregnancy Prevention Program, 10 funded under title II of the Consolidated 11 Appropriations Act, 2010 (Public Law 12 111–117; 123 Stat. 3253), or any substan- 13 tially similar successive program; or 14 (iii) the Centers for Disease Control 15 and Prevention’s Division of Adolescent 16 and School Health; and 17 (C) address health inequities among young 18 people that face systemic barriers resulting in 19 disproportionate rates of not less than one of 20 the following: 21 (i) Unintended pregnancies. 22 (ii) Sexually transmitted infections, 23 including HIV. 24 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 393 •S 3660 IS (iii) Dating violence and sexual vio- 1 lence. 2 (6) USE OF FUNDS.— 3 (A) IN GENERAL.—Each eligible entity 4 that receives a grant under this section shall 5 use the grant funds to carry out an education 6 program that provides adolescents with com- 7 prehensive sex education that— 8 (i) is age and developmentally appro- 9 priate; 10 (ii) is medically accurate and com- 11 plete; 12 (iii) substantially incorporates ele- 13 ments of evidence-based sex education in- 14 struction; or 15 (iv) creates a demonstration project 16 based on characteristics of effective pro- 17 grams. 18 (B) CONTENTS OF COMPREHENSIVE SEX 19 EDUCATION PROGRAMS.—The comprehensive 20 sex education programs funded under this sec- 21 tion shall include instruction and materials that 22 address— 23 (i) the physical, social, and emotional 24 changes of human development including, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 394 •S 3660 IS human anatomy, reproduction, and sexual 1 development; 2 (ii) healthy relationships, including 3 friendships, within families, and society, 4 that are based on mutual respect, and the 5 ability to distinguish between healthy and 6 unhealthy relationships, including— 7 (I) effective communication, ne- 8 gotiation and refusal skills, including 9 the skills to recognize and report in- 10 appropriate or abusive sexual ad- 11 vances; 12 (II) bodily autonomy, setting and 13 respecting personal boundaries, prac- 14 ticing personal safety, and consent; 15 and 16 (III) the limitations and harm of 17 gender- role stereotypes, violence, co- 18 ercion, bullying, harassment, and in- 19 timidation in relationships; 20 (iii) healthy decisionmaking skills 21 about sexuality and relationships that in- 22 clude— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 395 •S 3660 IS (I) critical thinking, problem 1 solving, self-efficacy, stress-manage- 2 ment, self-care, and decisionmaking; 3 (II) individual values and atti- 4 tudes; 5 (III) the promotion of positive 6 body images; 7 (IV) developing an understanding 8 that there are a range of body types 9 and encouraging positive feeling about 10 students’ own body types; 11 (V) information on how to re- 12 spect others and ensure safety on the 13 internet and when using other forms 14 of digital communication; 15 (VI) information on local services 16 and resources where students can ob- 17 tain additional information related to 18 bullying, harassment, dating violence 19 and sexual assault, suicide prevention, 20 and other related care; 21 (VII) encouragement for youth to 22 communicate with their parents or 23 guardians, health and social service 24 professionals, and other trusted adults 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 396 •S 3660 IS about sexuality and intimate relation- 1 ships; 2 (VIII) information on how to cre- 3 ate a safe environment for all stu- 4 dents and others in society; 5 (IX) examples of varying types of 6 relationships, couples, and family 7 structures; and 8 (X) affirmative representation of 9 varying gender identities, gender ex- 10 pressions, and sexual orientations, in- 11 cluding individuals and relationships 12 between same sex couples and their 13 families; 14 (iv) abstinence, delaying age of first 15 sexual activity, the use of condoms, preven- 16 tive medication, vaccination, birth control, 17 and other sexually transmitted infection 18 prevention measures, and the options for 19 pregnancy, including parenting, adoption, 20 and abortion, including— 21 (I) the importance of effectively 22 using condoms, preventive medication, 23 and applicable vaccinations to protect 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 397 •S 3660 IS against sexually transmitted infec- 1 tions, including HIV; 2 (II) the benefits of effective con- 3 traceptive and condom use in avoiding 4 unintended pregnancy; 5 (III) the relationship between 6 substance use and sexual health and 7 behaviors; and 8 (IV) information about local 9 health services where students can ob- 10 tain additional information and serv- 11 ices related to sexual and reproductive 12 health and other related care; 13 (v) through affirmative recognition, 14 the roles that traditions, values, religion, 15 norms, gender roles, acculturation, family 16 structure, health beliefs, and political 17 power play in how students make decisions 18 that affect their sexual health, using exam- 19 ples of various types of races, ethnicities, 20 cultures, and families, including single-par- 21 ent households and young families; 22 (vi) information about gender identity, 23 gender expression, and sexual orientation 24 for all students, including— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 398 •S 3660 IS (I) affirmative recognition that 1 people have different gender identi- 2 ties, gender expressions, and sexual 3 orientations; and 4 (II) community resources that 5 can provide additional support for in- 6 dividuals with varying gender identi- 7 ties, gender expressions, and sexual 8 orientations; and 9 (vii) opportunities to explore the roles 10 that race, ethnicity, immigration status, 11 disability status, economic status, home- 12 lessness, foster care status, and language 13 within different communities affect sexual 14 attitudes in society and culture and how 15 this may impact student sexual health. 16 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 17 AT INSTITUTIONS OF HIGHER EDUCATION.— 18 (1) PROGRAM AUTHORIZED.—The Secretary, in 19 coordination with the Secretary of Education, shall 20 award grants, on a competitive basis, to institutions 21 of higher education or consortia of such institutions 22 to enable such institutions to provide young people 23 with comprehensive sex education, as described in 24 paragraph (5)(B). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 399 •S 3660 IS (2) DURATION.—Grants awarded under this 1 subsection shall be for a period of 5 years. 2 (3) APPLICATIONS.—An institution of higher 3 education or consortium of such institutions desiring 4 a grant under this subsection shall submit an appli- 5 cation to the Secretary at such time, in such man- 6 ner, and containing such information as the Sec- 7 retary may require, including an assurance to par- 8 ticipate in the evaluation described in subsection (e). 9 (4) PRIORITY.—In awarding grants under this 10 subsection, the Secretary shall give priority to an in- 11 stitution of higher education that— 12 (A) has an enrollment of needy students, 13 as defined in section 318(b) of the Higher Edu- 14 cation Act of 1965 (20 U.S.C. 1059e(b)); 15 (B) is a Hispanic-serving institution, as 16 defined in section 502(a) of such Act (20 17 U.S.C. 1101a(a)); 18 (C) is a Tribal College or University, as 19 defined in section 316(b) of such Act (20 20 U.S.C. 1059c(b)); 21 (D) is an Alaska Native-serving institution, 22 as defined in section 317(b) of such Act (20 23 U.S.C. 1059d(b)); 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 400 •S 3660 IS (E) is a Native Hawaiian-serving institu- 1 tion, as defined in section 317(b) of such Act 2 (20 U.S.C. 1059d(b)); 3 (F) is a Predominately Black Institution, 4 as defined in section 318(b) of such Act (20 5 U.S.C. 1059e(b)); 6 (G) is a Native American-serving, non- 7 tribal institution, as defined in section 319(b) 8 of such Act (20 U.S.C. 1059f(b)); 9 (H) is an Asian American and Native 10 American Pacific Islander-serving institution, as 11 defined in section 320(b) of such Act (20 12 U.S.C. 1059g(b)); or 13 (I) is a minority institution, as defined in 14 section 365 of such Act (20 U.S.C. 1067k), 15 with an enrollment of needy students, as de- 16 fined in section 312 of such Act (20 U.S.C. 17 1058). 18 (5) USES OF FUNDS.— 19 (A) IN GENERAL.—An institution of higher 20 education, or a consortium, receiving a grant 21 under this subsection shall use grant funds to 22 integrate issues relating to comprehensive sex 23 education into the institution of higher edu- 24 cation, or consortium, in order to reach a large 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 401 •S 3660 IS number of students, by carrying out 1 or more 1 of the following activities: 2 (i) Developing or adopting educational 3 content for issues relating to comprehen- 4 sive sex education that will be incorporated 5 into student orientation, general education, 6 or core courses. 7 (ii) Developing or adopting, and im- 8 plementing schoolwide educational pro- 9 gramming outside of class that delivers ele- 10 ments of comprehensive sex education pro- 11 grams to students, faculty, and staff. 12 (iii) Developing or adopting innovative 13 technology-based approaches to deliver sex 14 education to students, faculty, and staff. 15 (iv) Developing or adopting, and im- 16 plementing peer-outreach and education 17 programs to generate discussion, educate, 18 and raise awareness among students about 19 issues relating to comprehensive sex edu- 20 cation. 21 (B) CONTENTS OF SEX EDUCATION PRO- 22 GRAMS.—Each institution of higher education’s 23 program of comprehensive sex education funded 24 under this section shall include instruction and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 402 •S 3660 IS materials that address the contents required 1 under subsection (b)(6). 2 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 3 TEACHER TRAINING.— 4 (1) PROGRAM AUTHORIZED.—The Secretary, in 5 coordination with the Director of the Centers for 6 Disease Control and Prevention and the Secretary of 7 Education, shall award grants, on a competitive 8 basis, to eligible entities to enable such eligible enti- 9 ties to carry out the activities described in para- 10 graph (5). 11 (2) DURATION.—Grants awarded under this 12 section shall be for a period of 5 years. 13 (3) ELIGIBLE ENTITY.—In this section, the 14 term ‘‘eligible entity’’ means— 15 (A) a State educational agency, as defined 16 in section 8101 of the Elementary and Sec- 17 ondary Education of 1965 (20 U.S.C. 7801); 18 (B) a local educational agency, as defined 19 in section 8101 of the Elementary and Sec- 20 ondary Education of 1965 (20 U.S.C. 7801); 21 (C) a Tribe or Tribal organization, as de- 22 fined in section 4 of the Indian Self-Determina- 23 tion and Education Assistance Act (25 U.S.C. 24 5304); 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 403 •S 3660 IS (D) a State or local department of health; 1 (E) a State or local department of edu- 2 cation; 3 (F) an educational service agency, as de- 4 fined in section 8101 of the Elementary and 5 Secondary Education of 1965 (20 U.S.C. 6 7801);; 7 (G) a nonprofit institution of higher edu- 8 cation, as defined in section 101 of the Higher 9 Education Act of 1965 (20 U.S.C. 1001); 10 (H) a national or statewide nonprofit orga- 11 nization that has as its primary purpose the im- 12 provement of provision of comprehensive sex 13 education through training and effective teach- 14 ing of comprehensive sex education; or 15 (I) a consortium of nonprofit organizations 16 that has as its primary purpose the improve- 17 ment of provision of comprehensive sex edu- 18 cation through training and effective teaching 19 of comprehensive sex education. 20 (4) APPLICATION.—An eligible entity desiring a 21 grant under this subsection shall submit an applica- 22 tion to the Secretary at such time, in such manner, 23 and containing such information as the Secretary 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 404 •S 3660 IS may require, including an assurance to participate in 1 the evaluation described in subsection (e). 2 (5) AUTHORIZED ACTIVITIES.— 3 (A) REQUIRED ACTIVITY.—Each eligible 4 entity receiving a grant under this section shall 5 use grant funds for professional development 6 and training of relevant faculty, school adminis- 7 trators, teachers, and staff, in order to increase 8 effective teaching of comprehensive sex edu- 9 cation students. 10 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 11 ble entity receiving a grant under this section 12 may use grant funds to— 13 (i) provide research-based training of 14 teachers for comprehensive sex education 15 for adolescents as a means of broadening 16 student knowledge about issues related to 17 human development, healthy relationships, 18 personal skills, and sexual behavior, includ- 19 ing abstinence, sexual health, and society 20 and culture; 21 (ii) support the dissemination of infor- 22 mation on effective practices and research 23 findings concerning the teaching of com- 24 prehensive sex education; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 405 •S 3660 IS (iii) support research on— 1 (I) effective comprehensive sex 2 education teaching practices; and 3 (II) the development of assess- 4 ment instruments and strategies to 5 document— 6 (aa) student understanding 7 of comprehensive sex education; 8 and 9 (bb) the effects of com- 10 prehensive sex education; 11 (iv) convene national conferences on 12 comprehensive sex education, in order to 13 effectively train teachers in the provision of 14 comprehensive sex education; and 15 (v) develop and disseminate appro- 16 priate research-based materials to foster 17 comprehensive sex education. 18 (C) SUBGRANTS.—Each eligible entity re- 19 ceiving a grant under this subsection may 20 award subgrants to nonprofit organizations that 21 possess a demonstrated record of providing 22 training to faculty, school administrators, 23 teachers, and staff on comprehensive sex edu- 24 cation to— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 406 •S 3660 IS (i) train teachers in comprehensive 1 sex education; 2 (ii) support Internet or distance learn- 3 ing related to comprehensive sex education; 4 (iii) promote rigorous academic stand- 5 ards and assessment techniques to guide 6 and measure student performance in com- 7 prehensive sex education; 8 (iv) encourage replication of best 9 practices and model programs to promote 10 comprehensive sex education; 11 (v) develop and disseminate effective, 12 research-based comprehensive sex edu- 13 cation learning materials; 14 (vi) develop academic courses on the 15 pedagogy of sex education at institutions 16 of higher education; or 17 (vii) convene State-based conferences 18 to train teachers in comprehensive sex edu- 19 cation and to identify strategies for im- 20 provement. 21 (e) IMPACT EVALUATION AND REPORTING.— 22 (1) MULTI-YEAR EVALUATION.— 23 (A) IN GENERAL.—Not later than 6 24 months after the date of the enactment of this 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 407 •S 3660 IS Act, the Secretary shall enter into a contract 1 with a nonprofit organization with experience in 2 conducting impact evaluations, to conduct a 3 multi-year evaluation on the impact of the 4 grants under subsections (b), (c), and (d), and 5 to report to Congress and the Secretary on the 6 findings of such evaluation. 7 (B) EVALUATION.—The evaluation con- 8 ducted under this subsection shall— 9 (i) be conducted in a manner con- 10 sistent with relevant, nationally recognized 11 professional and technical evaluation 12 standards; 13 (ii) use sound statistical methods and 14 techniques relating to the behavioral 15 sciences, including quasi-experimental de- 16 signs, inferential statistics, and other 17 methodologies and techniques that allow 18 for conclusions to be reached; 19 (iii) be carried out by an independent 20 organization that has not received a grant 21 under subsection (b), (c), or (d); and 22 (iv) be designed to provide informa- 23 tion on— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 408 •S 3660 IS (I) output measures, such as the 1 number of individuals served under 2 the grant and the number of hours of 3 instruction; 4 (II) outcome measures, including 5 measures relating to— 6 (aa) the knowledge that in- 7 dividuals participating in the 8 grant program have gained in 9 each of the following age and de- 10 velopmentally appropriate 11 areas— 12 (AA) growth and devel- 13 opment; 14 (BB) relationship dy- 15 namics; 16 (CC) ways to prevent 17 unintended pregnancy and 18 sexually transmitted infec- 19 tions, including HIV; and 20 (DD) sexual health; 21 (bb) the age and develop- 22 mentally appropriate skills that 23 individuals participating in the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 409 •S 3660 IS grant program have gained re- 1 garding— 2 (AA) negotiation and 3 communication; 4 (BB) decisionmaking 5 and goal-setting; 6 (CC) interpersonal 7 skills and healthy relation- 8 ships; and 9 (DD) condom use; and 10 (cc) the behaviors of adoles- 11 cents participating in the grant 12 program, including data about— 13 (AA) age of first inter- 14 course; 15 (BB) condom and con- 16 traceptive use at first inter- 17 course; 18 (CC) recent condom 19 and contraceptive use; 20 (DD) substance use; 21 (EE) dating abuse and 22 lifetime history of sexual as- 23 sault, dating violence, bul- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 410 •S 3660 IS lying, harassment, stalking; 1 and 2 (FF) academic per- 3 formance; and 4 (III) other measures necessary to 5 evaluate the impact of the grant pro- 6 gram. 7 (C) REPORT.—Not later than 6 years after 8 the date of enactment of this Act, the organiza- 9 tion conducting the evaluation under this sub- 10 section shall prepare and submit to the appro- 11 priate committees of Congress and the Sec- 12 retary an evaluation report. Such report shall 13 be made publicly available, including on the 14 website of the Department of Health and 15 Human Services. 16 (2) SECRETARY’S REPORT TO CONGRESS.—Not 17 later than 1 year after the date of the enactment of 18 this Act, and annually thereafter for a period of 5 19 years, the Secretary shall prepare and submit to the 20 appropriate committees of Congress a report on the 21 activities to provide adolescents and young people 22 with comprehensive sex education and pre-service 23 and in-service teacher training funded under this 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 411 •S 3660 IS section. The Secretary’s report to Congress shall in- 1 clude— 2 (A) a statement of how grants awarded by 3 the Secretary meet the purposes described in 4 subsection (a)(1); and 5 (B) information about— 6 (i) the number of eligible entities and 7 institutions of higher education that are 8 receiving grant funds under subsections 9 (b), (c), and (d); 10 (ii) the specific activities supported by 11 grant funds awarded under subsections 12 (b), (c), and (d); 13 (iii) the number of adolescents served 14 by grant programs funded under sub- 15 section (b); 16 (iv) the number of young people 17 served by grant programs funded under 18 subsection (c); 19 (v) the number of faculty, school ad- 20 ministrators, teachers, and staff trained 21 under subsection (d); and 22 (vi) the status of the evaluation re- 23 quired under paragraph (1). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 412 •S 3660 IS (f) NONDISCRIMINATION.—Programs funded under 1 this section shall not discriminate on the basis of actual 2 or perceived sex, race, color, ethnicity, national origin, dis- 3 ability, sexual orientation, gender identity, or religion. 4 Nothing in this section shall be construed to invalidate or 5 limit rights, remedies, procedures, or legal standards avail- 6 able under any other Federal law or any law of a State 7 or a political subdivision of a State, including the Civil 8 Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX 9 of the Education Amendments of 1972 (20 U.S.C. 1681 10 et seq.), section 504 of the Rehabilitation Act of 1973 (29 11 U.S.C. 794), the Americans with Disabilities Act of 1990 12 (42 U.S.C. 12101 et seq.), and section 1557 of the Patient 13 Protection and Affordable Care Act (42 U.S.C. 18116). 14 (g) LIMITATION.—No Federal funds provided under 15 this section may be used for health education programs 16 that— 17 (1) withhold health-promoting or life-saving in- 18 formation about sexuality-related topics, including 19 HIV; 20 (2) are medically inaccurate or have been sci- 21 entifically shown to be ineffective; 22 (3) promote gender or racial stereotypes; 23 (4) are insensitive and unresponsive to the 24 needs of sexually active young people; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 413 •S 3660 IS (5) are insensitive and unresponsive to the 1 needs of pregnant or parenting young people; 2 (6) are insensitive and unresponsive to the 3 needs of survivors of sexual abuse or assault; 4 (7) are insensitive and unresponsive to the 5 needs of youth of all physical, developmental, or 6 mental abilities; 7 (8) are insensitive and unresponsive to individ- 8 uals with varying gender identities, gender expres- 9 sions, and sexual orientations; or 10 (9) are inconsistent with the ethical imperatives 11 of medicine and public health. 12 (h) AMENDMENTS TO OTHER LAWS.— 13 (1) AMENDMENT TO THE PUBLIC HEALTH 14 SERVICE ACT.—Section 2500 of the Public Health 15 Service Act (42 U.S.C. 300ee) is amended by strik- 16 ing subsections (b) through (d) and inserting the fol- 17 lowing: 18 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 19 education and information receiving funds under this sub- 20 chapter shall include information about the potential ef- 21 fects of intravenous substance abuse.’’. 22 (2) AMENDMENTS TO THE ELEMENTARY AND 23 SECONDARY EDUCATION ACT OF 1965.—Section 8526 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 414 •S 3660 IS of the Elementary and Secondary Education Act of 1 (20 U.S.C. 7906) is amended— 2 (A) by striking paragraph (3); 3 (B) by redesignating paragraphs (4) and 4 (5) as paragraphs (3) and (4), respectively; 5 (C) in paragraph (4), by inserting ‘‘or’’ 6 after the semicolon; 7 (D) in paragraph (5), by striking ‘‘; or’’ 8 and inserting a period; and 9 (E) by striking paragraph (6). 10 (i) DEFINITIONS.—In this section: 11 (1) ADOLESCENTS.—The term ‘‘adolescents’’ 12 means individuals who are ages 10 through 19 at 13 the time of commencement of participation in a pro- 14 gram supported under this section. 15 (2) AGE AND DEVELOPMENTALLY APPRO- 16 PRIATE.—The term ‘‘age and developmentally appro- 17 priate’’ means topics, messages, and teaching meth- 18 ods suitable to particular age, age group of children 19 and adolescents, or developmental levels, based on 20 cognitive, emotional, social, and behavioral capacity 21 of most students at that age level. 22 (3) APPROPRIATE COMMITTEES OF CON- 23 GRESS.—The term ‘‘appropriate committees of Con- 24 gress’’ means the Committee on Health, Education, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 415 •S 3660 IS Labor, and Pensions of the Senate, the Committee 1 on Appropriations of the Senate, the Committee on 2 Energy and Commerce of the House of Representa- 3 tives, the Committee on Education and the Work- 4 force of the House of Representatives, and the Com- 5 mittee on Appropriations of the House of Represent- 6 atives. 7 (4) CHARACTERISTICS OF EFFECTIVE PRO- 8 GRAMS.—The term ‘‘characteristics of effective pro- 9 grams’’ means the aspects of evidence-based pro- 10 grams, including development, content, and imple- 11 mentation of such programs, that— 12 (A) have been shown to be effective in 13 terms of increasing knowledge, clarifying values 14 and attitudes, increasing skills, and impacting 15 upon behavior; and 16 (B) are widely recognized by leading med- 17 ical and public health agencies to be effective in 18 changing sexual behaviors that lead to sexually 19 transmitted infections, including HIV, unin- 20 tended pregnancy, and dating violence and sex- 21 ual assault among young people. 22 (5) COMPREHENSIVE SEX EDUCATION.—The 23 term ‘‘comprehensive sex education’’ means instruc- 24 tional part of a comprehensive school health edu- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 416 •S 3660 IS cation approach which addresses the physical, men- 1 tal, emotional, and social dimensions of human sexu- 2 ality; designed to motivate and assist students to 3 maintain and improve their sexual health, prevent 4 disease and reduce sexual health-related risk behav- 5 iors; and enable and empower students to develop 6 and demonstrate age and developmentally appro- 7 priate sexuality and sexual health-related knowledge, 8 attitudes, skills, and practices. 9 (6) CONSENT.—The term ‘‘consent’’ means af- 10 firmative, conscious, and voluntary agreement to en- 11 gage in interpersonal, physical, or sexual activity. 12 (7) CULTURALLY APPROPRIATE.—The term 13 ‘‘culturally appropriate’’ means materials and in- 14 struction that respond to culturally diverse individ- 15 uals, families and communities in an inclusive, re- 16 spectful and effective manner; including materials 17 and instruction that are inclusive of race, ethnicity, 18 languages, cultural background, religion, sex, gender 19 identity, sexual orientation, and different abilities. 20 (8) EVIDENCE-BASED.—The term ‘‘evidence- 21 based’’, when used with respect to sex education in- 22 struction, means a sex education program that has 23 been proven through rigorous evaluation to be effec- 24 tive in changing sexual behavior or incorporates ele- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 417 •S 3660 IS ments of other programs that have been proven to 1 be effective in changing sexual behavior. 2 (9) GENDER EXPRESSION.—The term ‘‘gender 3 expression’’, when used with respect to a sex edu- 4 cation program, means the expression of one’s gen- 5 der, such as through behavior, clothing, haircut, or 6 voice, and which may or may not conform to socially 7 defined behaviors and characteristics typically asso- 8 ciated with being either masculine or feminine. 9 (10) GENDER IDENTITY.—Except with respect 10 to subsection (f), the term ‘‘gender identity’’, when 11 used with respect to a sex education program, means 12 the gender-related identity, appearance, mannerisms, 13 or other gender-related characteristics of an indi- 14 vidual, regardless of the individual’s designated sex 15 at birth including a person’s deeply held sense or 16 knowledge of their own gender; such as male, fe- 17 male, both or neither. 18 (11) INCLUSIVE.—The term ‘‘inclusive’’, when 19 used with respect to a sex education program, means 20 curriculum that ensures that students from histori- 21 cally marginalized communities are reflected in 22 classroom materials and lessons. 23 (12) INSTITUTION OF HIGHER EDUCATION.— 24 The term ‘‘institution of higher education’’ has the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 418 •S 3660 IS meaning given the term in section 101 of the Higher 1 Education Act of 1965 (20 U.S.C. 1001). 2 (13) MEDICALLY ACCURATE AND COMPLETE.— 3 The term ‘‘medically accurate and complete’’, when 4 used with respect to a sex education program, means 5 that— 6 (A) the information provided through the 7 program is verified or supported by the weight 8 of research conducted in compliance with ac- 9 cepted scientific methods and is published in 10 peer-reviewed journals, where applicable; or 11 (B)(i) the program contains information 12 that leading professional organizations and 13 agencies with relevant expertise in the field rec- 14 ognize as accurate, objective, and complete; and 15 (ii) the program does not withhold infor- 16 mation about the effectiveness and benefits of 17 correct and consistent use of condoms and 18 other contraceptives. 19 (14) SECRETARY.—The term ‘‘Secretary’’ 20 means the Secretary of Health and Human Services. 21 (15) SEXUAL DEVELOPMENT.—The term ‘‘sex- 22 ual development’’ means the lifelong process of phys- 23 ical, behavioral, cognitive, and emotional growth and 24 change as it relates to an individual’s sexuality and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 419 •S 3660 IS sexual maturation, including puberty, identity devel- 1 opment, socio-cultural influences, and sexual behav- 2 iors. 3 (16) SEXUAL ORIENTATION.—Except with re- 4 spect to subsection (f), the term ‘‘sexual orienta- 5 tion’’, when used with respect to a sex education 6 program, means an individual’s attraction, including 7 physical or emotional, to the same or different gen- 8 der. 9 (17) YOUNG PEOPLE.—The term ‘‘young peo- 10 ple’’ means individuals who are ages 10 through 24 11 at the time of commencement of participation in a 12 program supported under this section. 13 (j) FUNDING.— 14 (1) APPROPRIATION.—For the purpose of car- 15 rying out this section, there is appropriated 16 $75,000,000 for each of fiscal years 2019 through 17 2024. Amounts appropriated under this subsection 18 shall remain available until expended. 19 (2) RESERVATIONS OF FUNDS.— 20 (A) The Secretary shall reserve 50 percent 21 of the amount appropriated under paragraph 22 (1) for the purposes of awarding grants for 23 comprehensive sex education for adolescents 24 under subsection (c). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 420 •S 3660 IS (B) The Secretary shall reserve 25 percent 1 of the amount appropriated under paragraph 2 (1) for the purposes of awarding grants for 3 comprehensive sex education at institutes of 4 higher education under subsection (d). 5 (C) The Secretary shall reserve 20 percent 6 of the amount appropriated under paragraph 7 (1) for the purposes of awarding grants for pre- 8 service and in-service teacher training under 9 subsection (e). 10 (D) The Secretary shall reserve 2 percent 11 of the amount appropriated under paragraph 12 (1) for the purpose of carrying out the impact 13 evaluation and reporting required under sub- 14 section (a). 15 (3) SECRETARIAL RESPONSIBILITIES.—The 16 Secretary shall reserve 3 percent of the amount ap- 17 propriated under paragraph (1) for each fiscal year 18 for expenditures by the Secretary to provide, directly 19 or through a competitive grant process, research, 20 training, and technical assistance, including dissemi- 21 nation of research and information regarding effec- 22 tive and promising practices, providing consultation 23 and resources, and developing resources and mate- 24 rials to support the activities of recipients of grants. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 421 •S 3660 IS In carrying out such functions, the Secretary shall 1 collaborate with a variety of entities that have exper- 2 tise in adolescent sexual health development, edu- 3 cation, and promotion. 4 (4) REPROGRAMMING OF ABSTINENCE ONLY 5 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli- 6 gated balance of funds made available to carry out 7 section 510 of the Social Security Act (42 U.S.C. 8 710) (as in effect on the day before the date of en- 9 actment of this Act) are hereby transferred and shall 10 be used by the Secretary to carry out this section. 11 The amounts transferred and made available to 12 carry out this section shall remain available until ex- 13 pended. 14 (5) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 15 RIAGE PROGRAM.—Section 510 of the Social Secu- 16 rity Act (42 U.S.C. 710 et seq.) is repealed. 17 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 18 GENCIES. 19 (a) MEDICARE.— 20 (1) LIMITATION ON PAYMENT.—Section 21 1866(a)(1) of the Social Security Act (42 U.S.C. 22 1395cc(a)(1)) is amended— 23 (A) by moving the indentation of subpara- 24 graph (W) 2 ems to the left; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 422 •S 3660 IS (B) in subparagraph (X)— 1 (i) by moving the indentation 2 ems 2 to the left; and 3 (ii) by striking ‘‘and’’ at the end; 4 (C) in subparagraph (Y), by striking the 5 period at the end and inserting ‘‘; and’’; and 6 (D) by inserting after subparagraph (Y) 7 the following new subparagraph: 8 ‘‘(Z) in the case of a hospital or critical access 9 hospital, to adopt and enforce a policy to ensure 10 compliance with the requirements of subsection (l) 11 and to meet the requirements of such subsection.’’. 12 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 13 the Social Security Act (42 U.S.C. 1395cc) is 14 amended by adding at the end the following new 15 subsection: 16 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 17 GENCIES.— 18 ‘‘(1) IN GENERAL.—For purposes of section 19 1866(a)(1)(Z), a hospital meets the requirements of 20 this subsection if the hospital provides each of the 21 services described in paragraph (2) to each indi- 22 vidual, whether or not eligible for benefits under this 23 title or under any other form of health insurance, 24 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 423 •S 3660 IS who comes to the hospital on or after January 1, 1 2019, and— 2 ‘‘(A) who states to hospital personnel that 3 they are victims of sexual assault; 4 ‘‘(B) who is accompanied by an individual 5 who states to hospital personnel that the indi- 6 vidual is a victim of sexual assault; or 7 ‘‘(C) whom hospital personnel, during the 8 course of treatment and care for the individual, 9 have reason to believe is a victim of sexual as- 10 sault. 11 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 12 purposes of paragraph (1), the services described in 13 this subparagraph are the following: 14 ‘‘(A) Provision of medically and factually 15 accurate and unbiased written and oral infor- 16 mation about emergency contraception that— 17 ‘‘(i) is written in clear and concise 18 language; 19 ‘‘(ii) is readily comprehensible; 20 ‘‘(iii) includes an explanation that 21 emergency contraception— 22 ‘‘(I) has been approved by the 23 Food and Drug Administration as an 24 over-the-counter or prescription medi- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 424 •S 3660 IS cation for individuals and is a safe 1 and effective way to prevent preg- 2 nancy after unprotected intercourse or 3 contraceptive failure if taken in a 4 timely manner; 5 ‘‘(II) is more effective the sooner 6 it is taken; and 7 ‘‘(III) does not cause an abortion 8 and cannot interrupt an established 9 pregnancy; 10 ‘‘(iv) meets such conditions regarding 11 the provision of such information in lan- 12 guages other than English as the Secretary 13 may establish; and 14 ‘‘(v) is provided without regard to the 15 ability of the individual or their family to 16 pay costs associated with the provision of 17 such information to the individual. 18 ‘‘(B) Immediate offer to provide emergency 19 contraception to the individual at the hospital 20 and, in the case that the individual accepts such 21 offer, immediate provision to the individual of 22 such contraception on the same day it is re- 23 quested without regard to the inability of the 24 individual or their family to pay costs associ- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 425 •S 3660 IS ated with the offer and provision of such con- 1 traception. 2 ‘‘(C) Development and implementation of a 3 written policy to ensure that an individual is 4 present at the hospital, or on-call, who— 5 ‘‘(i) has authority to dispense or pre- 6 scribe emergency contraception, independ- 7 ently, or under a protocol prepared by a 8 physician for the administration of emer- 9 gency contraception at the hospital to a 10 victim of sexual assault; and 11 ‘‘(ii) is trained to comply with the re- 12 quirements of this section. 13 ‘‘(D) Provision of medically and factually 14 accurate and unbiased written and oral infor- 15 mation and counseling about post-exposure pro- 16 phylaxis (PEP) protocol for the prevention of 17 HIV. 18 ‘‘(E) Immediately offer to begin PEP to 19 the individual at the hospital except in cases 20 where the medical professional’s best judgement 21 is that further evaluation is required or that 22 such a regimen will be substantially detrimental 23 to the individual’s health. Such provision shall 24 be offered regardless of the individual’s ability 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 426 •S 3660 IS to pay. Hospitals shall be responsible for ensur- 1 ing adequate supply of PEP medications to pro- 2 vide to patients. 3 ‘‘(3) DEFINITIONS.—For purposes of this para- 4 graph: 5 ‘‘(A) The term ‘emergency contraception’ 6 means a drug or device (as such terms are de- 7 fined in section 201 of the Federal Food, Drug, 8 and Cosmetic Act (21 U.S.C. 321)) or a drug 9 regimen that— 10 ‘‘(i) is used postcoitally; 11 ‘‘(ii) prevents pregnancy primarily by 12 preventing or delaying ovulation, and does 13 not terminate an established pregnancy; 14 and 15 ‘‘(iii) is approved by the Food and 16 Drug Administration. 17 ‘‘(B) The term ‘hospital’ includes a critical 18 access hospital, as defined in section 19 1861(mm)(1). 20 ‘‘(C) The term ‘sexual assault’ means co- 21 itus in which the individual involved does not 22 consent or lacks the legal capacity to consent.’’. 23 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 24 Section 1903(i) of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 427 •S 3660 IS 1396b(i)) is amended by inserting after paragraph (11) 1 the following new paragraph: 2 ‘‘(12) with respect to any amount expended for 3 care or services furnished under the plan by a hos- 4 pital on or after January 1, 2019, unless such hos- 5 pital meets the requirements specified in section 6 1866(l) for purposes of title XVIII.’’. 7 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 8 MACIES TO ENSURE PROVISION OF FDA-AP- 9 PROVED CONTRACEPTION. 10 Part B of title II of the Public Health Service Act 11 (42 U.S.C. 238 et seq.) is amended by adding at the end 12 the following: 13 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 14 OF FDA-APPROVED CONTRACEPTION. 15 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 16 pharmacy that receives Food and Drug Administration- 17 approved drugs or devices in interstate commerce shall 18 maintain compliance with the following: 19 ‘‘(1) If a customer requests a contraceptive, in- 20 cluding emergency contraception, that is in stock, 21 the pharmacy shall ensure that the contraceptive is 22 provided to the customer— 23 ‘‘(A) without delay; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 428 •S 3660 IS ‘‘(B) without regard to the customer’s age, 1 gender, gender identity, or sexual orientation; 2 ‘‘(C) without a requirement that identifica- 3 tion be presented; and 4 ‘‘(D) despite any conflicts of employees to 5 filling a prescription and dispensing a par- 6 ticular prescription drug or device due to sin- 7 cerely held moral, philosophical, or religious be- 8 liefs. 9 ‘‘(2) If a customer requests a contraceptive that 10 is not in stock and the pharmacy in the normal 11 course of business stocks contraception, the phar- 12 macy shall immediately inform the customer that the 13 contraceptive is not in stock and without delay offer 14 the customer the following options: 15 ‘‘(A) If the customer prefers to obtain the 16 contraceptive through a referral or transfer, the 17 pharmacy shall— 18 ‘‘(i) locate a pharmacy of the cus- 19 tomer’s choice or the closest pharmacy 20 confirmed to have the contraceptive in 21 stock; and 22 ‘‘(ii) refer the customer or transfer 23 the prescription to that pharmacy. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 429 •S 3660 IS ‘‘(B) If the customer prefers for the phar- 1 macy to order the contraceptive, the pharmacy 2 shall obtain the contraceptive under the phar- 3 macy’s standard procedure for expedited order- 4 ing of medication and notify the customer when 5 the contraceptive arrives. 6 ‘‘(3) The pharmacy shall ensure that its em- 7 ployees do not— 8 ‘‘(A) intimidate, threaten, or harass cus- 9 tomers in the delivery of services relating to a 10 request for contraception; 11 ‘‘(B) interfere with or obstruct the delivery 12 of services relating to a request for contracep- 13 tion; 14 ‘‘(C) intentionally misrepresent or deceive 15 customers about the availability of contracep- 16 tion or its mechanism of action; 17 ‘‘(D) breach medical confidentiality with 18 respect to a request for contraception or threat- 19 en to breach such confidentiality; or 20 ‘‘(E) refuse to return a valid, lawful pre- 21 scription for contraception upon customer re- 22 quest. 23 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 24 STOCKED.—Nothing in subsection (a)(2) shall be con- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 430 •S 3660 IS strued to require any pharmacy to comply with such sub- 1 section if the pharmacy does not ordinarily stock contra- 2 ceptives in the normal course of business. 3 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 4 MACY PRACTICE.—This section does not prohibit a phar- 5 macy from refusing to provide a contraceptive to a cus- 6 tomer in accordance with any of the following: 7 ‘‘(1) If it is unlawful to dispense the contracep- 8 tive to the customer without a valid, lawful prescrip- 9 tion and no such prescription is presented. 10 ‘‘(2) If the customer is unable to pay for the 11 contraceptive. 12 ‘‘(3) If the employee of the pharmacy refuses to 13 provide the contraceptive on the basis of a profes- 14 sional clinical judgment. 15 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec- 16 tion shall be construed to invalidate or limit rights, rem- 17 edies, procedures, or legal standards under title VII of the 18 Civil Rights Act of 1964. 19 ‘‘(e) PREEMPTION.—This section does not preempt 20 any provision of State law or any professional obligation 21 made applicable by a State board or other entity respon- 22 sible for licensing or discipline of pharmacies or phar- 23 macists, to the extent that such State law or professional 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 431 •S 3660 IS obligation provides protections for customers that are 1 greater than the protections provided by this section. 2 ‘‘(f) ENFORCEMENT.— 3 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 4 lates a requirement of subsection (a) is liable to the 5 United States for a civil penalty in an amount not 6 exceeding $1,000 per day of violation, not to exceed 7 $100,000 for all violations adjudicated in a single 8 proceeding. 9 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 10 aggrieved as a result of a violation of a requirement 11 of subsection (a) may, in any court of competent ju- 12 risdiction, commence a civil action against the phar- 13 macy involved to obtain appropriate relief, including 14 actual and punitive damages, injunctive relief, and a 15 reasonable attorney’s fee and cost. 16 ‘‘(3) LIMITATIONS.—A civil action under para- 17 graph (1) or (2) may not be commenced against a 18 pharmacy after the expiration of the 5-year period 19 beginning on the date on which the pharmacy alleg- 20 edly engaged in the violation involved. 21 ‘‘(g) DEFINITIONS.—In this section: 22 ‘‘(1) CONTRACEPTION.—The term ‘contracep- 23 tion’ or ‘contraceptive’ means any drug or device ap- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 432 •S 3660 IS proved by the Food and Drug Administration to pre- 1 vent pregnancy. 2 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 3 a person hired, by contract or any other form of an 4 agreement, by a pharmacy. 5 ‘‘(3) PHARMACY.—The term ‘pharmacy’ means 6 an entity that— 7 ‘‘(A) is authorized by a State to engage in 8 the business of selling prescription drugs at re- 9 tail; and 10 ‘‘(B) employs one or more employees. 11 ‘‘(4) PRODUCT.—The term ‘product’ means a 12 Food and Drug Administration-approved drug or de- 13 vice. 14 ‘‘(5) PROFESSIONAL CLINICAL JUDGMENT.— 15 The term ‘professional clinical judgment’ means the 16 use of professional knowledge and skills to form a 17 clinical judgment, in accordance with prevailing 18 medical standards. 19 ‘‘(6) WITHOUT DELAY.—The term ‘without 20 delay’, with respect to a pharmacy providing, pro- 21 viding a referral for, or ordering contraception, or 22 transferring the prescription for contraception, 23 means within the usual and customary timeframe at 24 the pharmacy for providing, providing a referral for, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 433 •S 3660 IS or ordering other products, or transferring the pre- 1 scription for other products, respectively. 2 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 3 fect on the 31st day after the date of the enactment of 4 this section, without regard to whether the Secretary has 5 issued any guidance or final rule regarding this section.’’. 6 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 7 WOMEN’S HEALTH. 8 Section 229(b) of the Public Health Service Act (42 9 U.S.C. 237a(b)) is amended— 10 (1) in paragraph (6), at the end, by striking 11 ‘‘and’’; 12 (2) in paragraph (7), at the end, by striking the 13 period and inserting a semicolon; and 14 (3) by adding at the end the following new 15 paragraph: 16 ‘‘(8) facilitate policymakers, health system lead- 17 ers and providers, consumers, and other stake- 18 holders in understanding optimal maternity care and 19 support for the provision of such care, including the 20 priorities of— 21 ‘‘(A) protecting, promoting, and supporting 22 the innate capacities of childbearing individuals 23 and their newborns for childbirth, breastfeed- 24 ing, and attachment; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 434 •S 3660 IS ‘‘(B) using obstetric interventions only 1 when such interventions are supported by 2 strong, high-quality evidence, and minimizing 3 overuse of maternity practices that have been 4 shown to have benefit in limited situations and 5 that can expose women, infants, or both to risk 6 of harm if used routinely and indiscriminately, 7 including continuous electronic fetal monitoring, 8 labor induction, epidural analgesia, primary ce- 9 sarean section, and routine repeat cesarean 10 birth; 11 ‘‘(C) reliably incorporating noninvasive, 12 evidence-based practices that have documented 13 correlation with considerable improvement in 14 outcomes with no detrimental side effects, such 15 as smoking cessation programs in pregnancy 16 and proven models of group prenatal care that 17 integrate health assessment, education, and 18 support into a unified program and supporting 19 evidence-based breastfeeding promotion efforts 20 with respect for a breastfeeding individual’s 21 personal decisionmaking; 22 ‘‘(D) a shared understanding of the quali- 23 fications of licensed providers of maternity care 24 and the best evidence about the safety, satisfac- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 435 •S 3660 IS tion, outcomes, and costs of their care, and ap- 1 propriate deployment of such caregivers within 2 the maternity care workforce to address the 3 needs of childbearing individuals and newborns 4 and the growing shortage of maternity care- 5 givers; 6 ‘‘(E) a shared understanding of the results 7 of the best available research comparing hos- 8 pital, birth center, and planned home births, in- 9 cluding information about each setting’s safety, 10 satisfaction, outcomes, and costs; and 11 ‘‘(F) high-quality, evidence-based child- 12 birth education that promotes a natural, 13 healthy, and safe approach to pregnancy, child- 14 birth, and early parenting; is taught by certified 15 educators, peer counselors, and health profes- 16 sionals; and promotes informed decisionmaking 17 by childbearing individual;’’. 18 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 19 THE PROMOTION OF OPTIMAL MATERNITY 20 OUTCOMES. 21 (a) IN GENERAL.—Part A of title II of the Public 22 Health Service Act (42 U.S.C. 202 et seq.) is amended 23 by adding at the end the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 436 •S 3660 IS ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 1 THE PROMOTION OF OPTIMAL MATERNITY 2 OUTCOMES. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Deputy Assistant Secretary for Women’s Health under 5 section 229 and in collaboration with the Federal officials 6 specified in subsection (b), shall establish the Interagency 7 Coordinating Committee on the Promotion of Optimal Ma- 8 ternity Outcomes (referred to in this section as the 9 ‘ICCPOM’). 10 ‘‘(b) OTHER AGENCIES.—The officials specified in 11 this subsection are the Secretary of Labor, the Secretary 12 of Defense, the Secretary of Veterans Affairs, the Surgeon 13 General, the Director of the Centers for Disease Control 14 and Prevention, the Administrator of the Health Re- 15 sources and Services Administration, the Administrator of 16 the Centers for Medicare & Medicaid Services, the Direc- 17 tor of the Indian Health Service, the Administrator of the 18 Substance Abuse and Mental Health Services Administra- 19 tion, the Director of the National Institute on Child 20 Health and Development, the Director of the Agency for 21 Healthcare Research and Quality, the Assistant Secretary 22 for Children and Families, the Deputy Assistant Secretary 23 for Minority Health, the Director of the Office of Per- 24 sonnel Management, and such other Federal officials as 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 437 •S 3660 IS the Secretary of Health and Human Services determines 1 to be appropriate. 2 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 3 Women’s Health shall serve as the chair of the ICCPOM. 4 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 5 program development across the Federal Government with 6 respect to promotion of optimal maternity care, provided, 7 however, that nothing in this section shall be construed 8 as transferring regulatory or program authority from an 9 agency to the ICCPOM. 10 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 11 seek the input of, and shall consult with, all appropriate 12 and interested stakeholders, including State health depart- 13 ments, public health research and interest groups, founda- 14 tions, childbearing individuals and their advocates, and 15 maternity care professional associations and organiza- 16 tions, reflecting racially, ethnically, demographically, and 17 geographically diverse communities. 18 ‘‘(f) ANNUAL REPORT.— 19 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 20 the ICCPOM, shall annually submit to Congress a 21 report that summarizes— 22 ‘‘(A) all programs and policies of Federal 23 agencies (including the Medicare Program 24 under title XVIII of the Social Security Act and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 438 •S 3660 IS the Medicaid program under title XIX of such 1 Act) designed to promote optimal maternity 2 care, focusing particularly on programs and 3 policies that support the adoption of evidence 4 based maternity care, as defined by timely, sci- 5 entifically sound systematic reviews; 6 ‘‘(B) all programs and policies of Federal 7 agencies (including the Medicare Program 8 under title XVIII of the Social Security Act and 9 the Medicaid program under title XIX of such 10 Act) designed to address the problems of mater- 11 nal mortality and morbidity, infant mortality, 12 prematurity, and low birth weight, including 13 such programs and policies designed to address 14 racial and ethnic disparities with respect to 15 each of such problems; 16 ‘‘(C) the extent of progress in reducing 17 maternal mortality and infant mortality, low 18 birth weight, and prematurity at State and na- 19 tional levels; and 20 ‘‘(D) such other information regarding op- 21 timal maternity care as the Secretary deter- 22 mines to be appropriate. 23 The information specified in subparagraph (C) shall 24 be included in each such report in a manner that 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 439 •S 3660 IS disaggregates such information by race, ethnicity, 1 and indigenous status in order to determine the ex- 2 tent of progress in reducing racial and ethnic dis- 3 parities and disparities related to indigenous status. 4 ‘‘(2) CERTAIN INFORMATION.—Each report 5 under paragraph (1) shall include information 6 (disaggregated by race, ethnicity, and indigenous 7 status, as applicable) on the following rates and 8 costs by State: 9 ‘‘(A) The rate of primary cesarean deliv- 10 eries and repeat cesarean deliveries. 11 ‘‘(B) The rate of vaginal births after cesar- 12 ean. 13 ‘‘(C) The rate of vaginal breech births. 14 ‘‘(D) The rate of induction of labor. 15 ‘‘(E) The rate of freestanding birth center 16 births. 17 ‘‘(F) The rate of planned and unplanned 18 home birth. 19 ‘‘(G) The rate of attended births by pro- 20 vider, including by an obstetrician-gynecologist, 21 family practice physician, obstetrician-gyne- 22 cologist physician assistant, certified nurse-mid- 23 wife, certified midwife, and certified profes- 24 sional midwife. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 440 •S 3660 IS ‘‘(H) The cost of maternity care 1 disaggregated by place of birth and provider of 2 care, including— 3 ‘‘(i) uncomplicated vaginal birth; 4 ‘‘(ii) complicated vaginal birth; 5 ‘‘(iii) uncomplicated cesarean birth; 6 and 7 ‘‘(iv) complicated cesarean birth. 8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 9 is authorized to be appropriated, in addition to amounts 10 authorized to be appropriated under section 229(e), to 11 carry out this section $1,000,000 for each of the fiscal 12 years 2019 through 2023.’’. 13 (b) CONFORMING AMENDMENTS.— 14 (1) INCLUSION AS DUTY OF HHS OFFICE ON 15 WOMEN’S HEALTH.—Section 229(b) of such Act (42 16 U.S.C. 237a(b)), as amended by section 514, is fur- 17 ther amended by adding at the end the following 18 new paragraph: 19 ‘‘(9) establish the Interagency Coordinating 20 Committee on the Promotion of Optimal Maternity 21 Outcomes in accordance with section 229A; and’’. 22 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 23 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 441 •S 3660 IS amended by inserting ‘‘(other than under subsection 1 (b)(9))’’ after ‘‘under this section’’. 2 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 3 Section 229(b) of the Public Health Service Act (42 4 U.S.C. 237a(b)), as amended by sections 514 and 515, 5 is further amended by adding at the end the following: 6 ‘‘(10) not later than one year after the date of 7 the enactment of the Health Equity and Account- 8 ability Act of 2018, develop and implement a 4-year 9 culturally and linguistically appropriate multimedia 10 consumer education campaign that is designed to 11 promote understanding and acceptance of evidence- 12 based maternity practices and models of care for op- 13 timal maternity outcomes among individuals of 14 childbearing ages and families of such individuals 15 and that— 16 ‘‘(A) highlights the importance of pro- 17 tecting, promoting, and supporting the innate 18 capacities of childbearing individuals and their 19 newborns for childbirth, breastfeeding, and at- 20 tachment; 21 ‘‘(B) promotes understanding of the impor- 22 tance of using obstetric interventions when 23 medically necessary and when supported by 24 strong, high-quality evidence; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 442 •S 3660 IS ‘‘(C) highlights the widespread overuse of 1 maternity practices that have been shown to 2 have benefit when used appropriately in situa- 3 tions of medical necessity, but which can expose 4 pregnant individuals, infants, or both to risk of 5 harm if used routinely and indiscriminately, in- 6 cluding continuous fetal monitoring, labor in- 7 duction, epidural anesthesia, elective primary 8 cesarean section, and repeat cesarean delivery; 9 ‘‘(D) emphasizes the noninvasive maternity 10 practices that have strong proven correlation or 11 may be associated with considerable improve- 12 ment in outcomes with no detrimental side ef- 13 fects, and are significantly underused in the 14 United States, including smoking cessation pro- 15 grams in pregnancy, group model prenatal care, 16 continuous labor support, nonsupine positions 17 for birth, and external version to turn breech 18 babies at term; 19 ‘‘(E) educates consumers about the quali- 20 fications of licensed providers of maternity care 21 and the best evidence about their safety, satis- 22 faction, outcomes, and costs; 23 ‘‘(F) informs consumers about the best 24 available research comparing birth center 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 443 •S 3660 IS births, planned home births, and hospital 1 births, including information about each set- 2 ting’s safety, satisfaction, outcomes, and costs; 3 ‘‘(G) fosters participation in high-quality, 4 evidence-based childbirth education that pro- 5 motes a natural, healthy, and safe approach to 6 pregnancy, childbirth, and early parenting; is 7 taught by certified educators, peer counselors, 8 and health professionals; and promotes in- 9 formed decisionmaking by childbearing individ- 10 uals; and 11 ‘‘(H) is pilot tested for consumer com- 12 prehension, cultural sensitivity, and acceptance 13 of the messages across geographically, racially, 14 ethnically, and linguistically diverse popu- 15 lations.’’. 16 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 17 VIEWS FOR CARE OF CHILDBEARING INDI- 18 VIDUALS AND NEWBORNS. 19 (a) IN GENERAL.—Not later than one year after the 20 date of the enactment of this Act, the Secretary of Health 21 and Human Services, through the Agency for Healthcare 22 Research and Quality, shall— 23 (1) make publicly available an online biblio- 24 graphic database identifying systematic reviews, in- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 444 •S 3660 IS cluding an explanation of the level and quality of 1 evidence, for care of childbearing individuals and 2 newborns; and 3 (2) initiate regular updates that incorporate 4 newly issued and updated systematic reviews. 5 (b) SOURCES.—To aim for a comprehensive inventory 6 of systematic reviews relevant to maternal and newborn 7 care, the database shall identify reviews from diverse 8 sources, including— 9 (1) scientific peer-reviewed journals; 10 (2) databases, including Cochrane Database of 11 Systematic Reviews, Clinical Evidence, and Data- 12 base of Abstracts of Reviews of Effects; and 13 (3) Internet Websites of agencies and organiza- 14 tions throughout the world that produce such sys- 15 tematic reviews. 16 (c) FEATURES.—The database shall— 17 (1) provide bibliographic citations for each 18 record within the database, and for each such cita- 19 tion include an explanation of the level and quality 20 of evidence; 21 (2) include abstracts, as available; 22 (3) provide reference to companion documents 23 as may exist for each review, such as evidence tables 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 445 •S 3660 IS and guidelines or consumer educational materials de- 1 veloped from the review; 2 (4) provide links to the source of the full review 3 and to any companion documents; 4 (5) provide links to the source of a previous 5 version or update of the review; 6 (6) be searchable by intervention or other topic 7 of the review, reported outcomes, author, title, and 8 source; and 9 (7) offer to users periodic electronic notification 10 of database updates relating to users’ topics of inter- 11 est. 12 (d) OUTREACH.—Not later than the first date the 13 database is made publicly available and periodically there- 14 after, the Secretary of Health and Human Services shall 15 publicize the availability, features, and uses of the data- 16 base under this section to the stakeholders described in 17 subsection (e). 18 (e) CONSULTATION.—For purposes of developing the 19 database under this section and maintaining and updating 20 such database, the Secretary of Health and Human Serv- 21 ices shall convene and consult with an advisory committee 22 composed of relevant stakeholders, including— 23 (1) Federal Medicaid administrators and State 24 agencies administrating State plans under title XIX 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 446 •S 3660 IS of the Social Security Act pursuant to section 1 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 2 (2) providers of maternity and newborn care 3 from both academic and community-based settings, 4 including obstetrician-gynecologists, family physi- 5 cians, certified nurse midwives, certified midwives, 6 certified professional midwives, physician assistants, 7 perinatal nurses, pediatricians, and nurse practi- 8 tioners; 9 (3) maternal-fetal medicine specialists; 10 (4) neonatologists; 11 (5) childbearing individuals and advocates for 12 such individuals, including childbirth educators cer- 13 tified by a nationally accredited program, rep- 14 resenting communities that are diverse in terms of 15 race, ethnicity, indigenous status, and geographic 16 area; 17 (6) employers and purchasers; 18 (7) health facility and system leaders, including 19 both hospital and birth center facilities; 20 (8) journalists; and 21 (9) bibliographic informatics specialists. 22 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 23 authorized to be appropriated $2,500,000 for each of the 24 fiscal years 2019 through 2021 for the purpose of devel- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 447 •S 3660 IS oping the database and such sums as may be necessary 1 for each subsequent fiscal year for updating the database 2 and providing outreach and notification to users, as de- 3 scribed in this section. 4 SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 5 SHORTAGE AREAS. 6 Section 332 of the Public Health Service Act (42 7 U.S.C. 254e) is amended by adding at the end the fol- 8 lowing: 9 ‘‘(k)(1) The Secretary, acting through the Adminis- 10 trator of the Health Resources and Services Administra- 11 tion, shall designate maternity care health professional 12 shortage areas in the States, publish a descriptive list of 13 the area’s population groups, medical facilities, and other 14 public facilities so designated, and at least annually review 15 and, as necessary, revise such designations. 16 ‘‘(2) For purposes of paragraph (1), a complete de- 17 scriptive list shall be published in the Federal Register not 18 later than one year after the date of the enactment of the 19 Health Equity and Accountability Act of 2018 and annu- 20 ally thereafter. 21 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 22 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 23 shall apply to the designation of a maternity care health 24 professional shortage area in a similar manner and extent 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 448 •S 3660 IS as such provisions apply to the designation of health pro- 1 fessional shortage areas, except in applying subsection 2 (b)(3), the reference in such subsection to ‘physicians’ 3 shall be deemed to be a reference to nationally certified 4 and State licensed obstetricians, family practice physicians 5 who practice full-scope maternity care, certified nurse 6 midwives, certified midwives, certified professional mid- 7 wives, and physician’s assistants who practice full scope 8 maternity care. 9 ‘‘(4) For purposes of this subsection, the term ‘ma- 10 ternity care health professional shortage area’ means— 11 ‘‘(A) an area in an urban or rural area (which 12 need not conform to the geographic boundaries of a 13 political subdivision and which is a rational area for 14 the delivery of health services) which the Secretary 15 determines has a shortage of providers of maternity 16 care health services including those referenced in 17 paragraph (3) or an urban or rural area that the 18 Secretary determines has lost a significant number 19 of such providers during the 10-year period begin- 20 ning with 2004 or has no obstetrical providers li- 21 censed to provide operative obstetrical services; 22 ‘‘(B) an area in an urban or rural area (which 23 need not conform to the geographic boundaries of a 24 political subdivision and which is a rational area for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 449 •S 3660 IS the delivery of health services) which the Secretary 1 determines has a shortage of hospital or labor and 2 delivery units, hospital birth center units, or free- 3 standing birth centers or an area that lost a signifi- 4 cant number of these units during the 10-year pe- 5 riod beginning with 2004; or 6 ‘‘(C) a population group which the Secretary 7 determines has such a shortage of providers or fa- 8 cilities.’’. 9 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 10 CENTERS PROGRAM TO INCLUDE CENTERS 11 ON OPTIMAL MATERNITY OUTCOMES. 12 (a) IN GENERAL.—Not later than one year after the 13 date of the enactment of this Act, the Secretary of Health 14 and Human Services, shall support the establishment of 15 additional Prevention Research Centers under the Preven- 16 tion Research Center Program administered by the Cen- 17 ters for Disease Control and Prevention. Such additional 18 centers shall each be known as a Center for Excellence 19 on Optimal Maternity Outcomes. 20 (b) RESEARCH.—Each Center for Excellence on Opti- 21 mal Maternity Outcomes shall— 22 (1) conduct at least one focused program of re- 23 search to improve maternity outcomes, including the 24 reduction of cesarean birth rates, elective inductions, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 450 •S 3660 IS prematurity rates, and low birth weight rates within 1 an underserved population that has a disproportion- 2 ately large burden of suboptimal maternity out- 3 comes, including maternal mortality and morbidity, 4 infant mortality, prematurity, or low birth weight; 5 (2) work with partners on special interest 6 projects, as specified by the Centers for Disease 7 Control and Prevention and other relevant agencies 8 within the Department of Health and Human Serv- 9 ices, and on projects funded by other sources; and 10 (3) involve a minimum of two distinct birth set- 11 ting models, such as a hospital labor and delivery 12 model and freestanding birth center model; or a hos- 13 pital labor and delivery model and planned home 14 birth model. 15 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 16 for Excellence on Optimal Maternity Outcomes shall in- 17 clude the following interdisciplinary providers of maternity 18 care: 19 (1) Obstetrician-gynecologists. 20 (2) At least two of the following providers: 21 (A) Family practice physicians. 22 (B) Nurse practitioners. 23 (C) Physician assistants. 24 (D) Certified professional midwives. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 451 •S 3660 IS (d) SERVICES.—Research conducted by each Center 1 for Excellence on Optimal Maternity Outcomes shall in- 2 clude at least 2 (and preferably more) of the following sup- 3 portive provider services: 4 (1) Mental health. 5 (2) Doula labor support. 6 (3) Nutrition education. 7 (4) Childbirth education. 8 (5) Social work. 9 (6) Physical therapy or occupation therapy. 10 (7) Substance abuse services. 11 (8) Home visiting. 12 (e) COORDINATION.—The programs of research at 13 each of the two Centers of Excellence on Optimal Mater- 14 nity Outcomes shall compliment and not replicate the 15 work of the other. 16 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 17 authorized to be appropriated to carry out this section 18 $2,000,000 for each of the fiscal years 2019 through 19 2023. 20 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 452 •S 3660 IS SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 1 CENTER FOR MEDICARE & MEDICAID INNO- 2 VATION TO INCLUDE MATERNITY CARE MOD- 3 ELS. 4 Section 1115A(b)(2)(B) of the Social Security Act 5 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 6 end the following new clause: 7 ‘‘(xxv) Promoting evidence-based mod- 8 els of care that have been associated with 9 reductions in maternal and infant health 10 disparities, including incorporating the use 11 of doula and promotoras support for preg- 12 nant and childbearing individuals into evi- 13 dence-based models of prenatal care, labor 14 and delivery, and postpartum care, and 15 supporting the appropriate use of out-of- 16 hospital birth models, including births at 17 home and in freestanding birth centers.’’. 18 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER- 19 NITY CARE EDUCATIONAL MODELS AND 20 TOOLS. 21 (a) IN GENERAL.—Not later than 6 months after the 22 date of the enactment of this Act, the Secretary of Health 23 and Human Services, acting in conjunction with the Ad- 24 ministrator of Health Resources and Services Administra- 25 tion, shall convene, for a 1-year period, an Interprofes- 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 453 •S 3660 IS sional Maternity Provider Education Commission to dis- 1 cuss and make recommendations for— 2 (1) a consensus standard physiologic maternity 3 care curriculum that takes into account the core 4 competencies for basic midwifery practice such as 5 those developed by the American College of Nurse 6 Midwives and the North American Registry of Mid- 7 wives, and the educational objectives for physicians 8 practicing in obstetrics and gynecology as deter- 9 mined by the Council on Resident Education in Ob- 10 stetrics and Gynecology; 11 (2) suggestions for multidisciplinary use of the 12 consensus physiologic curriculum; 13 (3) strategies to integrate and coordinate edu- 14 cation across maternity care disciplines, including 15 recommendations to increase medical and midwifery 16 student exposure to out-of-hospital birth; and 17 (4) pilot demonstrations of interprofessional 18 educational models. 19 (b) PARTICIPANTS.—The Commission shall include 20 maternity care educators, curriculum developers, service 21 leaders, certification leaders, and accreditation leaders 22 from the various professions that provide maternity care 23 in the United States. Such professions shall include obste- 24 trician gynecologists, certified nurse midwives or certified 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 454 •S 3660 IS midwives, family practice physicians, nurse practitioners, 1 physician assistants, certified professional midwives, and 2 perinatal nurses. Additionally, the Commission shall in- 3 clude representation from maternity care consumer advo- 4 cates. 5 (c) CURRICULUM.—The consensus standard physio- 6 logic maternity care curriculum described in subsection 7 (a)(1) shall— 8 (1) have a public health focus with a foundation 9 in health promotion and disease prevention; 10 (2) foster physiologic childbearing and woman 11 and family centered care; 12 (3) integrate strategies to reduce maternal and 13 infant morbidity and mortality; 14 (4) incorporate recommendations to ensure re- 15 spectful, safe, and seamless consultation, referral, 16 transport, and transfer of care when necessary; and 17 (5) include cultural sensitivity and strategies to 18 decrease disparities in maternity outcomes. 19 (d) REPORT.—Not later than 6 months after the final 20 meeting of the Commission, the Secretary of Health and 21 Human Services shall— 22 (1) submit to Congress a report containing the 23 recommendations made by the Commission under 24 this section; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 455 •S 3660 IS (2) make such report publicly available. 1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 2 authorized to be appropriated to carry out this section 3 $1,000,000 for each of the fiscal years 2019 and 2020, 4 and such sums as are necessary for each of the fiscal years 5 2021 through 2023. 6 SEC. 522. INCLUDING SERVICES FURNISHED BY CERTAIN 7 STUDENTS, INTERNS, AND RESIDENTS SU- 8 PERVISED BY CERTIFIED NURSE MIDWIVES 9 WITHIN INPATIENT HOSPITAL SERVICES 10 UNDER MEDICARE. 11 (a) IN GENERAL.—Section 1861(b) of the Social Se- 12 curity Act (42 U.S.C. 1395x(b)) is amended— 13 (1) in paragraph (6), by striking ‘‘; or’’ at the 14 end and inserting ‘‘, or in the case of services in a 15 hospital or osteopathic hospital by a student midwife 16 or an intern or resident-in-training under a teaching 17 program previously described in this paragraph who 18 is in the field of obstetrics and gynecology, if such 19 student midwife, intern, or resident-in-training is su- 20 pervised by a certified nurse-midwife to the extent 21 permitted under applicable State law and as may be 22 authorized by the hospital;’’; 23 (2) in paragraph (7), by striking the period at 24 the end and inserting ‘‘; or’’; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 456 •S 3660 IS (3) by adding at the end the following new 1 paragraph: 2 ‘‘(8) a certified nurse-midwife where the hos- 3 pital has a teaching program approved as specified 4 in paragraph (6), if— 5 ‘‘(A) the hospital elects to receive any pay- 6 ment due under this title for reasonable costs of 7 such services; and 8 ‘‘(B) all certified nurse-midwives in such 9 hospital agree not to bill charges for profes- 10 sional services rendered in such hospital to indi- 11 viduals covered under the insurance program 12 established by this title.’’. 13 (b) EFFECTIVE DATE.—The amendments made by 14 subsection (a) shall apply to services furnished on or after 15 the date of the enactment of this Act. 16 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 17 INCREASE DIVERSITY IN MATERNAL, REPRO- 18 DUCTIVE, AND SEXUAL HEALTH PROFES- 19 SIONALS. 20 (a) IN GENERAL.—The Secretary of Health and 21 Human Services, through the Administrator of the Health 22 Resources and Services Administration, shall carry out a 23 grant program under which the Secretary may make to 24 eligible health professional organizations— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 457 •S 3660 IS (1) for fiscal year 2019, planning grants de- 1 scribed in subsection (b); and 2 (2) for the subsequent 4-year period, implemen- 3 tation grants described in subsection (c). 4 (b) PLANNING GRANTS.— 5 (1) IN GENERAL.—Planning grants described in 6 this subsection are grants for the following purposes: 7 (A) To collect data and identify any work- 8 force disparities, with respect to a health pro- 9 fession, at each of the following areas along the 10 health professional continuum: 11 (i) Pipeline availability with respect to 12 students at the high school and college or 13 university levels considering and working 14 toward entrance in the profession. 15 (ii) Entrance into the training pro- 16 gram for the profession. 17 (iii) Graduation from such training 18 program. 19 (iv) Entrance into practice. 20 (v) Retention in practice for more 21 than a 5-year period. 22 (B) To develop one or more strategies to 23 address the workforce disparities within the 24 health profession, as identified under (and in 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 458 •S 3660 IS response to the findings pursuant to) subpara- 1 graph (A). 2 (2) APPLICATION.—To be eligible to receive a 3 grant under this subsection, an eligible health pro- 4 fessional organization shall submit to the Secretary 5 of Health and Human Services an application in 6 such form and manner and containing such informa- 7 tion as specified by the Secretary. 8 (3) AMOUNT.—Each grant awarded under this 9 subsection shall be for an amount not to exceed 10 $300,000. 11 (4) REPORT.—Each recipient of a grant under 12 this subsection shall submit to the Secretary of 13 Health and Human Services a report containing— 14 (A) information on the extent and distribu- 15 tion of workforce disparities identified through 16 the grant; and 17 (B) reasonable objectives and strategies 18 developed to address such disparities within a 19 5-, 10-, and 25-year period. 20 (c) IMPLEMENTATION GRANTS.— 21 (1) IN GENERAL.—Implementation grants de- 22 scribed in this subsection are grants to implement 23 one or more of the strategies developed pursuant to 24 a planning grant awarded under subsection (b). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 459 •S 3660 IS (2) APPLICATION.—To be eligible to receive a 1 grant under this subsection, an eligible health pro- 2 fessional organization shall submit to the Secretary 3 of Health and Human Services an application in 4 such form and manner as specified by the Secretary. 5 Each such application shall contain information on 6 the capability of the organization to carry out a 7 strategy described in paragraph (1), involvement of 8 partners or coalitions, plans for developing sustain- 9 ability of the efforts after the culmination of the 10 grant cycle, and any other information specified by 11 the Secretary. 12 (3) AMOUNT.—Each grant awarded under this 13 subsection shall be for an amount not to exceed 14 $500,000 each year during the 4-year period of the 15 grant. 16 (4) REPORTS.—For each of the first 3 years for 17 which an eligible health professional organization is 18 awarded a grant under this subsection, the organiza- 19 tion shall submit to the Secretary of Health and 20 Human Services a report on the activities carried 21 out by such organization through the grant during 22 such year and objectives for the subsequent year. 23 For the fourth year for which an eligible health pro- 24 fessional organization is awarded a grant under this 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 460 •S 3660 IS subsection, the organization shall submit to the Sec- 1 retary a report that includes an analysis of all the 2 activities carried out by the organization through the 3 grant and a detailed plan for continuation of out- 4 reach efforts. 5 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 6 TION DEFINED.—For purposes of this section, the term 7 ‘‘eligible health professional organization’’ means a profes- 8 sional organization representing obstetrician-gynecolo- 9 gists, certified nurse midwives, certified midwives, family 10 practice physicians, nurse practitioners whose scope of 11 practice includes maternity or sexual and reproductive 12 health care, physician assistants whose scope of practice 13 includes obstetrical or sexual and reproductive health care, 14 or certified professional midwives adolescent medicine spe- 15 cialists, and pediatricians who provide sexual and repro- 16 ductive health care. 17 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 18 authorized to be appropriated to carry out this section 19 $2,000,000 for fiscal year 2019 and $3,000,000 for each 20 of the fiscal years 2020 through 2023. 21 SEC. 524. INTERAGENCY UPDATE TO THE QUALITY FAMILY 22 PLANNING GUIDELINES. 23 (a) IN GENERAL.—Not later than six months after 24 the date of enactment of this Act, the Director of the Cen- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 461 •S 3660 IS ters for Disease Control and Prevention and the Office 1 of Population Affairs shall review and expand the 2014 2 Quality Family Planning Guidelines to address— 3 (1) health disparities; and 4 (2) the importance of patient-directed contra- 5 ceptive decisionmaking. 6 (b) CONSULTATION.—In carrying out subsection (a), 7 the Director of the Centers for Disease Control and Pre- 8 vention and the Office of Population Affairs shall convene 9 a meeting, and solicit the views of, stakeholders including 10 experts on health disparities, experts on reproductive coer- 11 cion, representatives of provider organizations, patient ad- 12 vocates, reproductive justice organizations, organizations 13 that represent racial and ethnic minority communities, or- 14 ganizations that represent people with disabilities, organi- 15 zations that represent LGBTQ persons, and organizations 16 that represent people with limited-English proficiency. 17 SEC. 525. DISSEMINATION OF THE QUALITY FAMILY PLAN- 18 NING GUIDELINES. 19 (a) IN GENERAL.—Not later than six months after 20 the date of enactment of this Act, the Secretary of Health 21 and Human Services and the Director of the Centers for 22 Disease Control and Prevention shall— 23 (1) develop a plan for outreach to publicly fund- 24 ed health care providers, including federally qualified 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 462 •S 3660 IS health centers and branches of the Indian Health 1 Service, about the quality family planning guidelines 2 referred to in section 524; and 3 (2) award grants to eligible entities to imple- 4 ment these guidelines for all patients seeking family 5 planning services. 6 (b) DEFINITION.—In this section, the term ‘‘eligible 7 entity’’ means a publicly funded health care provider that 8 serves persons of reproductive age. 9 Subtitle B—Pregnancy Screening 10 SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE 11 DEMONSTRATION PROGRAM. 12 Part P of title III of the Public Health Service Act 13 (42 U.S.C. 280g et seq.) is amended by adding at the end 14 the following: 15 ‘‘SEC. 399V–7. PREGNANCY INTENTION SCREENING INITIA- 16 TIVE DEMONSTRATION PROGRAM. 17 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 18 acting through the Director of the Centers for Disease 19 Control and Prevention, shall establish a demonstration 20 program to facilitate the clinical adoption of pregnancy in- 21 tention screening initiatives by health care providers. 22 ‘‘(b) GRANTS.—The Secretary may carry out the 23 demonstration program through awarding grants to eligi- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 463 •S 3660 IS ble entities to implement pregnancy intention screening 1 initiatives, collect data, and evaluate such initiatives. 2 ‘‘(c) ELIGIBLE ENTITIES.— 3 ‘‘(1) IN GENERAL.—An eligible entity under 4 this section is an entity described in paragraph (2) 5 that provides non-directive, comprehensive, medically 6 accurate information. 7 ‘‘(2) ENTITIES DESCRIBED.—For purposes of 8 paragraph (1), an entity described in this paragraph 9 is a community-based organization, voluntary health 10 organization, public health department, community 11 health center, or other interested public or private 12 health care provider or organization. 13 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 14 TIVE.—For purposes of this section, the term ‘pregnancy 15 intention screening initiative’ means any initiative by a 16 health care provider to routinely screen women with re- 17 spect to their pregnancy intentions and goals to either pre- 18 vent unintended pregnancies or improve the likelihood of 19 healthy pregnancies, in order to better provide health care 20 that meets the contraceptive or pre-pregnancy needs of 21 such women. 22 ‘‘(e) EVALUATION.— 23 ‘‘(1) IN GENERAL.—The Secretary, acting 24 through the Director of the Centers for Disease 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 464 •S 3660 IS Control and Prevention, shall, by grant or contract, 1 and after consultation as described in paragraph (2), 2 conduct an evaluation of the demonstration pro- 3 gram, with respect to pregnancy intention screening 4 initiatives, conducted under this section. The evalua- 5 tion shall include: 6 ‘‘(A) Assessment of the implementation of 7 pregnancy intention screening protocols among 8 a diverse group of patients and providers, in- 9 cluding collecting data on the experiences and 10 outcomes for diverse patient populations in a 11 variety of clinical settings. 12 ‘‘(B) Analysis of outcome measures that 13 will facilitate effective and widespread adoption 14 of such protocols by health care providers for 15 inquiring about and responding to pregnancy 16 intentions of women with both contraceptive 17 and pre-pregnancy care. 18 ‘‘(C) Consideration of health disparities 19 among the population served. 20 ‘‘(D) Assessment of the equitable and vol- 21 untary application of such initiatives to minor- 22 ity and medically underserved communities. 23 ‘‘(E) Assessment of the training, capacity, 24 and ongoing technical assistance needed for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 465 •S 3660 IS providers to effectively implement such preg- 1 nancy intention screening protocols. 2 ‘‘(F) Assessment of whether referral sys- 3 tems for selected protocols follow evidence-based 4 standards that ensure access to comprehensive 5 health services and appropriate follow-up care. 6 ‘‘(2) INDEPENDENT, EXPERT ADVISORY 7 PANEL.—In conducting the evaluation under para- 8 graph (1), the Director of the Centers for Disease 9 Control and Prevention shall consult with physi- 10 cians, physician assistants, and nurses who spe- 11 cialize in women’s health, and other experts in clin- 12 ical practice, program evaluation, and research. 13 ‘‘(3) REPORT.—Not later than one year after 14 the last day of the demonstration program under 15 this section, the Director of the Centers for Disease 16 Control and Prevention shall submit to Congress a 17 report on the results of the evaluation conducted 18 under paragraph (1) and shall make the report pub- 19 licly available. 20 ‘‘(f) FUNDING.— 21 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 22 To carry out this section, there is authorized to be 23 appropriated $5,000,000 for each of fiscal years 24 2019 through 2021. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 466 •S 3660 IS ‘‘(2) LIMITATION.—Not more than 25 percent 1 of funds appropriated to carry out this section pur- 2 suant to paragraph (1) for a fiscal year may be used 3 for purposes of the evaluation under subsection 4 (e).’’. 5 TITLE VI—MENTAL HEALTH 6 SEC. 601. MENTAL HEALTH FINDINGS. 7 Congress finds the following: 8 (1) Despite the existence of effective treat- 9 ments, disparities lie in the availability, accessibility, 10 and quality of mental health services for racial and 11 ethnic minorities. 12 (2) These disparities have powerful significance 13 for minority groups and for society as a whole. 14 (3) Racial and ethnic minorities bear a greater 15 burden from unmet mental health needs and thus 16 suffer a greater loss to their overall health and pro- 17 ductivity. 18 (4) The foremost barriers include the cost of 19 care, societal stigma, and the fragmented organiza- 20 tion of services. 21 (5) African-American attitudes toward mental 22 illness are another barrier to seeking mental health 23 care. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 467 •S 3660 IS (6) Mental illness retains considerable stigma, 1 and seeking treatment is not always encouraged. 2 (7) Mental illness is highly stigmatizing in 3 many Asian cultures. 4 (8) Addressing mental health stigma in commu- 5 nities will help increase utilization of mental health 6 services and reduce the burden of mental illness. 7 SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERA- 8 PIST SERVICES, MENTAL HEALTH COUN- 9 SELOR SERVICES, AND SUBSTANCE ABUSE 10 COUNSELOR SERVICES UNDER PART B OF 11 THE MEDICARE PROGRAM. 12 (a) COVERAGE OF SERVICES.— 13 (1) IN GENERAL.—Section 1861(s)(2) of the 14 Social Security Act (42 U.S.C. 1395x(s)(2)), as 15 amended by section 431(c), is amended— 16 (A) in subparagraph (GG), by striking 17 ‘‘and’’ at the end; 18 (B) in subparagraph (HH), by inserting 19 ‘‘and’’ at the end; and 20 (C) by adding at the end the following new 21 subparagraph: 22 ‘‘(II) marriage and family therapist services (as 23 defined in subsection (lll)(1)) and mental health 24 counselor services (as defined in subsection (lll)(3)) 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 468 •S 3660 IS and substance abuse counselor services (as defined 1 in subsection (lll)(5));’’. 2 (2) DEFINITIONS.—Section 1861 of the Social 3 Security Act (42 U.S.C. 1395x), as amended by sec- 4 tions 205(b)(a), 413(a), and 431(c), is amended by 5 adding at the end the following new subsection: 6 ‘‘Marriage and Family Therapist Services; Marriage and 7 Family Therapist; Mental Health Counselor Serv- 8 ices; Mental Health Counselor; Substance Abuse 9 Counselor Services; Substance Abuse Counselor 10 ‘‘(lll)(1) The term ‘marriage and family therapist 11 services’ means services performed by a marriage and 12 family therapist (as defined in paragraph (2)) for the diag- 13 nosis and treatment of mental illnesses, which the mar- 14 riage and family therapist is legally authorized to perform 15 under State law (or the State regulatory mechanism pro- 16 vided by State law) of the State in which such services 17 are performed, as would otherwise be covered if furnished 18 by a physician or as an incident to a physician’s profes- 19 sional service, but only if no facility or other provider 20 charges or is paid any amounts with respect to the fur- 21 nishing of such services. 22 ‘‘(2) The term ‘marriage and family therapist’ means 23 an individual who— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 469 •S 3660 IS ‘‘(A) possesses a master’s or doctoral degree 1 that qualifies for licensure or certification as a mar- 2 riage and family therapist pursuant to State law; 3 ‘‘(B) after obtaining such degree has performed 4 at least 2 years of clinical supervised experience in 5 marriage and family therapy; and 6 ‘‘(C) in the case of an individual performing 7 services in a State that provides for licensure or cer- 8 tification of marriage and family therapists, is li- 9 censed or certified as a marriage and family thera- 10 pist in such State. 11 ‘‘(3) The term ‘mental health counselor services’ 12 means services performed by a mental health counselor (as 13 defined in paragraph (4)) for the diagnosis and treatment 14 of mental illnesses that the mental health counselor is le- 15 gally authorized to perform under State law (or the State 16 regulatory mechanism provided by the State law) of the 17 State in which such services are performed, as would oth- 18 erwise be covered if furnished by a physician or as incident 19 to a physician’s professional service, but only if no facility 20 or other provider charges or is paid any amounts with re- 21 spect to the furnishing of such services. 22 ‘‘(4) The term ‘mental health counselor’ means an 23 individual who— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 470 •S 3660 IS ‘‘(A) possesses a master’s or doctor’s degree in 1 mental health counseling or a related field; 2 ‘‘(B) after obtaining such a degree has per- 3 formed at least 2 years of supervised mental health 4 counselor practice; and 5 ‘‘(C) in the case of an individual performing 6 services in a State that provides for licensure or cer- 7 tification of mental health counselors or professional 8 counselors, is licensed or certified as a mental health 9 counselor or professional counselor in such State. 10 ‘‘(5) The term ‘substance abuse counselor services’ 11 means services performed by a substance abuse counselor 12 (as defined in paragraph (6)) for the diagnosis and treat- 13 ment of substance abuse and addiction that the substance 14 abuse counselor is legally authorized to perform under 15 State law (or the State regulatory mechanism provided by 16 the State law) of the State in which such services are per- 17 formed, as would otherwise be covered if furnished by a 18 physician or as incident to a physician’s professional serv- 19 ice, but only if no facility or other provider charges or is 20 paid any amounts with respect to the furnishing of such 21 services. 22 ‘‘(6) The term ‘substance abuse counselor’ means an 23 individual who— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 471 •S 3660 IS ‘‘(A) has performed at least 2 years of super- 1 vised substance abuse counselor practice; 2 ‘‘(B) in the case of an individual performing 3 services in a State that provides for licensure or cer- 4 tification of substance abuse counselors or profes- 5 sional counselors, is licensed or certified as a sub- 6 stance abuse counselor or professional counselor in 7 such State; or 8 ‘‘(C) is a drug and alcohol counselor as defined 9 in section 40.281 of title 49, Code of Federal Regu- 10 lations.’’. 11 (3) PROVISION FOR PAYMENT UNDER PART 12 B.—Section 1832(a)(2)(B) of the Social Security 13 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 14 (A) by striking ‘‘and’’ at the end of clause 15 (iv); and 16 (B) by adding at the end the following new 17 clause: 18 ‘‘(v) marriage and family therapist 19 services, mental health counselor services, 20 and substance abuse counselor services; 21 and’’. 22 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 23 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 24 as amended by section 431(c)(3), is amended— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 472 •S 3660 IS (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 1 (B) by inserting before the semicolon at 2 the end the following: ‘‘, and (DD) with respect 3 to marriage and family therapist services, men- 4 tal health counselor services, and substance 5 abuse counselor services under section 6 1861(s)(2)(II), the amounts paid shall be 80 7 percent of the lesser of the actual charge for 8 the services or 75 percent of the amount deter- 9 mined for payment of a psychologist under sub- 10 paragraph (L)’’. 11 (5) EXCLUSION OF MARRIAGE AND FAMILY 12 THERAPIST SERVICES AND MENTAL HEALTH COUN- 13 SELOR SERVICES FROM SKILLED NURSING FACILITY 14 PROSPECTIVE PAYMENT SYSTEM.—Section 15 1888(e)(2)(A)(ii) of the Social Security Act (42 16 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 17 ‘‘marriage and family therapist services (as defined 18 in section 1861(lll)(1)), mental health counselor 19 services (as defined in section 1861(lll)(3)),’’ after 20 ‘‘qualified psychologist services,’’. 21 (6) INCLUSION OF MARRIAGE AND FAMILY 22 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 23 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 24 FOR ASSIGNMENT OF CLAIMS.—Section 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 473 •S 3660 IS 1842(b)(18)(C) of the Social Security Act (42 1 U.S.C. 1395u(b)(18)(C)) is amended by adding at 2 the end the following new clauses: 3 ‘‘(vii) A marriage and family therapist (as de- 4 fined in section 1861(lll)(2)). 5 ‘‘(viii) A mental health counselor (as defined in 6 section 1861(lll)(4)). 7 ‘‘(ix) A substance abuse counselor (as defined 8 in section 1861(lll)(6)).’’. 9 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 10 ICES PROVIDED IN CERTAIN SETTINGS.— 11 (1) RURAL HEALTH CLINICS AND FEDERALLY 12 QUALIFIED HEALTH CENTERS.—Section 13 1861(aa)(1)(B) of the Social Security Act (42 14 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 15 by a clinical social worker (as defined in subsection 16 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 17 (as defined in subsection (hh)(1)), by a marriage 18 and family therapist (as defined in subsection 19 (lll)(2)), or by a mental health counselor (as defined 20 in subsection (lll)(4)), or by a substance abuse coun- 21 selor (as defined in section 1861 (lll)(6)).’’. 22 (2) HOSPICE PROGRAMS.—Section 23 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 24 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 474 •S 3660 IS serting ‘‘or one marriage and family therapist (as 1 defined in subsection (lll)(2))’’ after ‘‘social worker’’. 2 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 3 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 4 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 5 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 6 amended by inserting ‘‘marriage and family therapist (as 7 defined in subsection (lll)(2)),’’ after ‘‘social worker,’’. 8 (d) EFFECTIVE DATE.—The amendments made by 9 this section shall apply with respect to services furnished 10 on or after January 1, 2019. 11 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 12 PROGRAM. 13 Part D of title V of the Public Health Service Act 14 (42 U.S.C. 290dd et seq.) is amended by adding at the 15 end the following: 16 ‘‘SEC. 550. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 17 PROVISION OF BEHAVIORAL HEALTH CARE 18 IN PRIMARY CARE SETTINGS. 19 ‘‘(a) GRANTS.—The Secretary, acting through the 20 Assistant Secretary for Mental Health and Substance 21 Abuse, shall award grants to eligible entities for the pur- 22 pose of establishing interprofessional health care teams 23 that provide behavioral health care. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 475 •S 3660 IS ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 1 a grant under this section, an entity shall be a Federally 2 qualified health center (as defined in section 1861(aa) of 3 the Social Security Act), rural health clinic, or behavioral 4 health program, serving a high proportion of individuals 5 from racial and ethnic minority groups (as defined in sec- 6 tion 1707(g)). 7 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 8 care funded through this section shall be scientifically 9 based, taking into consideration the results of the most 10 recent peer-reviewed research available. 11 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this section, there is authorized to be appro- 13 priated $20,000,000 for each of fiscal years 2019 through 14 2024.’’. 15 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 16 MENTAL HEALTH DISPARITIES RESEARCH 17 GAPS. 18 (a) IN GENERAL.—Not later than 6 months after the 19 date of the enactment of this Act, the Director of the Na- 20 tional Institute on Minority Health and Health Disparities 21 shall enter into an arrangement with the National Acad- 22 emy of Sciences to carry out the activities under sub- 23 section (b), or, if the National Academy of Sciences de- 24 clines to enter into such an arrangement, the Director of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 476 •S 3660 IS the National Institute on Minority Health and Health Dis- 1 parities, in cooperation with the Agency for Healthcare 2 Research and Quality, shall carry out the activities under 3 subsection (b). 4 (b) ACTIVITIES.—The applicable entity under sub- 5 section (a) shall— 6 (1) conduct a study with respect to mental 7 health disparities in racial and ethnic minority 8 groups (as defined in section 1707(g) of the Public 9 Health Service Act (42 U.S.C. 300u–6(g))); and 10 (2) submit to Congress a report on the results 11 of such study, including— 12 (A) a compilation of information on the dy- 13 namics of mental disorders in such racial and 14 ethnic minority groups; and 15 (B) a compilation of information on the 16 impact of exposure to community violence, ad- 17 verse childhood experiences, and other psycho- 18 logical traumas on mental disorders in such ra- 19 cial and minority groups. 20 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 21 DRESS RACIAL AND ETHNIC MINORITY MEN- 22 TAL HEALTH DISPARITIES. 23 (a) IN GENERAL.—The Secretary of Health and 24 Human Services, acting through the Assistant Secretary 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 477 •S 3660 IS for Mental Health and Substance Use, shall award grants 1 to qualified national organizations for the purposes of— 2 (1) developing, and disseminating to health pro- 3 fessional educational programs curricula or core 4 competencies addressing mental health disparities 5 among racial and ethnic minority groups for use in 6 the training of students in the professions of social 7 work, psychology, psychiatry, marriage and family 8 therapy, mental health counseling, and substance 9 abuse counseling; and 10 (2) certifying community health workers and 11 peer wellness specialists with respect to such cur- 12 ricula and core competencies and integrating and ex- 13 panding the use of such workers and specialists into 14 health care to address mental health disparities 15 among racial and ethnic minority groups. 16 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 17 tions receiving funds under subsection (a) may use the 18 funds to engage in the following activities related to the 19 development and dissemination of curricula or core com- 20 petencies described in subsection (a)(1): 21 (1) Formation of committees or working groups 22 comprised of experts from accredited health profes- 23 sions schools to identify core competencies relating 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 478 •S 3660 IS to mental health disparities among racial and ethnic 1 minority groups. 2 (2) Planning of workshops in national fora to 3 allow for public input into the educational needs as- 4 sociated with mental health disparities among racial 5 and ethnic minority groups. 6 (3) Dissemination and promotion of the use of 7 curricula or core competencies in undergraduate and 8 graduate health professions training programs na- 9 tionwide. 10 (4) Establishing external stakeholder advisory 11 boards to provide meaningful input into policy and 12 program development and best practices to reduce 13 mental health disparities among racial and ethnic 14 minority groups. 15 (c) DEFINITIONS.—In this section: 16 (1) QUALIFIED NATIONAL ORGANIZATION.—The 17 term ‘‘qualified national organization’’ means a na- 18 tional organization that focuses on the education of 19 students in programs of social work, psychology, 20 psychiatry, and marriage and family therapy. 21 (2) RACIAL AND ETHNIC MINORITY GROUP.— 22 The term ‘‘racial and ethnic minority group’’ has the 23 meaning given to such term in section 1707(g) of 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 479 •S 3660 IS the Public Health Service Act (42 U.S.C. 300u– 1 6(g)). 2 (d) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section 4 such sums as may be necessary for each of fiscal years 5 2019 through 2024. 6 SEC. 606. GEOACCESS STUDY. 7 The Assistant Secretary for Mental Health and Sub- 8 stance Use shall— 9 (1) conduct a study to— 10 (A) determine which geographic areas of 11 the United States have shortages of specialty 12 mental health providers; and 13 (B) assess the preparedness of speciality 14 mental health providers to deliver culturally and 15 linguistically appropriate, affordable, and acces- 16 sible services; and 17 (2) submit a report to Congress on the results 18 of such study. 19 SEC. 607. ASIAN AMERICAN, NATIVE HAWAIIAN, AND PA- 20 CIFIC ISLANDER BEHAVIORAL AND MENTAL 21 HEALTH OUTREACH AND EDUCATION STRAT- 22 EGIES. 23 Part D of title V of the Public Health Service Act 24 (42 U.S.C. 290dd et seq.), as amended by section 603, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 480 •S 3660 IS is further amended by adding at the end the following new 1 section: 2 ‘‘SEC. 551. BEHAVIORAL AND MENTAL HEALTH OUTREACH 3 AND EDUCATION STRATEGIES. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Assistant Secretary for Mental Health and Substance 6 Use, shall, in coordination with advocacy and behavioral 7 and mental health organizations serving populations of 8 Asian American, Native Hawaiian, and Pacific Islander 9 individuals or communities, develop and implement an out- 10 reach and education strategy to promote behavioral and 11 mental health and reduce stigma associated with mental 12 health conditions and substance abuse among the Asian 13 American, Native Hawaiian, and Pacific Islander popu- 14 lations. Such strategy shall— 15 ‘‘(1) be designed to— 16 ‘‘(A) meet the diverse cultural and lan- 17 guage needs of the various Asian American, 18 Native Hawaiian, and Pacific Islander popu- 19 lations; and 20 ‘‘(B) ensure such strategies are develop- 21 mentally and age appropriate; 22 ‘‘(2) increase awareness of symptoms of mental 23 illnesses common among such populations, taking 24 into account differences within subgroups, such as 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 481 •S 3660 IS gender, gender identity, age, sexual orientation, or 1 ethnicity, of such populations; 2 ‘‘(3) provide information on evidence-based, cul- 3 turally and linguistically appropriate and adapted 4 interventions and treatments; 5 ‘‘(4) ensure full participation of, and engage, 6 both consumers and community members in the de- 7 velopment and implementation of materials; and 8 ‘‘(5) seek to broaden the perspective among 9 both individuals in such communities and stake- 10 holders serving such communities to use a com- 11 prehensive public health approach to promoting be- 12 havioral health that addresses a holistic view of 13 health by focusing on the intersection between be- 14 havioral and physical health. 15 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 $300,000 for fiscal year 2019.’’. 18 SEC. 608. MENTAL HEALTH IN SCHOOLS. 19 (a) PURPOSE.—It is the purpose of this section to— 20 (1) revise, increase funding for, and expand the 21 scope of the Project AWARE State Educational 22 Agency Grant Program carried out by the Secretary 23 of Health and Human Services, in order to provide 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 482 •S 3660 IS access to more comprehensive school-based mental 1 health services and supports; 2 (2) provide for comprehensive staff development 3 for school and community service personnel working 4 in the school; and 5 (3) provide for comprehensive training for chil- 6 dren with mental health disorders, for parents, sib- 7 lings, and other family members of such children, 8 and for concerned members of the community. 9 (b) TECHNICAL AMENDMENTS.—The second part G 10 (relating to services provided through religious organiza- 11 tions) of title V of the Public Health Service Act (42 12 U.S.C. 290kk et seq.) is amended— 13 (1) by redesignating such part as part J; and 14 (2) by redesignating sections 581 through 584 15 as sections 596 through 596C, respectively. 16 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 17 DREN AND VIOLENCE.—Section 581 of the Public Health 18 Service Act (42 U.S.C. 290hh) is amended to read as fol- 19 lows: 20 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH AND CHIL- 21 DREN AND VIOLENCE. 22 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 23 with the Secretary of Education and in consultation with 24 the Attorney General, shall, directly or through grants, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 483 •S 3660 IS contracts, or cooperative agreements awarded to eligible 1 entities described in subsection (c), assist local commu- 2 nities and schools (including schools funded by the Bureau 3 of Indian Education) in applying a public health approach 4 to mental health services both in schools and in the com- 5 munity. Such approach should provide comprehensive age 6 appropriate services and supports, be linguistically and 7 culturally appropriate, be trauma-informed, and incor- 8 porate age appropriate strategies of positive behavioral 9 interventions and supports. A comprehensive school men- 10 tal health program funded under this section shall assist 11 children in dealing with trauma and violence. 12 ‘‘(b) ACTIVITIES.—Under the program under sub- 13 section (a), the Secretary may— 14 ‘‘(1) provide financial support to enable local 15 communities to implement a comprehensive cul- 16 turally and linguistically appropriate, trauma-in- 17 formed, and age-appropriate, school-based mental 18 health program that— 19 ‘‘(A) builds awareness of trauma; 20 ‘‘(B) trains appropriate staff to identify 21 signs of trauma or mental health disorders; and 22 ‘‘(C) incorporates positive behavioral inter- 23 ventions, family engagement, student treatment, 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 484 •S 3660 IS and multi-generational supports to foster the 1 health and development of children; 2 ‘‘(2) provide technical assistance to local com- 3 munities with respect to the development of pro- 4 grams described in paragraph (1); 5 ‘‘(3) provide assistance to local communities in 6 the development of policies to address child and ado- 7 lescent trauma and mental health issues and violence 8 when and if it occurs; 9 ‘‘(4) facilitate community partnerships among 10 families, students, law enforcement agencies, edu- 11 cation systems, mental health and substance use dis- 12 order service systems, family-based mental health 13 service systems, child welfare agencies, health care 14 service systems (including primary care physicians), 15 faith-based programs, trauma networks, and other 16 community-based systems; and 17 ‘‘(5) establish mechanisms for children and ado- 18 lescents to report incidents of violence or plans by 19 other children, adolescents, or adults to commit vio- 20 lence. 21 ‘‘(c) REQUIREMENTS.— 22 ‘‘(1) IN GENERAL.—To be eligible for a grant, 23 contract, or cooperative agreement under subsection 24 (a), an entity shall— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 485 •S 3660 IS ‘‘(A) be a partnership that— 1 ‘‘(i) shall include a State educational 2 agency and one or more local educational 3 agencies, with a local educational agency 4 serving as the lead partner; and 5 ‘‘(ii) may include, in accordance with 6 paragraph (2)(A)(i), appropriate public or 7 private entities that use interventions that 8 are evidence-based, as defined in section 9 8101 of the Elementary and Secondary 10 Education Act of 1965 (20 U.S.C. 7801); 11 and 12 ‘‘(B) submit an application, that is en- 13 dorsed by all members of the partnership, that 14 contains the assurances described in paragraph 15 (2). 16 ‘‘(2) REQUIRED ASSURANCES.—An application 17 under paragraph (1) shall contain assurances as fol- 18 lows: 19 ‘‘(A) That the eligible entity will ensure 20 that, in carrying out activities under this sec- 21 tion, the eligible entity will enter into a memo- 22 randum of understanding— 23 ‘‘(i) with at least 1 public or private 24 mental health entity, health care entity, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 486 •S 3660 IS law enforcement or juvenile justice entity, 1 child welfare agency, family-based mental 2 health entity, trauma network, or other 3 community-based entity; and 4 ‘‘(ii) that clearly states— 5 ‘‘(I) the responsibilities of each 6 partner with respect to the activities 7 to be carried out, including how fam- 8 ily engagement will be incorporated in 9 the activities; 10 ‘‘(II) how school-employed and 11 school-based mental health profes- 12 sionals will be utilized for carrying out 13 such responsibilities; 14 ‘‘(III) how each such partner will 15 be accountable for carrying out such 16 responsibilities; and 17 ‘‘(IV) the amount of non-Federal 18 funding or in-kind contributions that 19 each such partner will contribute in 20 order to sustain the program. 21 ‘‘(B) That the comprehensive school-based 22 mental health program carried out under this 23 section supports the flexible use of funds to ad- 24 dress— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 487 •S 3660 IS ‘‘(i) the promotion of the social, emo- 1 tional, and behavioral health of all students 2 in an environment that is conducive to 3 learning; 4 ‘‘(ii) the reduction in the likelihood of 5 at risk students developing social, emo- 6 tional, behavioral health problems, or sub- 7 stance use disorders; 8 ‘‘(iii) the early identification of social, 9 emotional, behavioral problems, or sub- 10 stance use disorders and the provision of 11 early intervention services; 12 ‘‘(iv) the treatment or referral for 13 treatment of students with existing social, 14 emotional, behavioral health problems, or 15 substance use disorders; and 16 ‘‘(v) the development and implementa- 17 tion of programs to assist children in deal- 18 ing with trauma and violence, including 19 program curricula, school supports, and 20 after-school programs. 21 ‘‘(C) That the comprehensive school-based 22 mental health program carried out under this 23 section will provide for in-service training of all 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 488 •S 3660 IS school personnel, including ancillary staff and 1 volunteers, in— 2 ‘‘(i) the techniques and supports need- 3 ed to identify early children with trauma 4 histories and children with, or at risk of, 5 mental illness; 6 ‘‘(ii) the use of referral mechanisms 7 that effectively link such children to appro- 8 priate treatment and intervention services 9 in the school and in the community and to 10 follow-up when services are not available; 11 ‘‘(iii) strategies that promote a school- 12 wide positive environment; 13 ‘‘(iv) strategies for promoting the so- 14 cial, emotional, mental, and behavioral 15 health of all students; and 16 ‘‘(v) strategies to increase the knowl- 17 edge and skills of school and community 18 leaders about the impact of trauma and vi- 19 olence and on the application of a public 20 health approach to comprehensive school- 21 based mental health programs. 22 ‘‘(D) That the comprehensive school-based 23 mental health program carried out under this 24 section will include comprehensive training for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 489 •S 3660 IS parents, siblings, and other family members of 1 children with mental health disorders, and for 2 concerned members of the community in— 3 ‘‘(i) the techniques and supports need- 4 ed to identify early children with trauma 5 histories, and children with, or at risk of, 6 mental illness; 7 ‘‘(ii) the use of referral mechanisms 8 that effectively link such children to appro- 9 priate treatment and intervention services 10 in the school and in the community and 11 follow-up when such services are not avail- 12 able; and 13 ‘‘(iii) strategies that promote a school- 14 wide positive environment. 15 ‘‘(E) That the comprehensive school-based 16 mental health program carried out under this 17 section will demonstrate the measures to be 18 taken to sustain the program after funding 19 under this section terminates (which may in- 20 clude seeking funding for the program under a 21 State Medicaid plan under title XIX of the So- 22 cial Security Act (42 U.S.C. 1396 et seq.) or a 23 waiver of such a plan). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 490 •S 3660 IS ‘‘(F) That the eligible entity is supported 1 by the State agency with primary responsibility 2 for behavioral health to ensure that the sustain- 3 ability of the programs is established after 4 funding under this section terminates. 5 ‘‘(G) That the comprehensive school-based 6 mental health program carried out under this 7 section will be based on trauma-informed and 8 evidence-based practices. 9 ‘‘(H) That the comprehensive school-based 10 mental health program carried out under this 11 section will be coordinated with early inter- 12 vening activities carried out under the Individ- 13 uals with Disabilities Education Act (20 U.S.C. 14 1400 et seq.). 15 ‘‘(I) That the comprehensive school-based 16 mental health program carried out under this 17 section will be trauma-informed and culturally 18 and linguistically appropriate. 19 ‘‘(J) That the comprehensive school-based 20 mental health program carried out under this 21 section will include a broad needs assessment of 22 youth who drop out of school due to policies of 23 ‘zero tolerance’ with respect to drugs, alcohol, 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 491 •S 3660 IS or weapons and an inability to obtain appro- 1 priate services. 2 ‘‘(K) That the mental health services pro- 3 vided through the comprehensive school-based 4 mental health program carried out under this 5 section will be provided by qualified mental and 6 behavioral health professionals who are certified 7 or licensed by the State involved and practicing 8 within their area of expertise. 9 ‘‘(3) COORDINATOR.—Any entity that is a 10 member of a partnership described in paragraph 11 (1)(A) may serve as the coordinator of funding and 12 activities under the grant if all members of the part- 13 nership agree. 14 ‘‘(4) COMPLIANCE WITH HIPAA.—A grantee 15 under this section shall be deemed to be a covered 16 entity for purposes of compliance with the regula- 17 tions promulgated under section 264(c) of the 18 Health Insurance Portability and Accountability Act 19 of 1996 (42 U.S.C. 1320d–2 note) with respect to 20 any patient records developed through activities 21 under the grant. 22 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 23 shall ensure that grants, contracts, or cooperative agree- 24 ments under subsection (a) will be distributed equitably 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 492 •S 3660 IS among the regions of the country and among urban and 1 rural areas. 2 ‘‘(e) DURATION OF AWARDS.—With respect to a 3 grant, contract, or cooperative agreement under sub- 4 section (a), the period during which payments under such 5 an award will be made to the recipient shall be 5 years. 6 An eligible entity described in subsection (c) may receive 7 only one award under this section, except that an eligible 8 entity that is providing services and supports on a regional 9 basis may receive additional funding after the expiration 10 of the preceding grant period. 11 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 12 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist- 13 ant Secretary shall develop a fiscally appropriate 14 process for evaluating activities carried out under 15 this section. Such process shall include— 16 ‘‘(A) the development of guidelines for the 17 submission of program data by grant, contract, 18 or cooperative agreement recipients; 19 ‘‘(B) the development of measures of out- 20 comes (in accordance with paragraph (2)) to be 21 applied by such recipients in evaluating pro- 22 grams carried out under this section; and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 493 •S 3660 IS ‘‘(C) the submission of annual reports by 1 such recipients concerning the effectiveness of 2 programs carried out under this section. 3 ‘‘(2) MEASURES OF OUTCOMES.— 4 ‘‘(A) IN GENERAL.—The Assistant Sec- 5 retary shall develop measures of outcomes to be 6 applied by recipients of assistance under this 7 section, and the Assistant Secretary, in evalu- 8 ating the effectiveness of programs carried out 9 under this section. Such measures shall include 10 student and family measures as provided for in 11 subparagraph (B) and local educational meas- 12 ures as provided for under subparagraph (C). 13 ‘‘(B) STUDENT AND FAMILY MEASURES OF 14 OUTCOMES.—The measures of outcomes devel- 15 oped under paragraph (1)(B) relating to stu- 16 dents and families shall, with respect to activi- 17 ties carried out under a program under this 18 section, at a minimum include provisions to 19 evaluate whether the program is effective in— 20 ‘‘(i) increasing social and emotional 21 competency; 22 ‘‘(ii) increasing academic competency 23 (as defined by the Secretary); 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 494 •S 3660 IS ‘‘(iii) reducing disruptive and aggres- 1 sive behaviors; 2 ‘‘(iv) improving child functioning; 3 ‘‘(v) reducing substance use disorders; 4 ‘‘(vi) reducing suspensions, truancy, 5 expulsions, and violence; 6 ‘‘(vii) increasing high school gradua- 7 tion rates, calculated using the four-year 8 adjusted cohort graduation rate or the ex- 9 tended-year adjusted cohort graduation 10 rate (as such terms are defined in section 11 8101 of the Elementary and Secondary 12 Education Act of 1965 (20 U.S.C. 7801)); 13 and 14 ‘‘(viii) improving access to care for 15 mental health disorders. 16 ‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 17 The outcome measures developed under para- 18 graph (1)(B) relating to local educational sys- 19 tems shall, with respect to activities carried out 20 under a program under this section, at a min- 21 imum include provisions to evaluate— 22 ‘‘(i) the effectiveness of comprehensive 23 school mental health programs established 24 under this section; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 495 •S 3660 IS ‘‘(ii) the effectiveness of formal part- 1 nership linkages among child and family 2 serving institutions, community support 3 systems, and the educational system; 4 ‘‘(iii) the progress made in sustaining 5 the program once funding under the grant 6 has expired; 7 ‘‘(iv) the effectiveness of training and 8 professional development programs for all 9 school personnel that incorporate indica- 10 tors that measure cultural and linguistic 11 competencies under the program in a man- 12 ner that incorporates appropriate cultural 13 and linguistic training; 14 ‘‘(v) the improvement in perception of 15 a safe and supportive learning environment 16 among school staff, students, and parents; 17 ‘‘(vi) the improvement in case-finding 18 of students in need of more intensive serv- 19 ices and referral of identified students to 20 early intervention and clinical services; 21 ‘‘(vii) the improvement in the imme- 22 diate availability of clinical assessment and 23 treatment services within the context of 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 496 •S 3660 IS the local community to students posing a 1 danger to themselves or others; 2 ‘‘(viii) the increased successful matric- 3 ulation to postsecondary school; and 4 ‘‘(ix) reduced referrals to juvenile jus- 5 tice. 6 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 7 ble entity described in subsection (c) that receives a 8 grant, contract, or cooperative agreement under this 9 section shall annually submit to the Assistant Sec- 10 retary a report that includes data to evaluate the 11 success of the program carried out by the entity 12 based on whether such program is achieving the pur- 13 poses of the program. Such reports shall utilize the 14 measures of outcomes under paragraph (2) in a rea- 15 sonable manner to demonstrate the progress of the 16 program in achieving such purposes. 17 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 18 Based on the data submitted under paragraph (3), 19 the Assistant Secretary shall annually submit to 20 Congress a report concerning the results and effec- 21 tiveness of the programs carried out with assistance 22 received under this section. 23 ‘‘(5) LIMITATION.—An eligible entity shall use 24 not more than 10 percent of amounts received under 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 497 •S 3660 IS a grant under this section to carry out evaluation 1 activities under this subsection. 2 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 3 retary shall establish comprehensive information and edu- 4 cation programs to disseminate the findings of the knowl- 5 edge development and application under this section to the 6 general public and to health care professionals. 7 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 8 APPROPRIATIONS.— 9 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 10 section shall be in an amount that is not more than 11 $2,000,000 for each of fiscal years 2019 through 12 2023. The Secretary shall determine the amount of 13 each such grant based on the population of children 14 up to age 21 of the area to be served under the 15 grant. 16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 17 There is authorized to be appropriated to carry out 18 this section, $200,000,000 for each of fiscal years 19 2019 through 2023.’’. 20 (d) CONFORMING AMENDMENT.—Part G of title V 21 of the Public Health Service Act (42 U.S.C. 290hh et 22 seq.), as amended by this section, is further amended by 23 striking the part heading and inserting the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 498 •S 3660 IS ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 1 TITLE VII—ADDRESSING HIGH 2 IMPACT MINORITY DISEASES 3 Subtitle A—Cancer 4 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 5 (a) SHORT TITLE.—This section may be cited as the 6 ‘‘Lung Cancer Mortality Reduction Act of 2018’’. 7 (b) FINDINGS.—Congress makes the following find- 8 ings: 9 (1) Lung cancer is the leading cause of cancer 10 death for both men and women, accounting for 25 11 percent of all cancer deaths. 12 (2) Lung cancer kills more people annually 13 than breast cancer, prostate cancer, colon cancer, 14 liver cancer, melanoma, and kidney cancer combined. 15 (3) Since the National Cancer Act of 1971 16 (Public Law 92–218; 85 Stat. 778), coordinated and 17 comprehensive research has raised the 5-year sur- 18 vival rates for breast cancer to 90 percent, for pros- 19 tate cancer to 99 percent, and for colon cancer to 20 64 percent. 21 (4) The 5-year survival rate for lung cancer is 22 still only 18 percent, and a similar coordinated and 23 comprehensive research effort is required to achieve 24 increases in lung cancer survivability rates. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 499 •S 3660 IS (5) Sixty percent of lung cancer cases are now 1 diagnosed in nonsmokers or former smokers. 2 (6) Two-thirds of nonsmokers diagnosed with 3 lung cancer are women. 4 (7) Certain minority populations, such as Afri- 5 can-American males, have disproportionately high 6 rates of lung cancer incidence and mortality, despite 7 their smoking rate being similar to other racial 8 groups. 9 (8) Members of the Baby Boomer Generation 10 are entering their 60s, the most common age at 11 which people develop lung cancer. 12 (9) Tobacco addiction and exposure to other 13 lung cancer carcinogens such as Agent Orange and 14 other herbicides and battlefield emissions are serious 15 problems among military personnel and war vet- 16 erans. 17 (10) Significant and rapid improvements in 18 lung cancer mortality can be expected through great- 19 er use and access to lung cancer screening tests for 20 at-risk individuals. 21 (11) Recent research has shown that screening 22 with low-dose computed tomography scan reduced 23 lung cancer death mortality by 20 percent for those 24 with a high risk of lung cancer through early detec- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 500 •S 3660 IS tion. The Centers for Medicare & Medicaid Services 1 supports annual lung cancer screening for high-risk 2 patients with low-dose computed tomography. 3 (12) Additional strategies are necessary to fur- 4 ther enhance the existing tests and therapies avail- 5 able to diagnose and treat lung cancer in the future. 6 (13) The August 2001 Report of the Lung 7 Cancer Progress Review Group of the National Can- 8 cer Institute stated that funding for lung cancer re- 9 search was ‘‘far below the levels characterized for 10 other common malignancies and far out of propor- 11 tion to its massive health impact’’. 12 (14) The Report of the Lung Cancer Progress 13 Review Group identified as its ‘‘highest priority’’ the 14 creation of integrated, multidisciplinary, multi-insti- 15 tutional research consortia organized around the 16 problem of lung cancer rather than around specific 17 research disciplines. 18 (15) The United States must enhance its re- 19 sponse to the issues raised in the Report of the 20 Lung Cancer Progress Review Group, and this can 21 be accomplished through the establishment of a co- 22 ordinated effort designed to reduce the lung cancer 23 mortality rate by 50 percent by 2020 and targeted 24 funding to support this coordinated effort. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 501 •S 3660 IS (c) SENSE OF CONGRESS CONCERNING INVESTMENT 1 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 2 gress that— 3 (1) lung cancer mortality reduction should be 4 made a national public health priority; and 5 (2) a comprehensive mortality reduction pro- 6 gram coordinated by the Secretary of Health and 7 Human Services is justified and necessary to ade- 8 quately address and reduce lung cancer mortality. 9 (d) LUNG CANCER MORTALITY REDUCTION PRO- 10 GRAM.— 11 (1) IN GENERAL.—Subpart 1 of part C of title 12 IV of the Public Health Service Act (42 U.S.C. 285 13 et seq.) is amended by adding at the end the fol- 14 lowing: 15 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 16 GRAM. 17 ‘‘(a) IN GENERAL.—Not later than 6 months after 18 the date of the enactment of the Health Equity and Ac- 19 countability Act of 2018, the Secretary, in consultation 20 with the Secretary of Defense, the Secretary of Veterans 21 Affairs, the Director of the National Institutes of Health, 22 the Director of the Centers for Disease Control and Pre- 23 vention, the Commissioner of Food and Drugs, the Admin- 24 istrator of the Centers for Medicare & Medicaid Services, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 502 •S 3660 IS the Director of the National Institute on Minority Health 1 and Health Disparities, and other members of the Lung 2 Cancer Advisory Board established under section 701 of 3 the Health Equity and Accountability Act of 2018, shall 4 implement a comprehensive program, to be known as the 5 Lung Cancer Mortality Reduction Program, to achieve a 6 reduction of at least 25 percent in the mortality rate of 7 lung cancer by 2020. 8 ‘‘(b) REQUIREMENTS.—The Program shall include at 9 least the following: 10 ‘‘(1) With respect to the National Institutes of 11 Health— 12 ‘‘(A) a strategic review and prioritization 13 by the National Cancer Institute of research 14 grants to achieve the goal of the Lung Cancer 15 Mortality Reduction Program in reducing lung 16 cancer mortality; 17 ‘‘(B) the provision of funds to enable the 18 Airway Biology and Disease Branch of the Na- 19 tional Heart, Lung, and Blood Institute to ex- 20 pand its research programs to include pre- 21 dispositions to lung cancer, the interrelationship 22 between lung cancer and other pulmonary and 23 cardiac disease, and the diagnosis and treat- 24 ment of those interrelationships; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 503 •S 3660 IS ‘‘(C) the provision of funds to enable the 1 National Institute of Biomedical Imaging and 2 Bioengineering to expedite the development of 3 computer-assisted diagnostic, surgical, treat- 4 ment, and drug-testing innovations to reduce 5 lung cancer mortality, such as through expan- 6 sion of the Institute’s Quantum Grant Program 7 and Image-Guided Interventions programs; and 8 ‘‘(D) the provision of funds to enable the 9 National Institute of Environmental Health 10 Sciences to implement research programs rel- 11 ative to the lung cancer incidence. 12 ‘‘(2) With respect to the Food and Drug Ad- 13 ministration— 14 ‘‘(A) activities under section 529B of the 15 Federal Food, Drug, and Cosmetic Act; and 16 ‘‘(B) activities under section 561 of the 17 Federal Food, Drug, and Cosmetic Act to ex- 18 pand access to investigational drugs and devices 19 for the diagnosis, monitoring, or treatment of 20 lung cancer. 21 ‘‘(3) With respect to the Centers for Disease 22 Control and Prevention, the establishment of an 23 early disease research and management program 24 under section 1511. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 504 •S 3660 IS ‘‘(4) With respect to the Agency for Healthcare 1 Research and Quality, the conduct of a biannual re- 2 view of lung cancer screening, diagnostic, and treat- 3 ment protocols, and the issuance of updated guide- 4 lines. 5 ‘‘(5) The promotion (including education) of 6 lung cancer screening within minority and rural pop- 7 ulations and the study of the effectiveness of efforts 8 to increase such screening. 9 ‘‘(6) The cooperation and coordination of all 10 minority and health disparity programs within the 11 Department of Health and Human Services to en- 12 sure that all aspects of the Lung Cancer Mortality 13 Reduction Program under this section adequately 14 address the burden of lung cancer on minority and 15 rural populations. 16 ‘‘(7) The cooperation and coordination of all to- 17 bacco control and cessation programs within agen- 18 cies of the Department of Health and Human Serv- 19 ices to achieve the goals of the Lung Cancer Mor- 20 tality Reduction Program under this section with 21 particular emphasis on the coordination of drug and 22 other cessation treatments with early detection pro- 23 tocols.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 505 •S 3660 IS (2) FEDERAL FOOD, DRUG, AND COSMETIC 1 ACT.—Subchapter B of chapter V of the Federal 2 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 3 seq.) is amended by adding at the end the following: 4 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 5 ‘‘(a) IN GENERAL.—The provisions of this sub- 6 chapter shall apply to a drug described in subsection (b) 7 to the same extent and in the same manner as such provi- 8 sions apply to a drug for a rare disease or condition. 9 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 10 subsection is— 11 ‘‘(1) a chemoprevention drug for precancerous 12 conditions of the lung; 13 ‘‘(2) a drug for targeted therapeutic treat- 14 ments, including any vaccine, for lung cancer; or 15 ‘‘(3) a drug to curtail or prevent nicotine addic- 16 tion. 17 ‘‘(c) BOARD.—The Board established under section 18 701 of the Health Equity and Accountability Act of 2018 19 shall monitor the program implemented under this sec- 20 tion.’’. 21 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 22 tion 561(e) of the Federal Food, Drug, and Cos- 23 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 24 serting before the period the following: ‘‘and shall 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 506 •S 3660 IS include expanding access to drugs under section 1 529B, with substantial consideration being given to 2 whether the totality of information available to the 3 Secretary regarding the safety and effectiveness of 4 an investigational drug, as compared to the risk of 5 morbidity and death from the disease, indicates that 6 a patient may obtain more benefit than risk if treat- 7 ed with the drug’’. 8 (4) CDC.—Title XV of the Public Health Serv- 9 ice Act (42 U.S.C. 300k et seq.) is amended by add- 10 ing at the end the following: 11 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 12 PROGRAM. 13 ‘‘The Secretary shall establish and implement an 14 early disease research and management program targeted 15 at the high incidence and mortality rates of lung cancer 16 among minority and low-income populations.’’. 17 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 18 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 19 and the Secretary of Veterans Affairs, each in coordina- 20 tion with the Secretary of Health and Human Services, 21 shall engage— 22 (1) in the implementation within the Depart- 23 ment of Defense and the Department of Veterans 24 Affairs of an early detection and disease manage- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 507 •S 3660 IS ment research program for military personnel and 1 veterans whose smoking history and exposure to car- 2 cinogens during active duty service has increased 3 their risk for lung cancer; and 4 (2) in the implementation of coordinated care 5 programs for military personnel and veterans diag- 6 nosed with lung cancer. 7 (f) LUNG CANCER ADVISORY BOARD.— 8 (1) IN GENERAL.—The Secretary of Health and 9 Human Services shall convene a Lung Cancer Advi- 10 sory Board (referred to in this section as the 11 ‘‘Board’’)— 12 (A) to monitor the programs established 13 under this section (and the amendments made 14 by this section); and 15 (B) to provide annual reports to the Con- 16 gress concerning benchmarks, expenditures, 17 lung cancer statistics, and the public health im- 18 pact of such programs. 19 (2) COMPOSITION.—The Board shall be com- 20 prised of— 21 (A) the Secretary of Health and Human 22 Services; 23 (B) the Secretary of Defense; 24 (C) the Secretary of Veterans Affairs; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 508 •S 3660 IS (D) 2 representatives each from the fields 1 of clinical medicine focused on lung cancer, 2 lung cancer research, imaging, drug develop- 3 ment, and lung cancer advocacy, to be ap- 4 pointed by the Secretary of Health and Human 5 Services. 6 (g) AUTHORIZATION OF APPROPRIATIONS.— 7 (1) IN GENERAL.—To carry out this section 8 (and the amendments made by this section), there 9 are authorized to be appropriated $75,000,0000 for 10 fiscal year 2019 and such sums as may be necessary 11 for each of fiscal years 2020 through 2023. 12 (2) LUNG CANCER MORTALITY REDUCTION PRO- 13 GRAM.—The amounts appropriated under paragraph 14 (1) shall be allocated as follows: 15 (A) $25,000,000 for fiscal year 2019, and 16 such sums as may be necessary for each of fis- 17 cal years 2020 through 2023, for the activities 18 described in section 417H(b)(1)(B) of the Pub- 19 lic Health Service Act, as added by subsection 20 (d); 21 (B) $25,000,000 for fiscal year 2019, and 22 such sums as may be necessary for each of fis- 23 cal years 2020 through 2023, for the activities 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 509 •S 3660 IS described in section 417H(b)(1)(C) of the Pub- 1 lic Health Service Act; 2 (C) $10,000,000 for fiscal year 2019, and 3 such sums as may be necessary for each of fis- 4 cal years 2020 through 2023, for the activities 5 described in section 417H(b)(1)(D) of the Pub- 6 lic Health Service Act; and 7 (D) $15,000,000 for fiscal year 2019, and 8 such sums as may be necessary for each of fis- 9 cal years 2020 through 2023, for the activities 10 described in section 417H(b)(3) of the Public 11 Health Service Act. 12 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 13 REACH, SCREENING, TESTING, ACCESS, AND 14 TREATMENT EFFECTIVENESS. 15 (a) SHORT TITLE.—This section may be cited as the 16 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 17 and Treatment Effectiveness Act of 2018’’ or the ‘‘PROS- 18 TATE Act’’. 19 (b) FINDINGS.—Congress makes the following find- 20 ings: 21 (1) Prostate cancer is the second leading cause 22 of cancer death among men. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 510 •S 3660 IS (2) In 2018, an estimated 164,690 men will be 1 diagnosed with prostate cancer and more than 2 29,000 will die from this disease. 3 (3) Roughly 2,000,000 to 3,000,000 people in 4 the United States are living with a diagnosis of pros- 5 tate cancer and its consequences. 6 (4) While prostate cancer generally affects older 7 individuals, younger men are also at risk for the dis- 8 ease, and when prostate cancer appears in early 9 middle age, it frequently takes on a more aggressive 10 form. 11 (5) There are significant racial and ethnic dis- 12 parities that demand attention; African Americans 13 have prostate cancer mortality rates that are more 14 than double those in the White population. 15 (6) Underserved rural populations have higher 16 rates of mortality compared to their urban counter- 17 parts, and innovative and cost-efficient methods to 18 improve rural access to high-quality care should take 19 advantage of advances in telehealth to diagnose and 20 treat prostate cancer when appropriate. 21 (7) Certain veterans populations may have 22 nearly twice the incidence of prostate cancer as the 23 general population of the United States. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 511 •S 3660 IS (8) Urologists may constitute the specialists 1 who diagnose and treat the vast majority of prostate 2 cancer patients. 3 (9) Although much basic and translational re- 4 search has been completed and much is currently 5 known, there are still many unanswered questions, 6 such as the extent to which known disparities are at- 7 tributable to disease etiology, access to care, or edu- 8 cation and awareness in the community. 9 (10) Causes of prostate cancer are not known. 10 There is not good information regarding how to dif- 11 ferentiate accurately, early on, between aggressive 12 and indolent forms of the disease. As a result, there 13 is significant overtreatment in prostate cancer. 14 There are no treatments that can durably arrest 15 growth or cure prostate cancer once it has metasta- 16 sized. 17 (11) A significant proportion (about 23 to 54 18 percent) of cases may be clinically indolent and 19 ‘‘overdiagnosed’’, resulting in significant overtreat- 20 ment. More accurate tests will allow men and their 21 families to face less physical, psychological, financial, 22 and emotional trauma, and billions of dollars could 23 be saved in private and public health care systems 24 in an area that has been identified by the Medicare 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 512 •S 3660 IS program under title XVIII of the Social Security Act 1 (42 U.S.C. 1395 et seq.) as one of 8 high-volume, 2 high-cost areas in the Resource Utilization Report 3 Program established under the Medicare Improve- 4 ments for Patients and Providers Act of 2008 (Pub- 5 lic Law 110–275). 6 (12) Prostate cancer research and health care 7 programs across Federal agencies should be coordi- 8 nated to improve accountability and actively encour- 9 age the translation of research into practice, to iden- 10 tify and implement best practices, in order to foster 11 an integrated and consistent focus on effective pre- 12 vention, diagnosis, and treatment of this disease. 13 (c) PROSTATE CANCER COORDINATION AND EDU- 14 CATION.— 15 (1) INTERAGENCY PROSTATE CANCER COORDI- 16 NATION AND EDUCATION TASK FORCE.—Not later 17 than 180 days after the date of the enactment of 18 this section, the Secretary of Veterans Affairs, in co- 19 operation with the Secretary of Defense and the Sec- 20 retary of Health and Human Services, shall estab- 21 lish an Interagency Prostate Cancer Coordination 22 and Education Task Force (in this section referred 23 to as the ‘‘Prostate Cancer Task Force’’). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 513 •S 3660 IS (2) DUTIES.—The Prostate Cancer Task Force 1 shall— 2 (A) develop a summary of advances in 3 prostate cancer research supported or con- 4 ducted by Federal agencies relevant to the diag- 5 nosis, prevention, and treatment of prostate 6 cancer, including psychosocial impairments re- 7 lated to prostate cancer treatment, and compile 8 a list of best practices that warrant broader 9 adoption in health care programs; 10 (B) consider establishing, and advocating 11 for, a guidance to enable physicians to allow 12 screening of men who are over age 74, on a 13 case-by-case basis, taking into account quality 14 of life and family history of prostate cancer; 15 (C) share and coordinate information on 16 Federal research and health care program ac- 17 tivities, including activities related to— 18 (i) determining how to improve re- 19 search and health care programs, including 20 psychosocial impairments related to pros- 21 tate cancer treatment; 22 (ii) identifying any gaps in the overall 23 research inventory and in health care pro- 24 grams; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 514 •S 3660 IS (iii) identifying opportunities to pro- 1 mote translation of research into practice; 2 and 3 (iv) maximizing the effects of Federal 4 efforts by identifying opportunities for col- 5 laboration and leveraging of resources in 6 research and health care programs that 7 serve individuals who are susceptible to or 8 diagnosed with prostate cancer; 9 (D) develop a comprehensive interagency 10 strategy and advise relevant Federal agencies in 11 the solicitation of proposals for collaborative, 12 multidisciplinary research and health care pro- 13 grams, including proposals to evaluate factors 14 that may be related to the etiology of prostate 15 cancer, that would— 16 (i) result in innovative approaches to 17 study emerging scientific opportunities or 18 eliminate knowledge gaps in research to 19 improve the prostate cancer research port- 20 folio of the Federal Government; 21 (ii) outline key research questions, 22 methodologies, and knowledge gaps; and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 515 •S 3660 IS (iii) ensure consistent action, as out- 1 lined by section 402(b) of the Public 2 Health Service Act; 3 (E) develop a coordinated message related 4 to screening and treatment for prostate cancer 5 to be reflected in educational and beneficiary 6 materials for Federal health programs as such 7 documents are updated; and 8 (F) not later than 2 years after the date 9 of the establishment of the Prostate Cancer 10 Task Force, submit to the Expert Advisory 11 Panel to be reviewed and returned within 30 12 days, and then within 90 days submitted to 13 Congress recommendations— 14 (i) regarding any appropriate changes 15 to research and health care programs, in- 16 cluding recommendations to improve the 17 research portfolio of the Department of 18 Veterans Affairs, the Department of De- 19 fense, National Institutes of Health, and 20 other Federal agencies to ensure that sci- 21 entifically based strategic planning is im- 22 plemented in support of research and 23 health care program priorities; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 516 •S 3660 IS (ii) designed to ensure that the re- 1 search and health care programs and ac- 2 tivities of the Department of Veterans Af- 3 fairs, the Department of Defense, the De- 4 partment of Health and Human Services, 5 and other Federal agencies are free of un- 6 necessary duplication; 7 (iii) regarding public participation in 8 decisions relating to prostate cancer re- 9 search and health care programs to in- 10 crease the involvement of patient advo- 11 cates, community organizations, and med- 12 ical associations representing a broad geo- 13 graphical area; 14 (iv) on how to best disseminate infor- 15 mation on prostate cancer research and 16 progress achieved by health care programs; 17 (v) about how to expand partnerships 18 between public entities, including Federal 19 agencies, and private entities to encourage 20 collaborative, cross-cutting research and 21 health care delivery; 22 (vi) assessing any cost savings and ef- 23 ficiencies realized through the efforts iden- 24 tified and supported in this section and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 517 •S 3660 IS recommending expansion of those efforts 1 that have proved most promising while also 2 ensuring against any conflicts in directives 3 from other congressional or statutory man- 4 dates or enabling statutes; 5 (vii) identifying key priority action 6 items from among the recommendations; 7 and 8 (viii) with respect to the level of fund- 9 ing needed by each agency to implement 10 the recommendations contained in the re- 11 port. 12 (3) MEMBERS OF THE PROSTATE CANCER TASK 13 FORCE.—The Prostate Cancer Task Force described 14 in this subsection shall be comprised of representa- 15 tives from such Federal agencies, as each head of 16 such applicable agencies determines necessary, to co- 17 ordinate a uniform message relating to prostate can- 18 cer screening and treatment where appropriate, in- 19 cluding representatives of the following: 20 (A) The Department of Veterans Affairs, 21 including representatives of each relevant pro- 22 gram area of the Department of Veterans Af- 23 fairs. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 518 •S 3660 IS (B) The Prostate Cancer Research Pro- 1 gram of the Congressionally Directed Medical 2 Research program of the Department of De- 3 fense. 4 (C) The Department of Health and 5 Human Services, including at a minimum rep- 6 resentatives of each of the following: 7 (i) The National Institutes of Health. 8 (ii) National research institutes and 9 centers, including the National Cancer In- 10 stitute, the National Institute of Allergy 11 and Infectious Diseases, and the Office of 12 Minority Health. 13 (iii) The Centers for Medicare & Med- 14 icaid Services. 15 (iv) The Food and Drug Administra- 16 tion. 17 (v) The Centers for Disease Control 18 and Prevention. 19 (vi) The Agency for Healthcare Re- 20 search and Quality. 21 (vii) The Health Resources and Serv- 22 ices Administration. 23 (4) APPOINTING EXPERT ADVISORY PANELS.— 24 The Prostate Cancer Task Force shall appoint ex- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 519 •S 3660 IS pert advisory panels, as such task force determines 1 appropriate, to provide input and concurrence from 2 individuals and organizations from the medical, 3 prostate cancer patient and advocate, research, and 4 delivery communities with expertise in prostate can- 5 cer diagnosis, treatment, and research, including 6 practicing urologists, primary care providers, and 7 others and individuals with expertise in education 8 and outreach to underserved populations affected by 9 prostate cancer. 10 (5) MEETINGS.—The Prostate Cancer Task 11 Force shall convene not less than twice a year, or 12 more frequently as the Secretary of Veterans Affairs 13 determines to be appropriate. 14 (6) FEDERAL ADVISORY COMMITTEE ACT.— 15 (A) IN GENERAL.—Except as provided in 16 subparagraph (B), the Federal Advisory Com- 17 mittee Act (5 U.S.C. App.) shall apply to the 18 Prostate Cancer Task Force. 19 (B) EXCEPTION.—Section 14(a)(2)(B) of 20 such Act (relating to the termination of advi- 21 sory committees) shall not apply to the Prostate 22 Cancer Task Force. 23 (7) SUNSET DATE.—The Prostate Cancer Task 24 Force shall terminate on September 30, 2021. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 520 •S 3660 IS (d) PROSTATE CANCER RESEARCH.— 1 (1) RESEARCH COORDINATION.—The Secretary 2 of Veterans Affairs, in coordination with the Sec- 3 retary of Defense and the Secretary of Health and 4 Human Services, shall establish and carry out a pro- 5 gram to coordinate and intensify prostate cancer re- 6 search. Such research program shall— 7 (A) develop advances in diagnostic and 8 prognostic methods and tests, including bio- 9 markers and an improved prostate cancer 10 screening blood test, including improvements or 11 alternatives to the prostate specific antigen test 12 and additional tests to distinguish indolent from 13 aggressive disease; 14 (B) develop better understanding of the 15 etiology of the disease (including an analysis of 16 lifestyle factors proven to be involved in higher 17 rates of prostate cancer, such as obesity and 18 diet, and in different ethnic, racial, and socio- 19 economic groups, such as the African-American, 20 Latino or Hispanic, and American Indian popu- 21 lations and men with a family history of pros- 22 tate cancer) to improve prevention efforts; 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 521 •S 3660 IS (C) expand basic research into prostate 1 cancer, including studies of fundamental molec- 2 ular and cellular mechanisms; 3 (D) identify and provide clinical testing of 4 novel agents for the prevention and treatment 5 of prostate cancer; 6 (E) establish clinical registries for prostate 7 cancer; 8 (F) use the National Institute of Bio- 9 medical Imaging and Bioengineering and the 10 National Cancer Institute for assessment of ap- 11 propriate imaging modalities; and 12 (G) address such other matters relating to 13 prostate cancer research as may be identified by 14 the Federal agencies participating in the pro- 15 gram under this subsection. 16 (2) PROSTATE CANCER ADVISORY BOARD.— 17 There is established in the Office of the Chief Sci- 18 entist of the Food and Drug Administration a Pros- 19 tate Cancer Scientific Advisory Board. Such board 20 shall be responsible for accelerating real-time shar- 21 ing of the latest research data and accelerating 22 movement of new medicines to patients. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 522 •S 3660 IS (3) UNDERSERVED MINORITY GRANT PRO- 1 GRAM.—In carrying out such program, the Secretary 2 shall— 3 (A) award grants to eligible entities to 4 carry out components of the research outlined 5 in paragraph (1); 6 (B) integrate and build upon existing 7 knowledge gained from comparative effective- 8 ness research; and 9 (C) recognize and address— 10 (i) the racial and ethnic disparities in 11 the incidence and mortality rates of pros- 12 tate cancer and men with a family history 13 of prostate cancer; 14 (ii) any barriers in access to care and 15 participation in clinical trials that are spe- 16 cific to racial, ethnic, and other under- 17 served minorities and men with a family 18 history of prostate cancer; 19 (iii) outreach and educational efforts 20 to raise awareness among the populations 21 described in clause (ii); and 22 (iv) appropriate access and utilization 23 of imaging modalities. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 523 •S 3660 IS (e) TELEHEALTH AND RURAL ACCESS PILOT 1 PROJECTS.— 2 (1) IN GENERAL.—The Secretary of Veterans 3 Affairs, in cooperation with the Secretary of Defense 4 and the Secretary of Health and Human Services 5 (referred to in this section collectively as the ‘‘Secre- 6 taries’’) shall establish 4-year telehealth pilot 7 projects for the purpose of analyzing the clinical out- 8 comes and cost-effectiveness associated with tele- 9 health services in a variety of geographic areas that 10 contain high proportions of medically underserved 11 populations, including African Americans, Latinos or 12 Hispanics, American Indians or Alaska Natives, and 13 those in rural areas. Such projects shall promote ef- 14 ficient use of specialist care through better coordina- 15 tion of primary care and physician extender teams 16 in underserved areas and more effectively employ 17 tumor boards to better counsel patients. 18 (2) ELIGIBLE ENTITIES.— 19 (A) IN GENERAL.—The Secretaries shall 20 select eligible entities to participate in the pilot 21 projects under this section. 22 (B) PRIORITY.—In selecting eligible enti- 23 ties to participate in the pilot projects under 24 this section, the Secretaries shall give priority 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 524 •S 3660 IS to such entities located in medically under- 1 served areas, particularly those that include Af- 2 rican Americans, Latinos and Hispanics, and 3 facilities of the Indian Health Service, including 4 Indian Health Service-operated facilities, trib- 5 ally operated facilities, and Urban Indian Clin- 6 ics, and those in rural areas. 7 (3) EVALUATION.—The Secretaries shall, 8 through the pilot projects, evaluate— 9 (A) the effective and economic delivery of 10 care in diagnosing and treating prostate cancer 11 with the use of telehealth services in medically 12 underserved and Tribal areas including collabo- 13 rative uses of health professionals and integra- 14 tion of the range of telehealth and other tech- 15 nologies; 16 (B) the effectiveness of improving the ca- 17 pacity of nonmedical providers and nonspecial- 18 ized medical providers to provide health services 19 for prostate cancer in medically underserved 20 and Tribal areas, including the exploration of 21 innovative medical home models with collabora- 22 tion between urologists, other relevant medical 23 specialists, including oncologists, radiologists, 24 and primary care teams and coordination of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 525 •S 3660 IS care through the efficient use of primary care 1 teams and physician extenders; and 2 (C) the effectiveness of using telehealth 3 services to provide prostate cancer treatment in 4 medically underserved areas, including the use 5 of tumor boards to facilitate better patient 6 counseling. 7 (4) REPORT.—Not later than 1 year after the 8 completion of the pilot projects under this sub- 9 section, the Secretaries shall submit to Congress a 10 report describing the outcomes of such pilot projects, 11 including any cost savings and efficiencies realized, 12 and providing recommendations, if any, for expand- 13 ing the use of telehealth services. 14 (f) EDUCATION AND AWARENESS.— 15 (1) IN GENERAL.—The Secretary of Veterans 16 Affairs (referred to in this subsection as the ‘‘Sec- 17 retary’’) shall develop a national education campaign 18 for prostate cancer. Such campaign shall involve the 19 use of written educational materials and public serv- 20 ice announcements consistent with the findings of 21 the Prostate Cancer Task Force under subsection 22 (c), that are intended to encourage men to seek 23 prostate cancer screening when appropriate. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 526 •S 3660 IS (2) RACIAL DISPARITIES AND THE POPULATION 1 OF MEN WITH A FAMILY HISTORY OF PROSTATE 2 CANCER.—In developing the national campaign 3 under paragraph (1), the Secretary shall ensure that 4 such educational materials and public service an- 5 nouncements are more readily available in commu- 6 nities experiencing racial disparities in the incidence 7 and mortality rates of prostate cancer and by men 8 of any race classification with a family history of 9 prostate cancer. 10 (3) GRANTS.—In carrying out the national 11 campaign under this section, the Secretary shall 12 award grants to nonprofit private entities to enable 13 such entities to test alternative outreach and edu- 14 cation strategies. 15 (g) AUTHORIZATION OF APPROPRIATIONS.— 16 (1) IN GENERAL.—There is authorized to be 17 appropriated to carry out this section for the period 18 of fiscal years 2019 through 2023 an amount equal 19 to the savings described in paragraph (2). 20 (2) CORRESPONDING REDUCTION.—The savings 21 described in this paragraph is the amount author- 22 ized to be appropriated by provisions of law other 23 than this section for the period of fiscal years 2019 24 through 2023 for Federal research and health care 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 527 •S 3660 IS program activities related to prostate cancer, re- 1 duced by the amount of Federal savings projected to 2 be achieved over such period by implementation of 3 this section. 4 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 5 BREAST AND CERVICAL CANCER PATIENTS 6 IN THE TERRITORIES. 7 (a) ELIMINATION OF FUNDING LIMITATIONS.— 8 (1) IN GENERAL.—Section 1108(g)(4) of the 9 Social Security Act (42 U.S.C. 1308(g)(4)) is 10 amended by adding at the end the following: ‘‘With 11 respect to fiscal years beginning with fiscal year 12 2019, payment for medical assistance for individuals 13 who are eligible for such assistance only on the basis 14 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 15 taken into account in applying subsection (f) (as in- 16 creased in accordance with paragraphs (1), (2), (3), 17 and (5) of this subsection) to Puerto Rico, the Vir- 18 gin Islands, Guam, the Northern Mariana Islands, 19 or American Samoa for such fiscal year.’’. 20 (2) TECHNICAL AMENDMENT.—Such section is 21 further amended by striking ‘‘(3), and (4)’’ and in- 22 serting ‘‘(3), and (5)’’. 23 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 24 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 528 •S 3660 IS 1396d(b)) is amended by adding at the end the following: 1 ‘‘Notwithstanding the first sentence of this subsection, 2 with respect to medical assistance described in clause (4) 3 of such sentence that is furnished in Puerto Rico, the Vir- 4 gin Islands, Guam, the Northern Mariana Islands, or 5 American Samoa in a fiscal year, the Federal medical as- 6 sistance percentage is equal to the highest such percentage 7 applied under such clause for such fiscal year for any of 8 the 50 States or the District of Columbia that provides 9 such medical assistance for any portion of such fiscal 10 year.’’ 11 (c) EFFECTIVE DATE.—The amendments made by 12 this section shall apply to payment for medical assistance 13 for items and services furnished on or after October 1, 14 2018. 15 SEC. 704. CANCER PREVENTION AND TREATMENT DEM- 16 ONSTRATION FOR ETHNIC AND RACIAL MI- 17 NORITIES. 18 (a) DEMONSTRATION.— 19 (1) IN GENERAL.—The Secretary of Health and 20 Human Services (referred to in this section as the 21 ‘‘Secretary’’) shall conduct demonstration projects 22 for the purpose of developing models and evaluating 23 methods that— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 529 •S 3660 IS (A) improve the quality of items and serv- 1 ices provided to target individuals in order to 2 facilitate reduced disparities in early detection 3 and treatment of cancer; 4 (B) improve clinical outcomes, satisfaction, 5 quality of life, appropriate use of items and 6 services covered under the Medicare program 7 under title XVIII of the Social Security Act (42 8 U.S.C. 1395 et seq.), and referral patterns with 9 respect to target individuals with cancer; 10 (C) eliminate disparities in the rate of pre- 11 ventive cancer screening measures, such as Pap 12 smears, prostate cancer screenings, colon cancer 13 screenings, breast cancer screenings, and com- 14 puted tomography scans, for lung cancer among 15 target individuals; 16 (D) promote collaboration with community- 17 based organizations to ensure cultural com- 18 petency of health care professionals and lin- 19 guistic access for target individuals who are 20 persons with limited-English proficiency; and 21 (E) encourage the incorporation of commu- 22 nity health workers to increase the efficiency 23 and appropriateness of cancer screening pro- 24 grams. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 530 •S 3660 IS (2) COMMUNITY HEALTH WORKER DEFINED.— 1 In this section, the term ‘‘community health worker’’ 2 includes a community health advocate, a lay health 3 worker, a community health representative, a peer 4 health promoter, a community health outreach work- 5 er, and a promotore de salud, who promotes health 6 or nutrition within the community in which the indi- 7 vidual resides. 8 (3) TARGET INDIVIDUAL DEFINED.—In this 9 section, the term ‘‘target individual’’ means an indi- 10 vidual of a racial and ethnic minority group, as de- 11 fined in section 1707(g)(1) of the Public Health 12 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 13 tled to benefits under part A, and enrolled under 14 part B, of title XVIII of the Social Security Act. 15 (b) PROGRAM DESIGN.— 16 (1) INITIAL DESIGN.—Not later than 1 year 17 after the date of the enactment of this Act, the Sec- 18 retary shall evaluate best practices in the private 19 sector, community programs, and academic research 20 of methods that reduce disparities among individuals 21 of racial and ethnic minority groups in the preven- 22 tion and treatment of cancer and shall design the 23 demonstration projects based on such evaluation. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 531 •S 3660 IS (2) NUMBER AND PROJECT AREAS.—Not later 1 than 2 years after the date of the enactment of this 2 Act, the Secretary shall implement at least 9 dem- 3 onstration projects, including the following: 4 (A) Two projects, each of which shall tar- 5 get different ethnic subpopulations, for each of 6 the 4 following major racial and ethnic minority 7 groups: 8 (i) American Indians and Alaska Na- 9 tives, Eskimos, and Aleuts. 10 (ii) Asian Americans. 11 (iii) Blacks and African Americans. 12 (iv) Latinos and Hispanics. 13 (v) Native Hawaiians and other Pa- 14 cific Islanders. 15 (B) One project within the Pacific Islands 16 or United States insular areas. 17 (C) At least one project in a rural area. 18 (D) At least one project in an inner-city 19 area. 20 (3) EXPANSION OF PROJECTS; IMPLEMENTA- 21 TION OF DEMONSTRATION PROJECT RESULTS.—The 22 Secretary shall continue the existing demonstration 23 projects and may expand the number of demonstra- 24 tion projects if the initial report under subsection (c) 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 532 •S 3660 IS contains an evaluation that demonstration 1 projects— 2 (A) reduce expenditures under the Medi- 3 care program under title XVIII of the Social 4 Security Act (42 U.S.C. 1395 et seq.); or 5 (B) do not increase expenditures under 6 such Medicare program and reduce racial and 7 ethnic health disparities in the quality of health 8 care services provided to target individuals and 9 increase satisfaction of Medicare beneficiaries 10 and health care providers. 11 (c) REPORT TO CONGRESS.— 12 (1) IN GENERAL.—Not later than 2 years after 13 the date the Secretary implements the initial dem- 14 onstration projects, and biannually thereafter, the 15 Secretary shall submit to Congress a report regard- 16 ing the demonstration projects. 17 (2) CONTENT OF REPORT.—Each report under 18 paragraph (1) shall include the following: 19 (A) A description of the demonstration 20 projects. 21 (B) An evaluation of— 22 (i) the cost-effectiveness of the dem- 23 onstration projects; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 533 •S 3660 IS (ii) the quality of the health care serv- 1 ices provided to target individuals under 2 the demonstration projects; and 3 (iii) beneficiary and health care pro- 4 vider satisfaction under the demonstration 5 projects. 6 (C) Any other information regarding the 7 demonstration projects that the Secretary de- 8 termines to be appropriate. 9 (d) WAIVER AUTHORITY.—The Secretary shall waive 10 compliance with the requirements of title XVIII of the So- 11 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 12 and for such period as the Secretary determines is nec- 13 essary to conduct demonstration projects. 14 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI- 15 CARE. 16 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 17 IN QUALITY OF CANCER CARE.— 18 (1) DEVELOPMENT OF MEASURES.—The Sec- 19 retary of Health and Human Services (in this sec- 20 tion referred to as the ‘‘Secretary’’) shall enter into 21 an agreement with an entity that specializes in de- 22 veloping quality measures for cancer care under 23 which the entity shall develop a uniform set of meas- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 534 •S 3660 IS ures to evaluate disparities in the quality of cancer 1 care and annually update such set of measures. 2 (2) MEASURES TO BE INCLUDED.—Such set of 3 measures shall include, with respect to the treatment 4 of cancer, measures of patient outcomes, the process 5 for delivering medical care related to such treat- 6 ment, patient counseling and engagement in deci- 7 sionmaking, patient experience of care, resource use, 8 and practice capabilities, such as care coordination. 9 (b) ESTABLISHMENT OF REPORTING PROCESS.— 10 (1) IN GENERAL.—The Secretary shall establish 11 a reporting process that requires and provides for a 12 method for health care providers specified under 13 paragraph (2) to submit to the Secretary and make 14 public data on the performance of such providers 15 during each reporting period through use of the 16 measures developed pursuant to subsection (a). Such 17 data shall be submitted in a form and manner and 18 at a time specified by the Secretary. 19 (2) SPECIFICATION OF PROVIDERS TO REPORT 20 ON MEASURES.—The Secretary shall specify the 21 classes of Medicare providers of services and sup- 22 pliers, including hospitals, cancer centers, physi- 23 cians, primary care providers, and specialty pro- 24 viders, that will be required under such process to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 535 •S 3660 IS publicly report on the measures specified under sub- 1 section (a). 2 (3) ASSESSMENT OF CHANGES.—Under such 3 reporting process, the Secretary shall establish a for- 4 mat that assesses changes in both the absolute and 5 relative disparities in cancer care over time. These 6 measures shall be presented in an easily comprehen- 7 sible format, such as those presented in the final 8 publications relating to Healthy People 2010 or the 9 National Healthcare Disparities Report. 10 (4) INITIAL IMPLEMENTATION.—The Secretary 11 shall implement the reporting process under this 12 subsection for reporting periods beginning not later 13 than 6 months after the date that measures are first 14 established under subsection (a). 15 Subtitle B—Viral Hepatitis and 16 Liver Cancer Control and Pre- 17 vention 18 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 19 AND PREVENTION. 20 (a) SHORT TITLE.—This subtitle may be cited as the 21 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 22 Act of 2018’’. 23 (b) FINDINGS.—Congress finds the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 536 •S 3660 IS (1) In the United States, approximately 1 4,400,000 persons are living with the hepatitis B 2 virus (referred to in this section as ‘‘HBV’’) or the 3 hepatitis C virus (referred to in this section as 4 ‘‘HCV’’). 5 (2) In the United States, chronic HBV and 6 HCV are the most common causes of liver cancer, 7 one of the most lethal and fastest growing cancers 8 in this country. Such viruses are the most common 9 cause of chronic liver disease, liver cirrhosis, and the 10 most common indications for liver transplantation. 11 At least 18,000 deaths per year in the United States 12 can be attributed to chronic HBV and HCV. Chron- 13 ic HCV is also a leading cause of death in Ameri- 14 cans living with HIV/AIDS; many of those living 15 with HIV/AIDS are coinfected with chronic HBV, 16 chronic HCV, or both. 17 (3) According to the Centers for Disease Con- 18 trol and Prevention (referred to in this section as 19 the ‘‘CDC’’), approximately 2 percent of the popu- 20 lation of the United States is living with chronic 21 HBV, chronic HCV, or both. The CDC has recog- 22 nized HCV as the Nation’s most common chronic 23 bloodborne virus infection and HBV as the deadliest 24 vaccine-preventable disease. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 537 •S 3660 IS (4) HBV is easily transmitted and is 100 times 1 more infectious than HIV. According to the CDC, 2 HBV is transmitted through contact with infectious 3 blood, semen, or other body fluids. HCV is trans- 4 mitted by contact with infectious blood, particularly 5 through percutaneous exposures (such as puncture 6 through the skin). 7 (5) The CDC estimates that in 2016, more 8 than 41,000 people in the United States were newly 9 infected with HCV and nearly 21,000 people in the 10 United States were newly infected with HBV. These 11 estimates could be much higher due to many rea- 12 sons, including lack of screening education and 13 awareness, and perceived marginalization of the pop- 14 ulations at risk. 15 (6) In 2012, CDC released new guidelines rec- 16 ommending every person born between 1945 and 17 1965 receive a one-time test. Among the estimated 18 102,000,000 (1,600,000 chronically HCV-infected) 19 eligible for screening, birth-cohort screening leads to 20 84,000 fewer cases of decompensated cirrhosis, 21 46,000 fewer cases of hepatocellular carcinoma, 22 10,000 fewer liver transplants, and 78,000 fewer 23 HCV-related deaths gained versus risk-based screen- 24 ing. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 538 •S 3660 IS (7) In 2013, the United States Preventive Serv- 1 ices Task Force (referred to in this section as the 2 ‘‘USPSTF’’) issued a Grade B rating for screening 3 for HCV infection in persons at high risk for infec- 4 tion and adults born between 1945 and 1965. In 5 2014, the USPSTF issued a Grade B for screening 6 for HBV in persons at high-risk of hepatitis B infec- 7 tion. In 2009, the USPSTF issued a Grade A for 8 screening pregnant women for HBV during their 9 first prenatal visit. 10 (8) There were 59 outbreaks (24 of HBV and 11 36 of HCV, including one of both HBV and HCV) 12 reported to CDC for investigation from 2008 13 through 2016 related to health care-associated infec- 14 tion of HBV and HCV, 56 of which occurred in non- 15 hospital settings. There were more than 115,983 pa- 16 tients potentially exposed to one of the viruses. 17 (9) Chronic HBV and chronic HCV usually do 18 not cause symptoms early in the course of the dis- 19 ease, but after many years of a clinically ‘‘silent’’ 20 phase, CDC estimates show more than 33 percent of 21 infected individuals will develop cirrhosis, end-stage 22 liver disease, or liver cancer. Since most individuals 23 with chronic HBV, HCV, or both are unaware of 24 their infection, they do not know to take precautions 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 539 •S 3660 IS to prevent the spread of their infection and can un- 1 knowingly exacerbate their own disease progression. 2 (10) HBV and HCV disproportionately affect 3 certain populations in the United States. Although 4 representing only about 6 percent of the population, 5 Asian Americans and Pacific Islanders account for 6 half of all chronic HBV cases in the United States. 7 Baby Boomers (those born between 1945 and 1965) 8 account for approximately 75 percent of domestic 9 chronic HCV cases. In addition, African Americans, 10 Latinos, and American Indian and Native Alaskans 11 are among the groups which have disproportionately 12 high rates of HBV or HCV infections in the United 13 States. 14 (11) For both chronic HBV and chronic HCV, 15 behavioral changes can slow disease progression if 16 diagnosis is made early. Early diagnosis, which is 17 determined through simple blood tests, can reduce 18 the risk of transmission and disease progression 19 through education and vaccination of household 20 members and other susceptible persons at risk. 21 (12) Advancements have led to the development 22 of improved diagnostic tests for viral hepatitis. 23 These tests, including rapid, point of care testing 24 and others in development, can facilitate testing, no- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 540 •S 3660 IS tification of results and post-test counseling, and re- 1 ferral to care at the time of the testing visit. In par- 2 ticular, these tests are also advantageous because 3 they can be used simultaneously with HIV rapid 4 testing for persons at risk for both HCV and HIV 5 infections. 6 (13) For those chronically infected with HBV 7 or HCV, regular monitoring can lead to the early de- 8 tection of liver cancer at a stage where a cure is still 9 possible. Liver cancer is the second deadliest cancer 10 in the United States; however, liver cancer has re- 11 ceived little funding for research, prevention, or 12 treatment. 13 (14) Treatment for chronic HCV can eradicate 14 the disease in approximately 90 percent of those cur- 15 rently treated. The treatment of chronic HBV can 16 effectively suppress viral replication in the over- 17 whelming majority (over 80 percent) of those treat- 18 ed, thereby reducing the risk of transmission and 19 progression to liver scarring or liver cancer, even 20 though a complete cure is much less common than 21 for HCV. 22 (15) To combat the viral hepatitis epidemic in 23 the United States, in February 2017, the Depart- 24 ment of Health and Human Services released its 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 541 •S 3660 IS ‘‘National Viral Hepatitis Action Plan 2017–2020’’ 1 (referred to in this section as the ‘‘HHS Action 2 Plan’’). In March 2017, the National Academies of 3 Sciences, Engineering, and Medicine released a re- 4 port entitled, ‘‘A National Strategy for the Elimi- 5 nation of Hepatitis B and C: Phase Two Report’’ 6 (referred to in this section as the ‘‘NAS report’’), 7 recommending specific actions to eliminate viral hep- 8 atitis as public health problems in the United States 9 by 2030. 10 (16) The annual health care costs attributable 11 to HBV and HCV in the United States are signifi- 12 cant. For HBV, it is estimated to be approximately 13 $2,500,000,000 ($2,000 per infected person). In 14 2000, the lifetime cost of HBV—before the avail- 15 ability of most current therapies—was approximately 16 $80,000 per chronically infected person, totaling 17 more than $100,000,000,000. For HCV, medical 18 costs for patients are expected to increase from 19 $30,000,000,000 in 2009 to over $85,000,000,000 20 in 2024. Avoiding these costs by screening and diag- 21 nosing individuals earlier—and connecting them to 22 appropriate treatment and care, will save lives and 23 critical health care dollars. Currently, without a 24 comprehensive screening, testing, and diagnosis pro- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 542 •S 3660 IS gram, most patients are diagnosed too late when 1 they need a liver transplant costing at least 2 $314,000 for uncomplicated cases or when they have 3 liver cancer or end-stage liver disease which costs 4 $30,980 to $110,576 per hospital admission. As 5 health care costs continue to grow, it is critical that 6 the Federal Government invests in effective mecha- 7 nisms to avoid documented cost drivers. 8 (17) According to the NAS report in 2010, 9 chronic HBV and HCV infections cause substantial 10 morbidity and mortality despite being preventable 11 and treatable. Deficiencies in the implementation of 12 established guidelines for the prevention, diagnosis, 13 and medical management of chronic HBV and HCV 14 infections perpetuate personal and economic bur- 15 dens. Existing grants are not sufficient for the scale 16 of the health burden presented by HBV and HCV. 17 (18) Screening and testing for HBV and HCV 18 is aligned with the goal of Healthy People 2020 to 19 increase immunization rates and reduce preventable 20 infectious diseases. Awareness of disease and access 21 to prevention and treatment remain essential compo- 22 nents for reducing infectious disease transmission. 23 (19) Federal support is necessary to increase 24 knowledge and awareness of HBV and HCV and to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 543 •S 3660 IS assist State and local prevention and control efforts 1 in reducing the morbidity and mortality of these 2 epidemics. 3 (20) The Secretary of Health and Human Serv- 4 ices has the discretion to carry out this subtitle (in- 5 cluding the amendments made by this subtitle) di- 6 rectly and through whichever of the agencies of the 7 Public Health Service the Secretary determines to be 8 appropriate, which may (in the Secretary’s discre- 9 tion) include the Centers for Disease Control and 10 Prevention, the Health Resources and Services Ad- 11 ministration, the Substance Abuse and Mental 12 Health Services Administration, the National Insti- 13 tutes of Health (including the National Institute on 14 Minority Health and Health Disparities), and other 15 agencies of such Service. 16 (21) The Centers for Disease Control and Pre- 17 vention reported a 233 percent increase in hepatitis 18 C cases from 2010 to 2016, stemming from the 19 opioid, heroin, and overdose epidemics affecting com- 20 munities nationwide. From 2014 to 2015, the num- 21 ber of reported cases of acute hepatitis B infection 22 in the United States rose for the first time since 23 2006, increasing by 20.7 percent, which is also 24 largely attributable to the opioid epidemic. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 544 •S 3660 IS (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 1 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 2 AND MEDICAL MANAGEMENT PLAN.—Title III of the 3 Public Health Service Act (42 U.S.C. 241 et seq.), as 4 amended by title V, is further amended— 5 (1) by striking section 317N (42 U.S.C. 247b– 6 15); and 7 (2) by adding after part W, as added by section 8 508, the following: 9 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 10 TITIS B AND HEPATITIS C PREVENTION, EDU- 11 CATION, RESEARCH, AND MEDICAL MANAGE- 12 MENT PLAN 13 ‘‘SEC. 399PP. BIENNIAL UPDATE OF THE PLAN. 14 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 15 ennial assessment of the Secretary’s plan for the preven- 16 tion, control, and medical management of, and education 17 and research relating to, hepatitis B and hepatitis C, for 18 the purposes of— 19 ‘‘(1) incorporating into such plan new knowl- 20 edge or observations relating to hepatitis B and hep- 21 atitis C (such as knowledge and observations that 22 may be derived from clinical, laboratory, and epide- 23 miological research and disease detection, preven- 24 tion, and surveillance outcomes); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 545 •S 3660 IS ‘‘(2) addressing gaps in the coverage or effec- 1 tiveness of the plan; and 2 ‘‘(3) evaluating and, if appropriate, updating 3 recommendations, guidelines, or educational mate- 4 rials of the Centers for Disease Control and Preven- 5 tion or the National Institutes of Health for health 6 care providers or the public on viral hepatitis in 7 order to be consistent with the plan. 8 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 9 Not later than October 1 of the first even-numbered year 10 beginning after the date of the enactment of this part, 11 and October 1 of each even-numbered year thereafter, the 12 Secretary shall publish in the Federal Register a notice 13 of the results of the assessments conducted under para- 14 graph (1). Such notice shall include— 15 ‘‘(1) a description of any revisions to the plan 16 referred to in subsection (a) as a result of the as- 17 sessment; 18 ‘‘(2) an explanation of the basis for any such 19 revisions, including the ways in which such revisions 20 can reasonably be expected to further promote the 21 original goals and objectives of the plan; and 22 ‘‘(3) in the case of a determination by the Sec- 23 retary that the plan does not need revision, an expla- 24 nation of the basis for such determination. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 546 •S 3660 IS ‘‘SEC. 399PP–1. ELEMENTS OF PROGRAM. 1 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 2 Secretary, acting through the Director of the Centers for 3 Disease Control and Prevention, the Administrator of the 4 Health Resources and Services Administration, and the 5 Administrator of the Substance Abuse and Mental Health 6 Services Administration, and in accordance with the plan 7 referred to in section 399PP(a), shall implement programs 8 to increase awareness and enhance knowledge and under- 9 standing of hepatitis B and hepatitis C. Such programs 10 shall include— 11 ‘‘(1) the conduct of culturally and language ap- 12 propriate health education in primary and secondary 13 schools, college campuses, public awareness cam- 14 paigns, and community outreach activities (especially 15 to the ethnic communities with high rates of chronic 16 hepatitis B and chronic hepatitis C and other high- 17 risk groups) to promote public awareness and knowl- 18 edge about the value of hepatitis A and hepatitis B 19 immunization, risk factors, the transmission and 20 prevention of hepatitis B and hepatitis C, the value 21 of screening for the early detection of hepatitis B 22 and hepatitis C, and options available for the treat- 23 ment of chronic hepatitis B and chronic hepatitis C; 24 ‘‘(2) the promotion of immunization programs 25 that increase awareness and access to hepatitis A 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 547 •S 3660 IS and hepatitis B vaccines for susceptible adults and 1 children; 2 ‘‘(3) the training of health care professionals 3 regarding the importance of vaccinating individuals 4 infected with hepatitis C and individuals who are at 5 risk for hepatitis C infection against hepatitis A and 6 hepatitis B; 7 ‘‘(4) the training of health care professionals 8 regarding the importance of vaccinating individuals 9 chronically infected with hepatitis B and individuals 10 who are at risk for chronic hepatitis B infection 11 against the hepatitis A virus; 12 ‘‘(5) the training of health care professionals 13 and health educators to make them aware of the 14 high rates of chronic hepatitis B and chronic hepa- 15 titis C in certain adult ethnic populations, and the 16 importance of prevention, detection, and medical 17 management of hepatitis B and hepatitis C and of 18 liver cancer screening; 19 ‘‘(6) the development and distribution of health 20 education curricula (including information relating 21 to the special needs of individuals infected with hep- 22 atitis B and hepatitis C, such as the importance of 23 prevention and early intervention, regular moni- 24 toring, the recognition of psychosocial needs, appro- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 548 •S 3660 IS priate treatment, and liver cancer screening) for in- 1 dividuals providing hepatitis B and hepatitis C coun- 2 seling; and 3 ‘‘(7) support for the implementation curricula 4 described in paragraph (6) by State and local public 5 health agencies. 6 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 7 PROGRAMS.— 8 ‘‘(1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall support the integra- 11 tion of activities described in paragraph (3) into ex- 12 isting clinical and public health programs at State, 13 local, territorial, and Tribal levels (including commu- 14 nity health clinics, programs for the prevention and 15 treatment of HIV/AIDS, sexually transmitted infec- 16 tions, and substance abuse, and programs for indi- 17 viduals in correctional settings). 18 ‘‘(2) COORDINATION OF DEVELOPMENT OF 19 FEDERAL SCREENING GUIDELINES.— 20 ‘‘(A) REFERENCES.—For purposes of this 21 subsection, the term ‘CDC Director’ means the 22 Director of the Centers for Disease Control and 23 Prevention, and the term ‘AHRQ Director’ 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 549 •S 3660 IS means the Director of the Agency for 1 Healthcare Research and Quality. 2 ‘‘(B) AGENCY FOR HEALTHCARE RE- 3 SEARCH AND QUALITY.—Due to the rapidly 4 evolving standard of care associated with diag- 5 nosing and treating viral hepatitis infection, the 6 AHRQ Director shall convene the Preventive 7 Services Task Force under section 915(a) to re- 8 view its recommendation for screening for HBV 9 and HCV infection every 3 years. 10 ‘‘(3) ACTIVITIES.— 11 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 12 ‘‘(i) IN GENERAL.—The Secretary 13 shall establish a mechanism by which to 14 support and promote the development of 15 State, local, territorial, and tribal vol- 16 untary hepatitis B and hepatitis C testing 17 programs to screen the high-prevalence 18 populations to aid in the early identifica- 19 tion of chronically infected individuals. 20 ‘‘(ii) CONFIDENTIALITY OF THE TEST 21 RESULTS.—The Secretary shall prohibit 22 the use of the results of a hepatitis B or 23 hepatitis C test conducted by a testing pro- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 550 •S 3660 IS gram developed or supported under this 1 subparagraph for any of the following: 2 ‘‘(I) Issues relating to health in- 3 surance. 4 ‘‘(II) To screen or determine 5 suitability for employment. 6 ‘‘(III) To discharge a person 7 from employment. 8 ‘‘(B) COUNSELING REGARDING VIRAL HEP- 9 ATITIS.—The Secretary shall support State, 10 local, territorial, and tribal programs in a wide 11 variety of settings, including those providing 12 primary and specialty health care services in 13 nonprofit private and public sectors, to— 14 ‘‘(i) provide individuals with ongoing 15 risk factors for hepatitis B and hepatitis C 16 infection with client-centered education 17 and counseling which concentrates on— 18 ‘‘(I) promoting testing of individ- 19 uals that have been exposed to their 20 blood, family members, and their sex- 21 ual partners; and 22 ‘‘(II) changing behaviors that 23 place individuals at risk for infection; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 551 •S 3660 IS ‘‘(ii) provide individuals chronically in- 1 fected with hepatitis B or hepatitis C with 2 education, health information, and coun- 3 seling to reduce their risk of— 4 ‘‘(I) dying from end-stage liver 5 disease and liver cancer; and 6 ‘‘(II) transmitting viral hepatitis 7 to others; and 8 ‘‘(iii) provide women chronically in- 9 fected with hepatitis B or hepatitis C who 10 are pregnant or of childbearing age with 11 culturally and linguistically appropriate 12 health information, such as how to prevent 13 hepatitis B perinatal infection, and to al- 14 leviate fears associated with pregnancy or 15 raising a family. 16 ‘‘(C) IMMUNIZATION.—The Secretary shall 17 support State, local, territorial, and tribal ef- 18 forts to expand the current vaccination pro- 19 grams to protect every child in the Nation and 20 all susceptible adults, particularly those infected 21 with hepatitis C and high-prevalence ethnic 22 populations and other high-risk groups, from 23 the risks of acute and chronic hepatitis B infec- 24 tion by— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 552 •S 3660 IS ‘‘(i) ensuring continued funding for 1 hepatitis B vaccination for all children 19 2 years of age or younger through the Vac- 3 cines for Children program; 4 ‘‘(ii) ensuring that the recommenda- 5 tions of the Advisory Committee on Immu- 6 nization Practices of the Centers for Dis- 7 ease Control and Prevention are followed 8 regarding the birth dose of hepatitis B vac- 9 cinations for newborns; 10 ‘‘(iii) requiring proof of hepatitis B 11 vaccination for entry into public or private 12 daycare, preschool, elementary school, sec- 13 ondary school, and institutions of higher 14 education; 15 ‘‘(iv) expanding the availability of 16 hepatitis B vaccination for all susceptible 17 adults to protect them from becoming 18 acutely or chronically infected, including 19 ethnic and other populations with high 20 prevalence rates of chronic hepatitis B in- 21 fection; 22 ‘‘(v) expanding the availability of hep- 23 atitis B vaccination for all susceptible 24 adults, particularly those of reproductive 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 553 •S 3660 IS age (women and men less than 45 years of 1 age), to protect them from the risk of hep- 2 atitis B infection; 3 ‘‘(vi) ensuring the vaccination of indi- 4 viduals infected, or at risk for infection, 5 with hepatitis C against hepatitis A, hepa- 6 titis B, and other infectious diseases, as 7 appropriate, for which such individuals 8 may be at increased risk; and 9 ‘‘(vii) ensuring the vaccination of indi- 10 viduals infected, or at risk for infection, 11 with hepatitis B against hepatitis A virus 12 and other infectious diseases, as appro- 13 priate, for which such individuals may be 14 at increased risk. 15 ‘‘(D) MEDICAL REFERRAL.—The Secretary 16 shall support State, local, territorial, and tribal 17 programs that support— 18 ‘‘(i) referral of persons chronically in- 19 fected with hepatitis B or hepatitis C— 20 ‘‘(I) for medical evaluation to de- 21 termine the appropriateness for 22 antiviral treatment to reduce the risk 23 of progression to cirrhosis and liver 24 cancer; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 554 •S 3660 IS ‘‘(II) for ongoing medical man- 1 agement including regular monitoring 2 of liver function and screening for 3 liver cancer; and 4 ‘‘(ii) referral of persons infected with 5 acute or chronic hepatitis B infection or 6 acute or chronic hepatitis C infection for 7 drug and alcohol abuse treatment where 8 appropriate. 9 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL 10 HEPATITIS PREVENTION COORDINATORS.—The Sec- 11 retary, acting through the CDC Director, shall pro- 12 vide increased support to adult viral hepatitis pre- 13 vention coordinators in State, local, territorial, and 14 tribal health departments in order to enhance the 15 additional management, networking, and technical 16 expertise needed to ensure successful integration of 17 hepatitis B and hepatitis C prevention and control 18 activities into existing public health programs. 19 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 20 ‘‘(1) IN GENERAL.—The Secretary, acting 21 through the Director of the Centers for Disease 22 Control and Prevention, shall support the establish- 23 ment and maintenance of a national chronic and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 555 •S 3660 IS acute hepatitis B and hepatitis C surveillance pro- 1 gram, in order to identify— 2 ‘‘(A) trends in the incidence of acute and 3 chronic hepatitis B and acute and chronic hepa- 4 titis C; 5 ‘‘(B) trends in the prevalence of acute and 6 chronic hepatitis B and acute and chronic hepa- 7 titis C infection among groups that may be dis- 8 proportionately affected; and 9 ‘‘(C) trends in liver cancer and end-stage 10 liver disease incidence and deaths, caused by 11 chronic hepatitis B and chronic hepatitis C in 12 the high-risk ethnic populations. 13 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 14 STUDIES.—The Secretary, acting through the Direc- 15 tor of the Centers for Disease Control and Preven- 16 tion, shall prepare a report outlining the population- 17 based seroprevalence studies currently underway, fu- 18 ture planned studies, the criteria involved in deter- 19 mining which seroprevalence studies to conduct, 20 defer, or suspend, and the scope of those studies, the 21 economic and clinical impact of hepatitis B and hep- 22 atitis C, and the impact of chronic hepatitis B and 23 chronic hepatitis C infections on the quality of life. 24 Not later than one year after the date of the enact- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 556 •S 3660 IS ment of this part, the Secretary shall submit the re- 1 port to the Committee on Health, Education, Labor, 2 and Pensions of the Senate and the Committee on 3 Energy and Commerce of the House of Representa- 4 tives. 5 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 6 not disclose any individually identifiable information 7 identified under paragraph (1) or derived through 8 studies under paragraph (2). 9 ‘‘(d) RESEARCH.—The Secretary, acting through the 10 Director of the Centers for Disease Control and Preven- 11 tion, the Director of the National Cancer Institute, and 12 the Director of the National Institutes of Health, shall— 13 ‘‘(1) conduct epidemiologic and community- 14 based research to develop, implement, and evaluate 15 best practices for hepatitis B and hepatitis C pre- 16 vention especially in the ethnic populations with high 17 rates of chronic hepatitis B and chronic hepatitis C 18 and other high-risk groups; 19 ‘‘(2) conduct research on hepatitis B and hepa- 20 titis C natural history, pathophysiology, improved 21 treatments and prevention (such as the hepatitis C 22 vaccine), and noninvasive tests that help to predict 23 the risk of progression to liver cirrhosis and liver 24 cancer; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 557 •S 3660 IS ‘‘(3) conduct research that will lead to better 1 noninvasive or blood tests to screen for liver cancer, 2 and more effective treatments of liver cancer caused 3 by chronic hepatitis B and chronic hepatitis C; and 4 ‘‘(4) conduct research comparing the effective- 5 ness of screening, diagnostic, management, and 6 treatment approaches for chronic hepatitis B, chron- 7 ic hepatitis C, and liver cancer in the affected com- 8 munities. 9 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 10 FECTED POPULATIONS.—In carrying out this section, the 11 Secretary shall provide expanded support for individuals 12 with limited access to health education, testing, and health 13 care services and groups that may be disproportionately 14 affected by hepatitis B and hepatitis C. 15 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 16 shall develop benchmarks for evaluating the effectiveness 17 of the programs and activities conducted under this sec- 18 tion and make determinations as to whether such bench- 19 marks have been achieved. 20 ‘‘SEC. 399PP–2. GRANTS. 21 ‘‘(a) IN GENERAL.—The Secretary may award grants 22 to, or enter into contracts or cooperative agreements with, 23 States, political subdivisions of States, territories, Indian 24 tribes, or nonprofit entities that have special expertise re- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 558 •S 3660 IS lating to hepatitis B, hepatitis C, or both, to carry out 1 activities under this part. 2 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 3 tract, or cooperative agreement under subsection (a), an 4 entity shall prepare and submit to the Secretary an appli- 5 cation at such time, in such manner, and containing such 6 information as the Secretary may require. 7 ‘‘SEC. 399PP–3. AUTHORIZATION OF APPROPRIATIONS. 8 ‘‘There are authorized to be appropriated to carry out 9 this part $90,000,000 for fiscal year 2019, $90,000,000 10 for fiscal year 2020, $110,000,000 for fiscal year 2021, 11 $130,000,000 for fiscal year 2022, and $150,000,000 for 12 fiscal year 2023.’’. 13 Subtitle C—Acquired Bone Marrow 14 Failure Diseases 15 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 16 (a) SHORT TITLE.—This subtitle may be cited as the 17 ‘‘Bone Marrow Failure Disease Research and Treatment 18 Act of 2018’’. 19 (b) FINDINGS.—The Congress finds the following: 20 (1) Between 20,000 and 30,000 people in the 21 United States are diagnosed each year with 22 myelodysplastic syndromes, aplastic anemia, parox- 23 ysmal nocturnal hemoglobinuria, and other acquired 24 bone marrow failure diseases. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 559 •S 3660 IS (2) Acquired bone marrow failure diseases have 1 a debilitating and often fatal impact on those diag- 2 nosed with these diseases. 3 (3) While some treatments for acquired bone 4 marrow failure diseases can prolong and improve the 5 quality of patients’ lives, there is no single cure for 6 these diseases. 7 (4) The prevalence of acquired bone marrow 8 failure diseases in the United States will continue to 9 grow as the general public ages. 10 (5) Evidence exists suggesting that acquired 11 bone marrow failure diseases occur more often in 12 minority populations, particularly in Asian-American 13 and Latino or Hispanic populations. 14 (6) The National Heart, Lung, and Blood Insti- 15 tute and the National Cancer Institute have con- 16 ducted important research into the causes of and 17 treatments for acquired bone marrow failure dis- 18 eases. 19 (7) The National Marrow Donor Program Reg- 20 istry has made significant contributions to the fight 21 against bone marrow failure diseases by connecting 22 millions of potential marrow donors with individuals 23 and families suffering from these conditions. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 560 •S 3660 IS (8) Despite these advances, a more comprehen- 1 sive Federal strategic effort among numerous Fed- 2 eral agencies is needed to discover a cure for ac- 3 quired bone marrow failure disorders. 4 (9) Greater Federal surveillance of acquired 5 bone marrow failure diseases is needed to gain a bet- 6 ter understanding of the causes of acquired bone 7 marrow failure diseases. 8 (10) The Federal Government should increase 9 its research support for and engage with public and 10 private organizations in developing a comprehensive 11 approach to combat and cure acquired bone marrow 12 failure diseases. 13 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 14 DISEASE REGISTRY.—Title III of the Public Health Serv- 15 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 16 after section 317W, as added by section 506, the fol- 17 lowing: 18 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 19 DISEASE REGISTRY. 20 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 21 ‘‘(1) IN GENERAL.—Not later than 6 months 22 after the date of the enactment of this section, the 23 Secretary, acting through the Director of the Cen- 24 ters for Disease Control and Prevention, shall— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 561 •S 3660 IS ‘‘(A) develop a system to collect data on 1 acquired bone marrow failure diseases; and 2 ‘‘(B) establish and maintain a national and 3 publicly available registry, to be known as the 4 National Acquired Bone Marrow Failure Dis- 5 ease Registry, in accordance with paragraph 6 (3). 7 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 8 MITTEE.—In carrying out this subsection, the Sec- 9 retary shall take into consideration the recommenda- 10 tions of the Advisory Committee on Acquired Bone 11 Marrow Failure Diseases established under sub- 12 section (b). 13 ‘‘(3) PURPOSES OF REGISTRY.—The National 14 Acquired Bone Marrow Failure Disease Registry 15 shall— 16 ‘‘(A) identify the incidence and prevalence 17 of acquired bone marrow failure diseases in the 18 United States; 19 ‘‘(B) be used to collect and store data on 20 acquired bone marrow failure diseases, includ- 21 ing data concerning— 22 ‘‘(i) the age, race or ethnicity, general 23 geographic location, sex, and family history 24 of individuals who are diagnosed with ac- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 562 •S 3660 IS quired bone marrow failure diseases, and 1 any other characteristics of such individ- 2 uals determined appropriate by the Sec- 3 retary; 4 ‘‘(ii) the genetic and environmental 5 factors that may be associated with devel- 6 oping acquired bone marrow failure dis- 7 eases; 8 ‘‘(iii) treatment approaches for deal- 9 ing with acquired bone marrow failure dis- 10 eases; 11 ‘‘(iv) outcomes for individuals treated 12 for acquired bone marrow failure diseases, 13 including outcomes for recipients of stem 14 cell therapeutic products as contained in 15 the database established pursuant to sec- 16 tion 379A; and 17 ‘‘(v) any other factors pertaining to 18 acquired bone marrow failure diseases de- 19 termined appropriate by the Secretary; and 20 ‘‘(C) be made available— 21 ‘‘(i) to the general public; and 22 ‘‘(ii) to researchers to facilitate fur- 23 ther research into the causes of, and treat- 24 ments for, acquired bone marrow failure 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 563 •S 3660 IS diseases in accordance with standard prac- 1 tices of the Centers for Disease Control 2 and Preventions. 3 ‘‘(b) ADVISORY COMMITTEE.— 4 ‘‘(1) ESTABLISHMENT.—Not later than 6 5 months after the date of the enactment of this sec- 6 tion, the Secretary, acting through the Director of 7 the Centers for Disease Control and Prevention, 8 shall establish an advisory committee, to be known 9 as the Advisory Committee on Acquired Bone Mar- 10 row Failure Diseases. 11 ‘‘(2) MEMBERS.—The members of the Advisory 12 Committee on Acquired Bone Marrow Failure Dis- 13 eases shall be appointed by the Secretary, acting 14 through the Director of the Centers for Disease 15 Control and Prevention, and shall include at least 16 one representative from each of the following: 17 ‘‘(A) A national patient advocacy organiza- 18 tion with experience advocating on behalf of pa- 19 tients suffering from acquired bone marrow 20 failure diseases. 21 ‘‘(B) The National Institutes of Health, in- 22 cluding at least one representative from each 23 of— 24 ‘‘(i) the National Cancer Institute; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 564 •S 3660 IS ‘‘(ii) the National Heart, Lung, and 1 Blood Institute; and 2 ‘‘(iii) the Office of Rare Diseases. 3 ‘‘(C) The Centers for Disease Control and 4 Prevention. 5 ‘‘(D) Clinicians with experience in— 6 ‘‘(i) diagnosing or treating acquired 7 bone marrow failure diseases; or 8 ‘‘(ii) medical data registries. 9 ‘‘(E) Epidemiologists who have experience 10 with data registries. 11 ‘‘(F) Publicly or privately funded research- 12 ers who have experience researching acquired 13 bone marrow failure diseases. 14 ‘‘(G) The entity operating the C.W. Bill 15 Young Cell Transplantation Program estab- 16 lished pursuant to section 379 and the entity 17 operating the C.W. Bill Young Cell Transplan- 18 tation Program Outcomes Database. 19 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 20 mittee on Acquired Bone Marrow Failure Diseases 21 shall provide recommendations to the Secretary on 22 the establishment and maintenance of the National 23 Acquired Bone Marrow Failure Disease Registry, in- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 565 •S 3660 IS cluding recommendations on the collection, mainte- 1 nance, and dissemination of data. 2 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 3 shall make the recommendations of the Advisory 4 Committee on Acquired Bone Marrow Failure Dis- 5 ease publicly available. 6 ‘‘(c) GRANTS.—The Secretary, acting through the 7 Director of the Centers for Disease Control and Preven- 8 tion, may award grants to, and enter into contracts and 9 cooperative agreements with, public or private nonprofit 10 entities for the management of, as well as the collection, 11 analysis, and reporting of data to be included in, the Na- 12 tional Acquired Bone Marrow Failure Disease Registry. 13 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 14 quired bone marrow failure disease’ means— 15 ‘‘(1) myelodysplastic syndromes; 16 ‘‘(2) aplastic anemia; 17 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 18 ‘‘(4) pure red cell aplasia; 19 ‘‘(5) acute myeloid leukemia that has pro- 20 gressed from myelodysplastic syndromes; or 21 ‘‘(6) large granular lymphocytic leukemia. 22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 $3,000,000 for each of fiscal years 2019 through 2023.’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 566 •S 3660 IS (d) PILOT STUDIES THROUGH THE AGENCY FOR 1 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 2 (1) PILOT STUDIES.—The Secretary of Health 3 and Human Services, acting through the Director of 4 the Agency for Toxic Substances and Disease Reg- 5 istry, shall conduct pilot studies to determine which 6 environmental factors, including exposure to toxins, 7 may cause acquired bone marrow failure diseases. 8 (2) COLLABORATION WITH THE RADIATION IN- 9 JURY TREATMENT NETWORK.—In carrying out the 10 directives of this section, the Secretary may collabo- 11 rate with the Radiation Injury Treatment Network 12 of the C.W. Bill Young Cell Transplantation Pro- 13 gram established pursuant to section 379 of the 14 Public Health Service Act (42 U.S.C. 274k) to— 15 (A) augment data for the pilot studies au- 16 thorized by this section; 17 (B) access technical assistance that may be 18 provided by the Radiation Injury Treatment 19 Network; or 20 (C) perform joint research projects. 21 (3) AUTHORIZATION OF APPROPRIATIONS.— 22 There is authorized to be appropriated to carry out 23 this section $1,000,000 for each of fiscal years 2019 24 through 2023. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 567 •S 3660 IS (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 1 BONE MARROW FAILURE DISEASES.—Title XVII of the 2 Public Health Service Act (42 U.S.C. 300u et seq.) is 3 amended by inserting after section 1707A the following: 4 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC- 5 QUIRED BONE MARROW FAILURE DISEASE. 6 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 7 ‘‘(1) IN GENERAL.—Not later than 6 months 8 after the date of the enactment of this section, the 9 Secretary, acting through the Deputy Assistant Sec- 10 retary for Minority Health, shall establish and co- 11 ordinate outreach and informational programs tar- 12 geted to minority populations affected by acquired 13 bone marrow failure diseases. 14 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 15 cused outreach and informational programs author- 16 ized by this section at the National Minority Health 17 Resource Center supported under section 1707(b)(8) 18 (including by means of the Center’s website, through 19 appropriate locations such as the Center’s knowledge 20 center, and through appropriate programs such as 21 the Center’s resource persons network) and through 22 minority health consultants located at each Depart- 23 ment of Health and Human Services regional of- 24 fice— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 568 •S 3660 IS ‘‘(A) shall make information about treat- 1 ment options and clinical trials for acquired 2 bone marrow failure diseases publicly available; 3 and 4 ‘‘(B) shall provide referral services for 5 treatment options and clinical trials. 6 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 7 ISLANDER OUTREACH.— 8 ‘‘(1) IN GENERAL.—The Secretary, acting 9 through the Deputy Assistant Secretary for Minority 10 Health, shall undertake a coordinated outreach ef- 11 fort to connect Hispanic, Asian-American, and Pa- 12 cific Islander communities with comprehensive serv- 13 ices focused on treatment of, and information about, 14 acquired bone marrow failure diseases. 15 ‘‘(2) COLLABORATION.—In carrying out this 16 subsection, the Secretary may collaborate with public 17 health agencies, nonprofit organizations, community 18 groups, and online entities to disseminate informa- 19 tion about treatment options and clinical trials for 20 acquired bone marrow failure diseases. 21 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 22 ‘‘(1) IN GENERAL.—Not later than 6 months 23 after the date of the enactment of this section, the 24 Secretary, acting through the Deputy Assistant Sec- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 569 •S 3660 IS retary for Minority Health, shall award grants to, or 1 enter into cooperative agreements with, entities to 2 perform research on acquired bone marrow failure 3 diseases. 4 ‘‘(2) REQUIREMENT.—Grants and cooperative 5 agreements authorized by this subsection shall be 6 awarded or entered into on a competitive, peer-re- 7 viewed basis. 8 ‘‘(3) SCOPE OF RESEARCH.—Research funded 9 under this section shall examine factors affecting the 10 incidence of acquired bone marrow failure diseases 11 in minority populations. 12 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 13 quired bone marrow failure disease’ has the meaning given 14 to such term in section 317X(d). 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 $2,000,000 for each of fiscal years 2019 through 2023.’’. 18 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 19 QUIRED BONE MARROW FAILURE DISEASES.— 20 (1) GRANTS.—The Secretary of Health and 21 Human Services, acting through the Director of the 22 Agency for Healthcare Research and Quality, shall 23 award grants to entities to improve diagnostic prac- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 570 •S 3660 IS tices and quality of care with respect to patients 1 with acquired bone marrow failure diseases. 2 (2) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this section $2,000,000 for each of fiscal years 2019 5 through 2023. 6 (g) DEFINITION.—In this section, the term ‘‘acquired 7 bone marrow failure disease’’ has the meaning given such 8 term in section 317X(d) of the Public Health Service Act, 9 as added by subsection (c). 10 Subtitle D—Cardiovascular Dis- 11 ease, Chronic Disease, and 12 Other Disease Issues 13 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 14 NORITY PATIENTS. 15 (a) IN GENERAL.—The Secretary, acting through the 16 Director of the Agency for Healthcare Research and Qual- 17 ity, shall convene a series of meetings to develop guidelines 18 for disease screening for minority patient populations that 19 have a higher than average risk for many chronic diseases 20 and cancers. 21 (b) PARTICIPANTS.—In convening meetings under 22 subsection (a), the Secretary shall ensure that meeting 23 participants include representatives of— 24 (1) professional societies and associations; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 571 •S 3660 IS (2) minority health organizations; 1 (3) health care researchers and providers, in- 2 cluding those with expertise in minority health; 3 (4) Federal health agencies, including the Of- 4 fice of Minority Health, the National Institute on 5 Minority Health and Health Disparities, and the 6 National Institutes of Health; and 7 (5) other experts as the Secretary determines 8 appropriate. 9 (c) DISEASES.—Screening guidelines for minority 10 populations shall be developed as appropriate under sub- 11 section (a) for— 12 (1) hypertension; 13 (2) hypercholesterolemia; 14 (3) diabetes; 15 (4) cardiovascular disease; 16 (5) cancers, including breast, prostate, colon, 17 cervical, and lung cancer; 18 (6) other pulmonary problems including sleep 19 apnea; 20 (7) asthma; 21 (8) diabetes; 22 (9) kidney diseases; 23 (10) eye diseases and disorders, including glau- 24 coma; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 572 •S 3660 IS (11) HIV/AIDS and sexually transmitted infec- 1 tions; 2 (12) uterine fibroids; 3 (13) autoimmune disease; 4 (14) mental health conditions; 5 (15) dental health conditions and oral diseases, 6 including oral cancer; 7 (16) environmental and related health illnesses 8 and conditions; 9 (17) sickle cell disease and sickle cell trait; 10 (18) violence and injury prevention and control; 11 (19) genetic and related conditions; 12 (20) heart disease and stroke; 13 (21) tuberculosis; 14 (22) chronic obstructive pulmonary disease; 15 (23) musculoskeletal diseases, arthritis, and 16 obesity; and 17 (24) other diseases determined appropriate by 18 the Secretary. 19 (d) DISSEMINATION.—Not later than 2 years after 20 the date of enactment of this Act, the Secretary shall pub- 21 lish and disseminate to health care provider organizations 22 the guidelines developed under subsection (a). 23 (e) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 573 •S 3660 IS such sums as may be necessary for each of fiscal years 1 2019 through 2023. 2 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 3 Section 1509 of the Public Health Service Act (42 4 U.S.C. 300n–4a) is amended— 5 (1) in subsection (a)— 6 (A) by striking the heading and inserting 7 ‘‘IN GENERAL.—’’; and 8 (B) in the matter preceding paragraph (1), 9 by striking ‘‘may make grants’’ and all that fol- 10 lows through ‘‘purpose’’ and inserting the fol- 11 lowing: ‘‘may make grants to such States for 12 the purpose’’; and 13 (2) in subsection (d)(1), by striking ‘‘there are 14 authorized’’ and all that follows through the period 15 and inserting ‘‘there are authorized to be appro- 16 priated $23,000,000 for fiscal year 2019, 17 $25,300,000 for fiscal year 2020, $27,800,000 for 18 fiscal year 2021, $30,800,000 for fiscal year 2022, 19 and $34,000,000 for fiscal year 2023.’’. 20 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 21 AND MINORITIES. 22 Part P of title III of the Public Health Service Act 23 (42 U.S.C. 280g et seq.), as amended by section 531, is 24 further amended by adding at the end the following: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 574 •S 3660 IS ‘‘SEC. 399V–8. REPORT ON CARDIOVASCULAR CARE FOR 1 WOMEN AND MINORITIES. 2 ‘‘Not later than September 30, 2019, and annually 3 thereafter, the Secretary shall prepare and submit to Con- 4 gress a report on the quality of and access to care for 5 women and minorities with heart disease, stroke, and 6 other cardiovascular diseases. The report shall contain rec- 7 ommendations for eliminating disparities in, and improv- 8 ing the treatment of, heart disease, stroke, and other car- 9 diovascular diseases in women, racial and ethnic minori- 10 ties, those for whom English is not their primary lan- 11 guage, and individuals with disabilities.’’. 12 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES- 13 SATION SERVICES IN MEDICAID AND PRI- 14 VATE HEALTH INSURANCE. 15 (a) REQUIRING MEDICAID COVERAGE OF COUN- 16 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO- 17 BACCO USE.—Section 1905 of the Social Security Act (42 18 U.S.C. 1396d) is amended— 19 (1) in subsection (a)(4)(D), by striking ‘‘by 20 pregnant women’’; and 21 (2) in subsection (bb)— 22 (A) by striking ‘‘by pregnant women’’ each 23 place it appears; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 575 •S 3660 IS (B) in paragraph (1), in the matter before 1 subparagraph (A), by inserting ‘‘by individuals’’ 2 before ‘‘who use tobacco’’; and 3 (C) in paragraph (2)(A), by striking ‘‘with 4 respect to pregnant women’’. 5 (b) EXCEPTION FROM OPTIONAL RESTRICTION 6 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 7 Section 1927(d)(2)(F) of the Social Security Act (42 8 U.S.C. 1396r–8(d)(2)(F)) is amended— 9 (1) by striking ‘‘in the case of pregnant 10 women’’; and 11 (2) by striking ‘‘under the over-the-counter 12 monograph process’’. 13 (c) STATE MONITORING AND PROMOTING OF COM- 14 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 15 MEDICAID.—Section 1902(a) of the Social Security Act 16 (42 U.S.C. 1396a(a)), as amended by section 462(a), is 17 amended— 18 (1) by striking ‘‘and’’ at the end of paragraph 19 (84); 20 (2) by striking the period at the end of para- 21 graph (85) and inserting ‘‘; and’’; and 22 (3) by inserting after paragraph (85) the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 576 •S 3660 IS ‘‘(86) provide for the State to monitor and pro- 1 mote the use of comprehensive tobacco cessation 2 services under the State plan, including conducting 3 an outreach campaign to increase awareness of, and 4 the benefits of using, such services among— 5 ‘‘(A) individuals entitled to medical assist- 6 ance under the State plan who use tobacco 7 products; and 8 ‘‘(B) clinicians and others who provide 9 services to individuals entitled to medical assist- 10 ance under the State plan.’’. 11 (d) FEDERAL REIMBURSEMENT FOR MEDICAID OUT- 12 REACH CAMPAIGN TO INCREASE AWARENESS.—Section 13 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) 14 is amended— 15 (1) by striking the period at the end of para- 16 graph (7) and inserting ‘‘; plus’’; and 17 (2) by inserting after paragraph (7) the fol- 18 lowing new paragraph: 19 ‘‘(8) an amount equal to 90 percent of the 20 sums expended during each quarter which are attrib- 21 utable to the development, implementation, and eval- 22 uation of an outreach campaign to— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 577 •S 3660 IS ‘‘(A) increase awareness of comprehensive 1 tobacco cessation services covered in the State 2 plan among— 3 ‘‘(i) individuals who are likely to be el- 4 igible for medical assistance under the 5 State plan; and 6 ‘‘(ii) clinicians and others who provide 7 services to individuals who are likely to be 8 eligible for medical assistance under the 9 State plan; and 10 ‘‘(B) increase awareness of the benefits of 11 using comprehensive tobacco cessation services 12 covered in the State plan among— 13 ‘‘(i) individuals who are likely to be el- 14 igible for medical assistance under the 15 State plan; and 16 ‘‘(ii) clinicians and others who provide 17 services to individuals who are likely to be 18 eligible for medical assistance under the 19 State plan about the benefits of using com- 20 prehensive tobacco cessation services.’’. 21 (e) REMOVAL OF COST SHARING FOR COUNSELING 22 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 23 USE UNDER MEDICAID.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 578 •S 3660 IS (1) GENERAL COST SHARING LIMITATIONS.— 1 Section 1916 of the Social Security Act (42 U.S.C. 2 1396o) is amended— 3 (A) in subsections (a)(2)(B) and (b)(2)(B), 4 by striking ‘‘and counseling and pharmacother- 5 apy for cessation of tobacco use by pregnant 6 women (as defined in section 1905(bb) of this 7 title) and covered outpatient drugs (as defined 8 in subsection (k)(2) of section 1927 and includ- 9 ing nonprescription drugs described in sub- 10 section (d)(2) of such section) that are pre- 11 scribed for purposes of promoting, and when 12 used to promote, tobacco cessation by pregnant 13 women in accordance with the Guideline re- 14 ferred to in section 1905(bb)(2)(A)’’ each place 15 it appears; and 16 (B) in each of subsections (a)(2)(B) and 17 (b)(2)(B) by inserting ‘‘and counseling and 18 pharmacotherapy for cessation of tobacco use 19 (as defined in section 1905d(bb) of this title) 20 and covered outpatient drugs (as defined in 21 subsection (k)(2) of section 1927 and including 22 nonprescription drugs described in subsection 23 (d)(2) of such section) that are prescribed for 24 purposes of promoting, and when used to pro- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 579 •S 3660 IS mote, tobacco cessation in accordance with the 1 Guideline referred to in section 2 1905(bb)(2)(A)’’ after ‘‘(or at the option of the 3 State, any services furnished to pregnant 4 women’’. 5 (2) APPLICATION TO ALTERNATIVE COST SHAR- 6 ING.—Section 1916A(b)(3)(B) of such Act (42 7 U.S.C. 1396o–1(b)(3)(B)) is amended— 8 (A) in clause (iii), by striking ‘‘, and coun- 9 seling and pharmacotherapy for cessation of to- 10 bacco use by pregnant women (as defined in 11 section 1905(bb))’’; and 12 (B) by adding at the end the following: 13 ‘‘(xi) Counseling and pharmacothera- 14 py for cessation of tobacco use (as defined 15 in section 1905(bb)) and covered out- 16 patient drugs (as defined in subsection 17 (k)(2) of section 1927 and including non- 18 prescription drugs described in subsection 19 (d)(2) of such section) that are prescribed 20 for purposes of promoting, and when used 21 to promote, tobacco cessation in accord- 22 ance with the Guideline referred to in sec- 23 tion 1396d (bb)(2)(A) of this title.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 580 •S 3660 IS (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES- 1 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 2 the Social Security Act (42 U.S.C. 1396r–8) is amended— 3 (1) by striking in paragraph (1)(A) ‘‘A State’’ 4 and inserting ‘‘Except as otherwise provided in para- 5 graph (6), a State’’; 6 (2) by redesignating paragraphs (6) and (7) as 7 paragraphs (7) and (8), respectively; and 8 (3) by inserting after paragraph (5) the fol- 9 lowing: 10 ‘‘(6) NO PRIOR AUTHORIZATION PROGRAMS FOR 11 TOBACCO CESSATION DRUGS.—A State plan under 12 this title shall not require, as a condition of coverage 13 or payment for a covered outpatient drug for which 14 Federal financial participation is available in accord- 15 ance with this section, the approval of an agent 16 when used to promote smoking cessation, including 17 agents approved by the Food and Drug Administra- 18 tion for the purposes of promoting, and when used 19 to promote, tobacco cessation.’’. 20 (g) COMPREHENSIVE COVERAGE OF TOBACCO CES- 21 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 22 Section 2713 of the Public Health Service Act (42 U.S.C. 23 300gg–3) is amended by adding at the end the following: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 581 •S 3660 IS ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 1 plan and a health insurance issuer offering group or indi- 2 vidual health insurance coverage shall not impose any 3 prior authorization requirement for tobacco cessation 4 counseling and pharmacotherapy that has in effect a rat- 5 ing of ‘A’ or ‘B’ in the current recommendations of the 6 United States Preventive Services Task Force.’’. 7 (h) EFFECTIVE DATE.—The amendments made by 8 this section shall apply to items and services furnished on 9 or after January 1, 2019. 10 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 11 HEALTH. 12 (a) IN GENERAL.—The Secretary of Health and 13 Human Services shall expand and intensify the conduct 14 and support of the research activities of the National In- 15 stitutes of Health and the National Institute of Dental 16 and Craniofacial Research to improve the oral health of 17 the population through the prevention and management 18 of oral diseases and conditions. 19 (b) INCLUDED RESEARCH ACTIVITIES.—Research 20 activities under subsection (a) shall include— 21 (1) comparative effectiveness research and clin- 22 ical disease management research addressing early 23 childhood caries and oral cancer; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 582 •S 3660 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. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 6 APPROVED CLINICAL TRIALS. 7 (a) IN GENERAL.—Title XIX of the Social Security 8 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 9 section 1943 the following new section: 10 ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 11 TRIAL. 12 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO- 13 CIATED WITH APPROVED CLINICAL TRIALS.— 14 ‘‘(1) INCLUSION.—Subject to paragraph (2), 15 routine patient costs shall include all items and serv- 16 ices consistent with the medical assistance provided 17 under the State plan that would otherwise be pro- 18 vided to the individual under such State plan if such 19 individual was not enrolled in an approved clinical 20 trial, including any items or services related to the 21 prevention, detection, and treatment of any medical 22 complications that arise as a result of participation 23 in the approved clinical trial. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 583 •S 3660 IS ‘‘(2) EXCLUSION.—For purposes of paragraph 1 (1), routine patient costs does not include— 2 ‘‘(A) the investigational item, device, or 3 service itself; 4 ‘‘(B) items and services that are provided 5 solely to satisfy data collection and analysis 6 needs and that are not used in the direct clin- 7 ical management of the patient; or 8 ‘‘(C) a service that is clearly inconsistent 9 with widely accepted and established standards 10 of care for a particular diagnosis. 11 ‘‘(3) INFORMATION CONCERNING CLINICAL 12 TRIALS.— 13 ‘‘(A) IN GENERAL.—Subject to subpara- 14 graph (B), the Secretary, in consultation with 15 relevant stakeholders, shall develop a single 16 standardized electronic form for use by the indi- 17 vidual or the referring health care provider to 18 submit to the State agency administering the 19 State plan in order to verify that the clinical 20 trial meets the conditions established for an ap- 21 proved clinical trial (as defined in subsection 22 (c)). 23 ‘‘(B) EXCLUDED INFORMATION.—For pur- 24 poses of subparagraph (A) or any such request 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 584 •S 3660 IS by the State agency for information regarding 1 a clinical trial, an individual or referring health 2 care provider shall not be required to submit— 3 ‘‘(i) the clinical protocol document for 4 the clinical trial; or 5 ‘‘(ii) subject to subparagraph (C), any 6 additional information other than such in- 7 formation as is required pursuant to the 8 form described in subparagraph (A). 9 ‘‘(C) OPTIONAL INFORMATION.—For pur- 10 poses of subparagraphs (A) and (B)(ii), the 11 form may include a requirement that the refer- 12 ring health care provider attest that the indi- 13 vidual is eligible to participate in the clinical 14 trial pursuant to the trial protocol and that in- 15 dividual participation in such trial would be ap- 16 propriate. 17 ‘‘(D) REVIEW OF INFORMATION.— 18 ‘‘(i) IN GENERAL.—A State plan 19 under this title shall establish a process for 20 timely review by the State agency of the 21 form and information submitted pursuant 22 to subparagraph (A) and, not later than 23 48 hours after receipt of such form, con- 24 firmation that the information provided in 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 585 •S 3660 IS such form satisfies the requirements estab- 1 lished under such subparagraph, with such 2 process to include establishment and oper- 3 ation of a 24-hour, toll-free telephone num- 4 ber and email address to provide for expe- 5 dited communication. 6 ‘‘(ii) FAILURE TO RESPOND.—If an 7 individual or the referring health care pro- 8 vider does not receive a response or re- 9 quest for additional information from the 10 State agency following the 48-hour period 11 described in clause (i), the information 12 provided in the form may be presumed to 13 satisfy the requirements established under 14 this paragraph. 15 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 16 PROVED CLINICAL TRIALS.— 17 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 18 For purposes of participation in an approved clinical 19 trial by an individual eligible for medical assistance 20 under this title, the State agency administering the 21 State plan shall make reasonable efforts to ensure 22 that the individual is provided with access to a pro- 23 vider who is— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 586 •S 3660 IS ‘‘(A) participating in the approved clinical 1 trial; 2 ‘‘(B) located not more than 25 miles from 3 the residence of the individual (or, if no such 4 provider is available, as close as possible to the 5 residence of the individual); and 6 ‘‘(C) a participating provider under the 7 State plan or has been deemed to be a partici- 8 pating provider under the State plan for pur- 9 poses of providing medical assistance to the in- 10 dividual during their participation in the ap- 11 proved clinical trial. 12 ‘‘(2) INFORMATIONAL MATERIALS.—The State 13 agency administering the plan approved under this 14 title shall develop informational materials and pro- 15 grams to encourage participating providers to make 16 appropriate referrals to physicians and other appro- 17 priate health care professionals who can provide in- 18 dividuals with access to approved clinical trials. 19 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 20 The term ‘approved clinical trial’ has the same meaning 21 as provided under subsection (d) of the section 2709 of 22 the Public Health Service Act that relates to coverage for 23 individuals participating in approved clinical trials.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 587 •S 3660 IS (b) CONFORMING AMENDMENT.—Section 1902(a) of 1 the Social Security Act (42 U.S.C. 1396a(a)), as amended 2 by section 734(c), is amended— 3 (1) by striking ‘‘and’’ at the end of paragraph 4 (85); 5 (2) by striking the period at the end of para- 6 graph (86) and inserting ‘‘; and’’; and 7 (3) by inserting after paragraph (86) the fol- 8 lowing new paragraph: 9 ‘‘(87) provide that participation in an approved 10 clinical trial and coverage of routine patient costs 11 associated with such trial for an individual eligible 12 for medical assistance under this title is conducted 13 in accordance with the requirements under section 14 1944.’’. 15 (c) EFFECTIVE DATE.— 16 (1) IN GENERAL.—Except as provided in para- 17 graph (2), the amendments made by this section 18 shall apply to calendar quarters beginning on or 19 after October 1, 2018. 20 (2) DELAY PERMITTED FOR STATE PLAN 21 AMENDMENT.—In the case of a State plan for med- 22 ical assistance under title XIX of the Social Security 23 Act which the Secretary of Health and Human Serv- 24 ices determines requires State legislation (other than 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 588 •S 3660 IS legislation appropriating funds) in order for the plan 1 to meet the additional requirements imposed by the 2 amendments made by this section, the State plan 3 shall not be regarded as failing to comply with the 4 requirements of such title solely on the basis of its 5 failure to meet these additional requirements before 6 the first day of the first calendar quarter beginning 7 after the close of the first regular session of the 8 State legislature that begins after the date of enact- 9 ment of this Act. For purposes of the previous sen- 10 tence, in the case of a State that has a 2-year legis- 11 lative session, each year of such session shall be 12 deemed to be a separate regular session of the State 13 legislature. 14 Subtitle E—HIV/AIDS 15 SEC. 741. STATEMENT OF POLICY. 16 It is the policy of the United States to achieve an 17 AIDS-free generation, and to— 18 (1) expand access to lifesaving antiretroviral 19 therapy for people living with HIV/AIDS and imme- 20 diately link people to continuous and coordinated 21 high-quality care when they learn they are infected 22 with HIV; 23 (2) expand targeted efforts to prevent HIV in- 24 fection using a combination of effective, evidence- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 589 •S 3660 IS based approaches, including routine HIV screening, 1 and universal access to HIV prevention tools in the 2 communities where HIV/AIDS is most heavily con- 3 centrated, particularly communities of color; 4 (3) ensure laws, policies, and regulations do not 5 impede access to prevention, treatment, and care for 6 people living with HIV/AIDS or at risk for acquiring 7 HIV; 8 (4) accelerate research for more efficacious HIV 9 prevention and treatments tools, a cure, and a vac- 10 cine; and 11 (5) respect the human rights and dignity of 12 persons living with HIV/AIDS. 13 SEC. 742. FINDINGS. 14 The Congress finds the following: 15 (1) Over 1,000,000 people are estimated to be 16 living with HIV in the United States according to 17 the Centers for Disease Control and Prevention, 15 18 percent of whom are unaware of their HIV-positive 19 status. 20 (2) Annually there are about 37,600 new HIV 21 infections and 20,000 deaths in people with an HIV 22 diagnoses in 50 States and 6 dependent areas of the 23 United States. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 590 •S 3660 IS (3) The Centers for Disease Control and Pre- 1 vention estimates that, in 2015, there were approxi- 2 mately 37,600 people newly diagnosed with HIV. 3 The estimated number of annual new HIV infections 4 declined 10 percent from 2010 to 2014. However, 5 the number of new infections is increasing among 6 certain populations, such as Latino gay and bisexual 7 men, where annual infections increase 14 percent. 8 New infections among Black gay or bisexual men 9 are remaining stable. 10 (4) HIV disproportionately affects certain popu- 11 lations in the United States. Though African Ameri- 12 cans represent approximately 12 percent of the pop- 13 ulation, African Americans account for almost half 14 (45 percent) of all people living with HIV in the 15 United States. Men who have sex with men account 16 for 67 percent of all new HIV infections and are the 17 only risk group in which HIV infections continue to 18 increase. 19 (5) Disparities exist among Latinos and His- 20 panics; in 2015, Latinos and Hispanics made up 18 21 percent of the United States population and 24 per- 22 cent of new infections. 23 (6) Though the rate of new infections among 24 American Indians and Alaska Natives (referred to in 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 591 •S 3660 IS this section as ‘‘AI/AN’’) is proportional to their 1 population size, from 2005 to 2014, the annual 2 number of HIV diagnoses increased 19 percent 3 among AI/AN overall and 63 percent among AI/AN 4 gay and bisexual men. 5 (7) Asian Americans account for about 2 per- 6 cent of new HIV infections, but in 2013, 22 percent 7 were undiagnosed, the highest rate of undiagnosed 8 HIV among any race or ethnicity. 9 (8) The latest data from the Centers for Dis- 10 ease Control and Prevention in 2015 indicate that 11 new infections among women declined 20 percent. 12 (9) The history of HIV shows that culturally 13 relevant and gender-responsive supportive services, 14 including psychosocial support, treatment literacy, 15 case management, and transportation are necessary 16 strategies to reach and engage women and girls in 17 medical care. 18 (10) The limited data available on transgender 19 individuals point to a disproportionate burden of 20 HIV infection. 21 (11) Stigma and discrimination contribute to 22 such disparities. 23 (12) The Centers for Disease Control and Pre- 24 vention has determined that increasing the propor- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 592 •S 3660 IS tion of people who know their HIV status is an es- 1 sential component of comprehensive HIV/AIDS 2 treatment and prevention efforts and that early di- 3 agnosis is critical in order for people with HIV/ 4 AIDS to receive life-extending therapy. Additionally, 5 the Centers for Disease Control and Prevention rec- 6 ommend routine HIV screening in health care set- 7 tings for all patients aged 13 to 64, regardless of 8 risk. 9 (13) In 1998, Congress created the National 10 Minority AIDS Initiative to provide technical assist- 11 ance, build capacity, and strengthen outreach efforts 12 among local institutions and community-based orga- 13 nizations that serve racial and ethnic minorities liv- 14 ing with or vulnerable to HIV/AIDS. 15 (14) To combat the HIV epidemic in the United 16 States, the National HIV/AIDS Strategy (referred 17 to in this section as ‘‘NHAS’’) provides a framework 18 of increasing access to care, reducing new infections, 19 and eliminating HIV-related health disparities. The 20 vision of NHAS is ‘‘The United States will become 21 a place where new HIV infections are rare and when 22 they do occur, every person, regardless of age, gen- 23 der, race/ethnicity, gender identity, or socioeconomic 24 circumstance, will have unfettered access to high 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 593 •S 3660 IS quality, life-extending care, free from stigma and 1 discrimination.’’. 2 (15) At present, many States and United 3 States territories have criminal statutes based on 4 ‘‘exposure’’ to HIV. Most of these laws were adopted 5 before the availability of effective antiretroviral 6 treatment for HIV/AIDS. 7 (16) Research shows that stable housing leads 8 to better health outcomes for those living with HIV. 9 Inadequate or unstable housing is not only a barrier 10 to effective treatment, but also increases the likeli- 11 hood of engaging in risky behaviors leading to HIV 12 infection. Insecure housing puts people with HIV/ 13 AIDS at risk of premature death from exposure to 14 other diseases, poor nutrition, and lack of medical 15 care. 16 (17) Due to advances in treatment, many peo- 17 ple living with HIV/AIDS (referred to in this section 18 as ‘‘PLWHA’’) today are living healthy lives and 19 have the ability and desire to fully participate in all 20 aspects of community life, including employment. 21 Research associates being employed with tremendous 22 economic, social, and health benefits for many people 23 living with HIV/AIDS. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 594 •S 3660 IS (18) The common benefits associated with em- 1 ployment include income, autonomy, productivity, 2 and status within society, daily structure, making a 3 contribution to one’s community, and increased skills 4 and self-esteem. Research also indicates that many 5 people with disabilities, including PLWHA, report 6 perceiving themselves as being less disabled or not 7 disabled at all, when working. Furthermore, some 8 studies link working with better physical and mental 9 health outcomes for PLWHA when compared to 10 those who are not working. Preliminary data also 11 suggest that transitioning to employment is associ- 12 ated with reduced HIV-related health risk behavior 13 for many people. 14 (19) On July 16, 2012, the Food and Drug Ad- 15 ministration approved the first drug to reduce the 16 risk of HIV infection in uninfected individuals who 17 are at high risk of HIV infection and who may en- 18 gage in sexual activity with HIV-infected partners. 19 (20) Syringe service programs have been associ- 20 ated with lowered HIV infections, lower hepatitis C 21 infections, and increased linkage to substance use 22 treatment. 23 (21) There is now conclusive scientific evidence 24 that a person living with HIV who is on 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 595 •S 3660 IS antiretroviral therapy and is durably virally sup- 1 pressed (defined as having a consistent viral load of 2 less than <200 copies/ml) does not sexually trans- 3 mit HIV. The conclusive evidence about the highly 4 effective preventative benefits of antiretroviral ther- 5 apy provides an unprecedented opportunity to im- 6 prove the lives of people living with HIV, improve 7 treatment uptake and adherence, and advocate for 8 expanded access to treatment and care. 9 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 10 ANCE PROGRAM TREATMENTS. 11 Section 2623 of the Public Health Service Act (42 12 U.S.C. 300ff–31b) is amended by adding at the end the 13 following: 14 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 15 SISTANCE PROGRAM TREATMENTS.—In addition to 16 amounts otherwise authorized to be appropriated for car- 17 rying out this subpart, there are authorized to be appro- 18 priated such sums as may be necessary to carry out sec- 19 tions 2612(b)(3)(B) and 2616 for each of fiscal years 20 2019 through 2022.’’. 21 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 22 SYSTEM. 23 (a) GRANTS.—The Secretary of Health and Human 24 Services, acting through the Director of the Centers for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 596 •S 3660 IS Disease Control and Prevention, shall make grants to 1 States to support integration of public health surveillance 2 systems into all electronic health records in order to allow 3 rapid communications between the clinical setting and 4 health departments, by means that include— 5 (1) providing technical assistance and policy 6 guidance to State and local health departments, clin- 7 ical providers, and other agencies serving individuals 8 with HIV to improve the interoperability of data sys- 9 tems relevant to monitoring HIV care and sup- 10 portive services; 11 (2) capturing longitudinal data pertaining to 12 the initiation and ongoing prescription or dispensing 13 of antiretroviral therapy for individuals diagnosed 14 with HIV (such as through pharmacy-based report- 15 ing); 16 (3) obtaining information— 17 (A) on a voluntary basis, on sexual orienta- 18 tion and gender identity; and 19 (B) on sources of coverage (or the lack of 20 coverage) for medical treatment (including cov- 21 erage through the Medicaid program, the Medi- 22 care program, the program under title XXVI of 23 the Public Health Service Act (42 U.S.C. 24 300ff–11 et seq.); commonly referred to as the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 597 •S 3660 IS ‘‘Ryan White HIV/AIDS Program’’), other pub- 1 lic funding, private insurance, and health main- 2 tenance organizations); and 3 (4) obtaining and using current geographic 4 markers of residence (such as current address, zip 5 code, partial zip code, and census block). 6 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 7 rying out this section, the Secretary of Health and Human 8 Services shall ensure that appropriate privacy and security 9 safeguards are met to prevent unauthorized disclosure of 10 protected health information and compliance with the 11 HIPAA privacy and security law (as defined in section 12 3009 of the Public Health Service Act (42 U.S.C. 300jj– 13 19)) and other relevant laws and regulations. 14 (c) PROHIBITION AGAINST IMPROPER USE OF 15 DATA.—No grant under this section may be used to allow 16 or facilitate the collection or use of surveillance or clinical 17 data or records— 18 (1) for punitive measures of any kind, civil or 19 criminal, against the subject of such data or records; 20 or 21 (2) for imposing any requirement or restriction 22 with respect to an individual without the individual’s 23 written consent. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 598 •S 3660 IS (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 such sums as may be necessary for each of fiscal years 3 2019 through 2023. 4 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 5 LINKAGE TO AND RETENTION IN APPRO- 6 PRIATE CARE. 7 (a) STRATEGIES.—The Secretary of Health and 8 Human Services, in collaboration with the Director of the 9 Centers for Disease Control and Prevention, the Assistant 10 Secretary for Mental Health and Substance Use, the Di- 11 rector of the Office of AIDS Research, the Administrator 12 of the Health Resources and Services Administration, and 13 the Administrator of the Centers for Medicare & Medicaid 14 Services, shall— 15 (1) identify evidence-based strategies most ef- 16 fective at addressing the multifaceted issues that im- 17 pede disease status awareness and linkage to and re- 18 tention in appropriate care, taking into consideration 19 health care systems issues, clinic and provider 20 issues, and individual psychosocial, environmental, 21 and other contextual factors; 22 (2) support the wide-scale implementation of 23 the evidence-based strategies identified pursuant to 24 paragraph (1), including through incorporating such 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 599 •S 3660 IS strategies into health care coverage supported by the 1 Medicaid program under title XIX of the Social Se- 2 curity Act (42 U.S.C. 1396 et seq.), the program 3 under title XXVI of the Public Health Service Act 4 (42 U.S.C. 300ff–11 et seq.; commonly referred to 5 as the ‘‘Ryan White HIV/AIDS Program’’), and 6 health plans purchased through an American Health 7 Benefit Exchange established pursuant to section 8 1311 of the Patient Protection and Affordable Care 9 Act (42 U.S.C. 18031); and 10 (3) not later than 1 year after the date of the 11 enactment of this Act, submit a report to the Con- 12 gress on the status of activities under paragraphs 13 (1) and (2). 14 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated 16 such sums as may be necessary for fiscal years 2019 17 through 2023. 18 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 19 CARE AND ANTIRETROVIRAL ADHERENCE 20 FOR PERSONS WITH HIV. 21 (a) SENSE OF CONGRESS.—It is the sense of Con- 22 gress that AIDS research has led to scientific advance- 23 ments that have— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 600 •S 3660 IS (1) saved the lives of millions of people with 1 HIV/AIDS; 2 (2) prevented millions of people from being in- 3 fected; and 4 (3) had broad benefits that extend far beyond 5 helping people at risk for or living with HIV. 6 (b) IN GENERAL.—The Secretary of Health and 7 Human Services, acting through the Director of the Na- 8 tional Institutes of Health, shall expand, intensify, and co- 9 ordinate operational and translational research and other 10 activities of the National Institutes of Health regarding 11 methods— 12 (1) to increase adoption of evidence-based ad- 13 herence strategies within HIV care and treatment 14 programs; 15 (2) to increase HIV testing and case detection 16 rates; 17 (3) to reduce HIV-related health disparities; 18 (4) to ensure that research to improve adher- 19 ence to HIV care and treatment programs address 20 the unique concerns of women; 21 (5) to integrate HIV/AIDS prevention and care 22 services with mental health and substance use pre- 23 vention and treatment delivery systems; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 601 •S 3660 IS (6) to increase knowledge on the implementa- 1 tion of preexposure prophylaxis (referred to in this 2 section as ‘‘PrEP’’), including with respect to— 3 (A) who can benefit most from PrEP; 4 (B) how to provide PrEP safely and effi- 5 ciently; 6 (C) how to integrate PrEP with other es- 7 sential prevention methods such as condoms; 8 and 9 (D) how to ensure high levels of adherence; 10 and 11 (7) to increase knowledge of undetectable and 12 untransmittable a person living with HIV who is on 13 antiretroviral therapy and is durably virally sup- 14 pressed (defined as having a consistent viral load of 15 less than <200 copies/ml) cannot sexually transmit 16 HIV. 17 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as may be necessary for fiscal years 2019 20 through 2023. 21 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 22 ETHNIC MINORITY COMMUNITIES. 23 (a) IN GENERAL.—For the purpose of reducing HIV/ 24 AIDS in racial and ethnic minority communities, the Sec- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 602 •S 3660 IS retary of Health and Human Services, acting through the 1 Deputy Assistant Secretary for Minority Health, may 2 make grants to public health agencies and faith-based or- 3 ganizations to conduct— 4 (1) outreach activities related to HIV/AIDS 5 prevention and testing activities; 6 (2) HIV/AIDS prevention activities; and 7 (3) HIV/AIDS testing activities. 8 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 9 out this section, there are authorized to be appropriated 10 such sums as may be necessary for fiscal years 2019 11 through 2023. 12 SEC. 748. MINORITY AIDS INITIATIVE. 13 (a) EXPANDED FUNDING.—The Secretary of Health 14 and Human Services, in collaboration with the Deputy As- 15 sistant Secretary for Minority Health, the Director of the 16 Centers for Disease Control and Prevention, the Adminis- 17 trator of the Health Resources and Services Administra- 18 tion, and the Assistant Secretary for Mental Health and 19 Substance Use, shall provide funds and carry out activities 20 to expand the Minority HIV/AIDS Initiative. 21 (b) USE OF FUNDS.—The additional funds made 22 available under this section may be used, through the Mi- 23 nority AIDS Initiative, to support the following activities: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 603 •S 3660 IS (1) Providing technical assistance and infra- 1 structure support to reduce HIV/AIDS in minority 2 populations. 3 (2) Increasing minority populations’ access to 4 HIV/AIDS prevention and care services. 5 (3) Building strong community programs and 6 partnerships to address HIV prevention and the 7 health care needs of specific racial and ethnic minor- 8 ity populations. 9 (c) PRIORITY INTERVENTIONS.—Within the racial 10 and ethnic minority populations referred to in subsection 11 (b), priority in conducting intervention services shall be 12 given to— 13 (1) men who have sex with men; 14 (2) youth; 15 (3) persons who engage in intravenous drug 16 abuse; 17 (4) women; 18 (5) homeless individuals; and 19 (6) individuals incarcerated or in the penal sys- 20 tem. 21 (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 22 rying out this section, there are authorized to be appro- 23 priated $610,000,000 for fiscal year 2019 and such sums 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 604 •S 3660 IS as may be necessary for each of fiscal years 2020 through 1 2023. 2 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 3 VIDUALS WITH HIV/AIDS. 4 (a) IN GENERAL.—The Secretary of Health and 5 Human Services, acting through the Administrator of the 6 Health Resources and Services Administration, shall ex- 7 pand, intensify, and coordinate workforce initiatives of the 8 Health Resources and Services Administration to increase 9 the capacity of the health workforce focusing primarily on 10 HIV/AIDS to meet the demand for culturally competent 11 care, and may award grants for any of the following: 12 (1) Development of curricula for training pri- 13 mary care providers in HIV/AIDS prevention and 14 care, including routine HIV testing. 15 (2) Support to expand access to culturally and 16 linguistically accessible benefits counselors, trained 17 peer navigators, and mental and behavioral health 18 professionals with expertise in HIV/AIDS. 19 (3) Training health care professionals to pro- 20 vide care to individuals with HIV/AIDS. 21 (4) Development by grant recipients under title 22 XXVI of the Public Health Service Act (42 U.S.C. 23 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 24 White HIV/AIDS Program’’) and other persons, of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 605 •S 3660 IS policies for providing culturally relevant and sen- 1 sitive treatment to individuals with HIV/AIDS, with 2 particular emphasis on treatment to racial and eth- 3 nic minorities, men who have sex with men, and 4 women, young people, and children with HIV/AIDS. 5 (5) Development and implementation of pro- 6 grams to increase the use of telehealth to respond to 7 HIV/AIDS-specific health care needs in rural and 8 minority communities, with particular emphasis 9 given to medically underserved communities and in- 10 sular areas. 11 (6) Evaluating interdisciplinary medical pro- 12 vider care team models that promote high-quality 13 care, with particular emphasis on care to racial and 14 ethnic minorities. 15 (7) Training health care professionals to make 16 them aware of the high rates of chronic hepatitis B 17 and chronic hepatitis C in adult racial and ethnic 18 populations, and the importance of prevention, de- 19 tection, and medical management of hepatitis B and 20 hepatitis C and of liver cancer screening. 21 (8) Development of curricula for training pri- 22 mary care providers that HIV/AIDS and tuber- 23 culosis are significant mutual comorbidities, and 24 that a patient who tests positive for one disease 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 606 •S 3660 IS should be offered and encouraged to receive testing 1 for the other. 2 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 3 out this section, there are authorized to be appropriated 4 such sums as may be necessary for fiscal years 2019 5 through 2023. 6 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 7 GRAM. 8 (a) IN GENERAL.—The Secretary may enter into an 9 agreement with any physician, nurse practitioner, or phy- 10 sician assistant under which— 11 (1) the physician, nurse practitioner, or physi- 12 cian assistant agrees to serve as a medical provider 13 for a period of not less than 2 years— 14 (A) at a Ryan White-funded or title X- 15 funded facility with a critical shortage of doc- 16 tors (as determined by the Secretary); or 17 (B) in an area with a high incidence of 18 HIV/AIDS; and 19 (2) the Secretary agrees to make payments in 20 accordance with subsection (b) on the professional 21 education loans of the physician, nurse practitioner, 22 or physician assistant. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 607 •S 3660 IS (b) MANNER OF PAYMENTS.—The payments de- 1 scribed in subsection (a) shall be made by the Secretary 2 as follows: 3 (1) Upon completion by the physician, nurse 4 practitioner, or physician assistant for whom the 5 payments are to be made of the first year of the 6 service specified in the agreement entered into with 7 the Secretary under subsection (a), the Secretary 8 shall pay 30 percent of the principal of and the in- 9 terest on the individual’s professional education 10 loans. 11 (2) Upon completion by the physician, nurse 12 practitioner, or physician assistant of the second 13 year of such service, the Secretary shall pay another 14 30 percent of the principal of and the interest on 15 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.—Sub- 21 part III of part D of title III of the Public Health Service 22 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 23 with this section, apply to the program carried out under 24 this section in the same manner and to the same extent 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 608 •S 3660 IS as such provisions apply to the National Health Service 1 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 Congress a re- 5 port describing the program carried out under this section, 6 including statements regarding the following: 7 (1) The number of physicians, nurse practi- 8 tioners, and physician assistants enrolled in the pro- 9 gram. 10 (2) The number and amount of loan repay- 11 ments. 12 (3) The placement location of loan repayment 13 recipients at facilities described in subsection (a)(1). 14 (4) The default rate and actions required. 15 (5) The amount of outstanding default funds. 16 (6) To the extent that it can be determined, the 17 reason for the default. 18 (7) The demographics of individuals partici- 19 pating in the program. 20 (8) An evaluation of the overall costs and bene- 21 fits of the program. 22 (e) DEFINITIONS.—In this section: 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 609 •S 3660 IS (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 1 human immunodeficiency virus and acquired im- 2 mune deficiency syndrome. 3 (2) NURSE PRACTITIONER.—The term ‘‘nurse 4 practitioner’’ means a registered nurse who has com- 5 pleted an accredited graduate degree program in ad- 6 vanced nurse practice and has successfully passed a 7 national certification exam. 8 (3) PHYSICIAN.—The term ‘‘physician’’ means 9 a graduate of a school of medicine who has com- 10 pleted postgraduate training in general or pediatric 11 medicine. 12 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi- 13 cian assistant’’ means a medical provider who com- 14 pleted an accredited physician assistant training pro- 15 gram and successfully passed the Physician Assist- 16 ant National Certifying Examination. 17 (5) PROFESSIONAL EDUCATION LOAN.—The 18 term ‘‘professional education loan’’— 19 (A) means a loan that is incurred for the 20 cost of attendance (including tuition, other rea- 21 sonable educational expenses, and reasonable 22 living costs) at a school of medicine, nursing, or 23 physician assistant training program; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 610 •S 3660 IS (B) includes only the portion of the loan 1 that is outstanding on the date the physician, 2 nurse practitioner, or physician assistant in- 3 volved begins the service specified in the agree- 4 ment under subsection (a). 5 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 6 White-funded’’ means, with respect to a facility, re- 7 ceiving funds under title XXVI of the Public Health 8 Service Act (42 U.S.C. 300ff–11 et seq.). 9 (7) SECRETARY.—The term ‘‘Secretary’’ means 10 the Secretary of Health and Human Services. 11 (8) SCHOOL OF MEDICINE.—The term ‘‘school 12 of medicine’’ has the meaning given to that term in 13 section 799B of the Public Health Service Act (42 14 U.S.C. 295p). 15 (9) TITLE X-FUNDED.—The term ‘‘title X-fund- 16 ed’’ means, with respect to a facility, receiving funds 17 under title X of the Public Health Service Act (42 18 U.S.C. 300 et seq.). 19 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 20 out this section, there are authorized to be appropriated 21 such sums as may be necessary for fiscal years 2019 22 through 2023. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 611 •S 3660 IS SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary may enter into an 3 agreement with any dentist under which— 4 (1) the dentist agrees to serve as a dentist for 5 a period of not less than 2 years at a facility with 6 a critical shortage of dentists (as determined by the 7 Secretary) in an area with a high incidence of HIV/ 8 AIDS; and 9 (2) the Secretary agrees to make payments in 10 accordance with subsection (b) on the dental edu- 11 cation loans of the dentist. 12 (b) MANNER OF PAYMENTS.—The payments de- 13 scribed in subsection (a) shall be made by the Secretary 14 as follows: 15 (1) Upon completion by the dentist for whom 16 the payments are to be made of the first year of the 17 service specified in the agreement entered into with 18 the Secretary under subsection (a), the Secretary 19 shall pay 30 percent of the principal of and the in- 20 terest on the dental education loans of the dentist. 21 (2) Upon completion by the dentist of the sec- 22 ond year of such service, the Secretary shall pay an- 23 other 30 percent of the principal of and the interest 24 on such loans. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 612 •S 3660 IS (3) Upon completion by that individual of a 1 third year of such service, the Secretary shall pay 2 another 25 percent of the principal of and the inter- 3 est on such loans. 4 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub- 5 part III of part D of title III of the Public Health Service 6 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 7 with this section, apply to the program carried out under 8 this section in the same manner and to the same extent 9 as such provisions apply to the National Health Service 10 Corps Loan Repayment Program. 11 (d) REPORTS.—Not later than 18 months after the 12 date of the enactment of this Act, and annually thereafter, 13 the Secretary shall prepare and submit to the Congress 14 a report describing the program carried out under this sec- 15 tion, including statements regarding the following: 16 (1) The number of dentists enrolled in the pro- 17 gram. 18 (2) The number and amount of loan repay- 19 ments. 20 (3) The placement location of loan repayment 21 recipients at facilities described in subsection (a)(1). 22 (4) The default rate and actions required. 23 (5) The amount of outstanding default funds. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 613 •S 3660 IS (6) To the extent that it can be determined, the 1 reason for the default. 2 (7) The demographics of individuals partici- 3 pating in the program. 4 (8) An evaluation of the overall costs and bene- 5 fits of the program. 6 (e) DEFINITIONS.—In this section: 7 (1) DENTAL EDUCATION LOAN.—The term 8 ‘‘dental education loan’’— 9 (A) means a loan that is incurred for the 10 cost of attendance (including tuition, other rea- 11 sonable educational expenses, and reasonable 12 living costs) at a school of dentistry; and 13 (B) includes only the portion of the loan 14 that is outstanding on the date the dentist in- 15 volved begins the service specified in the agree- 16 ment under subsection (a). 17 (2) DENTIST.—The term ‘‘dentist’’ means a 18 graduate of a school of dentistry who has completed 19 postgraduate training in general or pediatric den- 20 tistry. 21 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 22 human immunodeficiency virus and acquired im- 23 mune deficiency syndrome. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 614 •S 3660 IS (4) SCHOOL OF DENTISTRY.—The term ‘‘school 1 of dentistry’’ has the meaning given to that term in 2 section 799B of the Public Health Service Act (42 3 U.S.C. 295p). 4 (5) SECRETARY.—The term ‘‘Secretary’’ means 5 the Secretary of Health and Human Services. 6 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 7 out this section, there are authorized to be appropriated 8 such sums as may be necessary for each of fiscal years 9 2019 through 2023. 10 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 11 ING DRUG USERS. 12 (a) SENSE OF CONGRESS.—It is the sense of Con- 13 gress that providing sterile syringes and sterilized equip- 14 ment to injecting drug users substantially reduces risk of 15 HIV infection, increases the probability that they will ini- 16 tiate drug treatment, and does not increase drug use. 17 (b) IN GENERAL.—The Secretary of Health and 18 Human Services may provide grants and technical assist- 19 ance for the purpose of reducing the rate of HIV infections 20 among injecting drug users through a comprehensive 21 package of services for such users, including the provision 22 of sterile syringes, education and outreach, access to infec- 23 tious disease testing, overdose prevention, and treatment 24 for drug dependence. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 615 •S 3660 IS (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 such sums as may be necessary for fiscal years 2019 3 through 2023. 4 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 5 POPULATIONS. 6 (a) IN GENERAL.—The Secretary shall submit to 7 Congress and the President an annual report on the im- 8 pact of HIV/AIDS for racial and ethnic minority commu- 9 nities, women, and youth aged 24 and younger. 10 (b) CONTENTS.—The report under subsection (a) 11 shall include information on the— 12 (1) progress that has been made in reducing 13 the impact of HIV/AIDS in such communities; 14 (2) opportunities that exist to make additional 15 progress in reducing the impact of HIV/AIDS in 16 such communities; 17 (3) challenges that may impede such additional 18 progress; and 19 (4) Federal funding necessary to achieve sub- 20 stantial reductions in HIV/AIDS in racial and ethnic 21 minority communities. 22 SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 23 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 24 of Congress that national observance days highlighting the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 616 •S 3660 IS impact of HIV/AIDS on communities of color include the 1 following: 2 (1) National Black HIV/AIDS Awareness Day. 3 (2) National Latino AIDS Awareness Day. 4 (3) National Asian and Pacific Islander HIV/ 5 AIDS Awareness Day. 6 (4) National Native American HIV/AIDS 7 Awareness Day. 8 (5) National Youth HIV/AIDS Awareness Day. 9 (b) CALL TO ACTION.—It is the sense of Congress 10 that the President should call on members of communities 11 of color— 12 (1) to become involved at the local community 13 level in HIV/AIDS testing, policy, and advocacy; 14 (2) to become aware, engaged, and empowered 15 on the HIV/AIDS epidemic within their commu- 16 nities; and 17 (3) to urge members of their communities to re- 18 duce risk factors, practice safe sex and other preven- 19 tive measures, be tested for HIV/AIDS, and seek 20 care when appropriate. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 617 •S 3660 IS SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 1 POLICIES, AND REGULATIONS REGARDING 2 THE CRIMINAL PROSECUTION OF INDIVID- 3 UALS FOR HIV-RELATED OFFENSES. 4 (a) DEFINITIONS.— 5 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 6 ‘‘HIV/AIDS’’ have the meanings given to such terms 7 in section 2689 of the Public Health Service Act (42 8 U.S.C. 300ff–88). 9 (2) STATE.—The term ‘‘State’’ includes the 10 District of Columbia, American Samoa, the Com- 11 monwealth of the Northern Mariana Islands, Guam, 12 Puerto Rico, and the United States Virgin Islands. 13 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 14 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 15 AIDS.—It is the sense of Congress that Federal and State 16 laws, policies, and regulations regarding people living with 17 HIV/AIDS— 18 (1) should not place unique or additional bur- 19 dens on such individuals solely as a result of their 20 HIV status; and 21 (2) should instead demonstrate a public health- 22 oriented, evidence-based, medically accurate, and 23 contemporary understanding of— 24 (A) the multiple factors that lead to HIV 25 transmission; 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 618 •S 3660 IS (B) the relative risk of HIV transmission 1 routes; 2 (C) the current health implications of liv- 3 ing with HIV; 4 (D) the associated benefits of treatment 5 and support services for people living with HIV; 6 and 7 (E) the impact of punitive HIV-specific 8 laws and policies on public health, on people liv- 9 ing with or affected by HIV, and on their fami- 10 lies and communities. 11 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 12 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 13 PROSECUTION OF INDIVIDUALS FOR HIV–RELATED OF- 14 FENSES.— 15 (1) REVIEW OF FEDERAL AND STATE LAWS.— 16 (A) IN GENERAL.—Not later than 90 days 17 after the date of the enactment of this Act, the 18 Attorney General, the Secretary of Health and 19 Human Services, and the Secretary of Defense 20 acting jointly (in this paragraph and paragraph 21 (2) referred to as the ‘‘designated officials’’) 22 shall initiate a national review of Federal and 23 State laws, policies, regulations, and judicial 24 precedents and decisions regarding criminal and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 619 •S 3660 IS related civil commitment cases involving people 1 living with HIV/AIDS, including in regards to 2 the Uniform Code of Military Justice. 3 (B) CONSULTATION.—In carrying out the 4 review under subparagraph (A), the designated 5 officials shall ensure diverse participation and 6 consultation from each State, including with— 7 (i) State attorneys general (or their 8 representatives); 9 (ii) State public health officials (or 10 their representatives); 11 (iii) State judicial and court system 12 officers, including judges, district attor- 13 neys, prosecutors, defense attorneys, law 14 enforcement, and correctional officers; 15 (iv) members of the United States 16 Armed Forces, including members of other 17 Federal services subject to the Uniform 18 Code of Military Justice; 19 (v) people living with HIV/AIDS, par- 20 ticularly those who have been subject to 21 HIV-related prosecution or who are from 22 communities whose members have been 23 disproportionately subject to HIV-specific 24 arrests and prosecutions; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 620 •S 3660 IS (vi) legal advocacy and HIV/AIDS 1 service organizations that work with people 2 living with HIV/AIDS; 3 (vii) nongovernmental health organi- 4 zations that work on behalf of people living 5 with HIV/AIDS; and 6 (viii) trade organizations or associa- 7 tions representing persons or entities de- 8 scribed in clauses (i) through (vii). 9 (C) RELATION TO OTHER REVIEWS.—In 10 carrying out the review under subparagraph 11 (A), the designated officials may utilize other 12 existing reviews of criminal and related civil 13 commitment cases involving people living with 14 HIV/AIDS, including any such review con- 15 ducted by any Federal or State agency or any 16 public health, legal advocacy, or trade organiza- 17 tion or association if the designated officials de- 18 termine that such reviews were conducted in ac- 19 cordance with the principles set forth in sub- 20 section (b). 21 (2) REPORT.—No later than 180 days after ini- 22 tiating the review required by paragraph (1), the At- 23 torney General shall transmit to Congress and make 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 621 •S 3660 IS publicly available a report containing the results of 1 the review, which includes the following: 2 (A) For each State and for the Uniform 3 Code of Military Justice, a summary of the rel- 4 evant laws, policies, regulations, and judicial 5 precedents and decisions regarding criminal 6 cases involving people living with HIV/AIDS, 7 including, if applicable, the following: 8 (i) A determination of whether such 9 laws, policies, regulations, and judicial 10 precedents and decisions place any unique 11 or additional burdens upon people living 12 with HIV/AIDS. 13 (ii) A determination of whether such 14 laws, policies, regulations, and judicial 15 precedents and decisions demonstrate a 16 public health-oriented, evidence-based, 17 medically accurate, and contemporary un- 18 derstanding of— 19 (I) the multiple factors that lead 20 to HIV transmission; 21 (II) the relative risk of HIV 22 transmission routes; 23 (III) the current health implica- 24 tions of living with HIV; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 622 •S 3660 IS (IV) the associated benefits of 1 treatment and support services for 2 people living with HIV; and 3 (V) the impact of punitive HIV- 4 specific laws and policies on public 5 health, on people living with or af- 6 fected by HIV, and on their families 7 and communities. 8 (iii) An analysis of the public health 9 and legal implications of such laws, poli- 10 cies, regulations, and judicial precedents, 11 including an analysis of the consequences 12 of having a similar penal scheme applied to 13 comparable situations involving other com- 14 municable diseases. 15 (iv) An analysis of the proportionality 16 of punishments imposed under HIV-spe- 17 cific laws, policies, regulations, and judicial 18 precedents, taking into consideration pen- 19 alties attached to violation of State laws 20 against similar degrees of endangerment or 21 harm, such as driving while intoxicated or 22 transmission of other communicable dis- 23 eases, or more serious harms, such as ve- 24 hicular manslaughter offenses. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 623 •S 3660 IS (B) An analysis of common elements 1 shared among State laws, policies, regulations, 2 and judicial precedents. 3 (C) A set of best practice recommendations 4 directed to State governments, including State 5 attorneys general, public health officials, and 6 judicial officers, in order to ensure that laws, 7 policies, regulations, and judicial precedents re- 8 garding people living with HIV/AIDS are in ac- 9 cordance with the principles set forth in sub- 10 section (b). 11 (D) Recommendations for adjustments to 12 the Uniform Code of Military Justice, as may 13 be necessary, in order to ensure that laws, poli- 14 cies, regulations, and judicial precedents re- 15 garding people living with HIV/AIDS are in ac- 16 cordance with the principles set forth in sub- 17 section (b). 18 (3) GUIDANCE.—Within 90 days of the release 19 of the report required by paragraph (2), the Attor- 20 ney General and the Secretary of Health and 21 Human Services, acting jointly, shall develop and 22 publicly release updated guidance for States based 23 on the set of best practice recommendations required 24 by paragraph (2)(C) in order to assist States dealing 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 624 •S 3660 IS with criminal and related civil commitment cases re- 1 garding people living with HIV/AIDS. 2 (4) MONITORING AND EVALUATION SYSTEM.— 3 Within 60 days of the release of the guidance re- 4 quired by paragraph (3), the Attorney General and 5 the Secretary of Health and Human Services, acting 6 jointly, shall establish an integrated monitoring and 7 evaluation system which includes, where appropriate, 8 objective and quantifiable performance goals and in- 9 dicators to measure progress toward statewide im- 10 plementation in each State of the best practice rec- 11 ommendations required in paragraph (2)(C), includ- 12 ing to monitor, track, and evaluate the effectiveness 13 of assistance provided pursuant to subsection (d). 14 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 15 CIES, OR REGULATIONS.—Within 90 days of the re- 16 lease of the report required by paragraph (2), the 17 Attorney General, the Secretary of Health and 18 Human Services, and the Secretary of Defense, act- 19 ing jointly, shall develop and transmit to the Presi- 20 dent and the Congress, and make publicly available, 21 such proposals as may be necessary to implement 22 adjustments to Federal laws, policies, or regulations, 23 including to the Uniform Code of Military Justice, 24 based on the recommendations required by para- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 625 •S 3660 IS graph (2)(D), either through Executive order or 1 through changes to statutory law. 2 (6) AUTHORIZATION OF APPROPRIATIONS.— 3 (A) IN GENERAL.—There are authorized to 4 be appropriated such sums as may be necessary 5 for the purpose of carrying out this subsection. 6 Amounts authorized to be appropriated by the 7 preceding sentence are in addition to amounts 8 otherwise authorized to be appropriated for 9 such purpose. 10 (B) AVAILABILITY OF FUNDS.—Amounts 11 appropriated pursuant to the authorization of 12 appropriations in subparagraph (A) are author- 13 ized to remain available until expended. 14 (d) AUTHORIZATION TO PROVIDE GRANTS.— 15 (1) GRANTS BY ATTORNEY GENERAL.— 16 (A) IN GENERAL.—The Attorney General 17 may provide assistance to eligible State and 18 local entities and eligible nongovernmental orga- 19 nizations for the purpose of incorporating the 20 best practice recommendations developed under 21 subsection (c)(2)(C) within relevant State laws, 22 policies, regulations, and judicial decisions re- 23 garding people living with HIV/AIDS. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 626 •S 3660 IS (B) AUTHORIZED ACTIVITIES.—The assist- 1 ance authorized by subparagraph (A) may in- 2 clude— 3 (i) direct technical assistance to eligi- 4 ble State and local entities in order to de- 5 velop, disseminate, or implement State 6 laws, policies, regulations, or judicial deci- 7 sions that conform with the best practice 8 recommendations developed under sub- 9 section (c)(2)(C); 10 (ii) direct technical assistance to eligi- 11 ble nongovernmental organizations in order 12 to provide education and training, includ- 13 ing through classes, conferences, meetings, 14 and other educational activities, to eligible 15 State and local entities; and 16 (iii) subcontracting authority to allow 17 eligible State and local entities and eligible 18 nongovernmental organizations to seek 19 technical assistance from legal and public 20 health experts with a demonstrated under- 21 standing of the principles underlying the 22 best practice recommendations developed 23 under subsection (c)(2)(C). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 627 •S 3660 IS (2) GRANTS BY SECRETARY OF HEALTH AND 1 HUMAN SERVICES.— 2 (A) IN GENERAL.—The Secretary of 3 Health and Human Services, acting through the 4 Director of the Centers for Disease Control and 5 Prevention, may provide assistance to State and 6 local public health departments and eligible 7 nongovernmental organizations for the purpose 8 of supporting eligible State and local entities to 9 incorporate the best practice recommendations 10 developed under subsection (c)(2)(C) within rel- 11 evant State laws, policies, regulations, and judi- 12 cial decisions regarding people living with HIV/ 13 AIDS. 14 (B) AUTHORIZED ACTIVITIES.—The assist- 15 ance authorized by subparagraph (A) may in- 16 clude— 17 (i) direct technical assistance to State 18 and local public health departments in 19 order to support the development, dissemi- 20 nation, or implementation of State laws, 21 policies, regulations, or judicial decisions 22 that conform with the set of best practice 23 recommendations developed under sub- 24 section (c)(2)(C); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 628 •S 3660 IS (ii) direct technical assistance to eligi- 1 ble nongovernmental organizations in order 2 to provide education and training, includ- 3 ing through classes, conferences, meetings, 4 and other educational activities, to State 5 and local public health departments; and 6 (iii) subcontracting authority to allow 7 State and local public health departments 8 and eligible nongovernmental organizations 9 to seek technical assistance from legal and 10 public health experts with a demonstrated 11 understanding of the principles underlying 12 the best practice recommendations devel- 13 oped under subsection (c)(2)(C). 14 (3) LIMITATION.—As a condition of receiving 15 assistance through this subsection, eligible State and 16 local entities, State and local public health depart- 17 ments, and eligible nongovernmental organizations 18 shall agree— 19 (A) not to place any unique or additional 20 burdens on people living with HIV/AIDS solely 21 as a result of their HIV status; and 22 (B) that if the entity, department, or orga- 23 nization promulgates any laws, policies, regula- 24 tions, or judicial decisions regarding people liv- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 629 •S 3660 IS ing with HIV/AIDS, such actions shall dem- 1 onstrate a public health-oriented, evidence- 2 based, medically accurate, and contemporary 3 understanding of— 4 (i) the multiple factors that lead to 5 HIV transmission; 6 (ii) the relative risk of HIV trans- 7 mission routes; 8 (iii) the current health implications of 9 living with HIV; 10 (iv) the associated benefits of treat- 11 ment and support services for people living 12 with HIV; and 13 (v) the impact of punitive HIV-spe- 14 cific laws and policies on public health, on 15 people living with or affected by HIV, and 16 on their families and communities. 17 (4) REPORT.—No later than 1 year after the 18 date of the enactment of this Act, and annually 19 thereafter, the Attorney General and the Secretary 20 of Health and Human Services, acting jointly, shall 21 transmit to Congress and make publicly available a 22 report describing, for each State, the impact and ef- 23 fectiveness of the assistance provided through this 24 Act. Each such report shall include— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 630 •S 3660 IS (A) a detailed description of the progress 1 each State has made, if any, in implementing 2 the best practice recommendations developed 3 under subsection (c)(2)(C) as a result of the as- 4 sistance provided under this subsection, and 5 based on the performance goals and indicators 6 established as part of the monitoring and eval- 7 uation system in subsection (c)(4); 8 (B) a brief summary of any outreach ef- 9 forts undertaken during the prior year by the 10 Attorney General and the Secretary of Health 11 and Human Services to encourage States to 12 seek assistance under this subsection in order 13 to implement the best practice recommenda- 14 tions developed under subsection (c)(2)(C); 15 (C) a summary of how assistance provided 16 through this subsection is being utilized by eli- 17 gible State and local entities, State and local 18 public health departments, and eligible non- 19 governmental organizations and, if applicable, 20 any contractors, including with respect to non- 21 governmental organizations, the type of tech- 22 nical assistance provided, and an evaluation of 23 the impact of such assistance on eligible State 24 and local entities; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 631 •S 3660 IS (D) a summary and description of eligible 1 State and local entities, State and local public 2 health departments, and eligible nongovern- 3 mental organizations receiving assistance 4 through this subsection, including if applicable, 5 a summary and description of any contractors 6 selected to assist in implementing such assist- 7 ance. 8 (5) DEFINITIONS.—For the purposes of this 9 subsection: 10 (A) ELIGIBLE STATE AND LOCAL ENTI- 11 TIES.—The term ‘‘eligible State and local enti- 12 ties’’ means the relevant individuals, offices, or 13 organizations that directly participate in the de- 14 velopment, dissemination, or implementation of 15 State laws, policies, regulations, or judicial deci- 16 sions, including— 17 (i) State governments, including State 18 attorneys general, State departments of 19 justice, and State National Guards, or 20 their equivalents; 21 (ii) State judicial and court systems, 22 including trial courts, appellate courts, 23 State supreme courts and courts of appeal, 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 632 •S 3660 IS and State correctional facilities, or their 1 equivalents; and 2 (iii) local governments, including city 3 and county governments, district attorneys, 4 and local law enforcement departments, or 5 their equivalents. 6 (B) STATE AND LOCAL PUBLIC HEALTH 7 DEPARTMENTS.—The term ‘‘State and local 8 public health departments’’ means the fol- 9 lowing: 10 (i) State public health departments, or 11 their equivalents, including the chief officer 12 of such departments and infectious disease 13 and communicable disease specialists with- 14 in such departments. 15 (ii) Local public health departments, 16 or their equivalents, including city and 17 county public health departments, the chief 18 officer of such departments, and infectious 19 disease and communicable disease special- 20 ists within such departments. 21 (iii) Public health departments or offi- 22 cials, or their equivalents, within State or 23 local correctional facilities. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 633 •S 3660 IS (iv) Public health departments or offi- 1 cials, or their equivalents, within State Na- 2 tional Guards. 3 (v) Any other recognized State or 4 local public health organization or entity 5 charged with carrying out official State or 6 local public health duties. 7 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 8 NIZATIONS.—The term ‘‘eligible nongovern- 9 mental organizations’’ means the following: 10 (i) Nongovernmental organizations, 11 including trade organizations or associa- 12 tions that represent— 13 (I) State attorneys general, or 14 their equivalents; 15 (II) State public health officials, 16 or their equivalents; 17 (III) State judicial and court offi- 18 cers, including judges, district attor- 19 neys, prosecutors, defense attorneys, 20 law enforcement, and correctional offi- 21 cers; 22 (IV) State National Guards; 23 (V) people living with HIV/AIDS; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 634 •S 3660 IS (VI) legal advocacy and HIV/ 1 AIDS service organizations that work 2 with people living with HIV/AIDS; 3 and 4 (VII) nongovernmental health or- 5 ganizations that work on behalf of 6 people living with HIV/AIDS. 7 (ii) Nongovernmental organizations, 8 including trade organizations or associa- 9 tions that demonstrate a public-health ori- 10 ented, evidence-based, medically accurate, 11 and contemporary understanding of— 12 (I) the multiple factors that lead 13 to HIV transmission; 14 (II) the relative risk of HIV 15 transmission routes; 16 (III) the current health implica- 17 tions of living with HIV; 18 (IV) the associated benefits of 19 treatment and support services for 20 people living with HIV; and 21 (V) the impact of punitive HIV- 22 specific laws and policies on public 23 health, on people living with or af- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 635 •S 3660 IS fected by HIV, and on their families 1 and communities. 2 (6) AUTHORIZATION OF APPROPRIATIONS.— 3 (A) IN GENERAL.—In addition to amounts 4 otherwise made available, there are authorized 5 to be appropriated to the Attorney General and 6 the Secretary of Health and Human Services 7 such sums as may be necessary to carry out 8 this subsection for each of the fiscal years 2019 9 through 2023. 10 (B) AVAILABILITY OF FUNDS.—Amounts 11 appropriated pursuant to the authorizations of 12 appropriations in subparagraph (A) are author- 13 ized to remain available until expended. 14 SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 15 ONS. 16 (a) DEFINITIONS.—For the purposes of this section: 17 (1) COMMUNITY ORGANIZATION.—The term 18 ‘‘community organization’’ means a public health 19 care facility or a nonprofit organization which pro- 20 vides health- or STI-related services according to es- 21 tablished public health standards. 22 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 23 The term ‘‘comprehensive sexuality education’’ 24 means sexuality education— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 636 •S 3660 IS (A) that includes information about absti- 1 nence and about the proper use and disposal of 2 sexual barrier protection devices; and 3 (B) which is— 4 (i) evidence-based; 5 (ii) medically accurate; 6 (iii) age and developmentally appro- 7 priate; 8 (iv) gender and identity sensitive; 9 (v) culturally and linguistically appro- 10 priate; and 11 (vi) structured to promote critical 12 thinking, self-esteem, respect for others, 13 and the development of healthy attitudes 14 and relationships. 15 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 16 rectional facility’’ means any prison, penitentiary, 17 adult detention facility, juvenile detention facility, 18 jail, or other facility to which persons may be sent 19 after conviction of a crime or act of juvenile delin- 20 quency within the United States. 21 (4) INCARCERATED PERSON.—The term ‘‘incar- 22 cerated person’’ means any person who is serving a 23 sentence in a correctional facility after conviction of 24 a crime. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 637 •S 3660 IS (5) SEXUALLY TRANSMITTED INFECTION.—The 1 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 2 means any disease or infection that is commonly 3 transmitted through sexual activity, including HIV/ 4 AIDS, gonorrhea, chlamydia, syphilis, genital her- 5 pes, viral hepatitis, and human papillomavirus. 6 (6) SEXUAL BARRIER PROTECTION DEVICE.— 7 The term ‘‘sexual barrier protection device’’ means 8 any FDA-approved physical device which has not 9 been tampered with and which reduces the prob- 10 ability of STI transmission or infection between sex- 11 ual partners, including female condoms, male 12 condoms, and dental dams. 13 (7) STATE.—The term ‘‘State’’ includes the 14 District of Columbia, American Samoa, the Com- 15 monwealth of the Northern Mariana Islands, Guam, 16 Puerto Rico, and the United States Virgin Islands. 17 (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 18 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 19 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 20 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 21 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 22 later than 30 days after the date of enactment of 23 this Act, the Attorney General shall direct the Direc- 24 tor of the Bureau of Prisons to allow community or- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 638 •S 3660 IS ganizations to, in accordance with all relevant Fed- 1 eral laws and regulations which govern visitation in 2 correctional facilities— 3 (A) distribute sexual barrier protection de- 4 vices in Federal correctional facilities; and 5 (B) engage in STI counseling and STI pre- 6 vention education in Federal correctional facili- 7 ties. 8 (2) INFORMATION REQUIREMENT.—Any com- 9 munity organization permitted to distribute sexual 10 barrier protection devices under paragraph (1) shall 11 ensure that the persons to whom the devices are dis- 12 tributed are informed about the proper use and dis- 13 posal of sexual barrier protection devices in accord- 14 ance with established public health practices. Any 15 community organization conducting STI counseling 16 or STI prevention education under paragraph (1) 17 shall offer comprehensive sexuality education. 18 (3) POSSESSION OF DEVICE PROTECTED.—A 19 Federal correctional facility may not, because of the 20 possession or use of a sexual barrier protection de- 21 vice— 22 (A) take adverse action against an incar- 23 cerated person; or 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 639 •S 3660 IS (B) consider possession or use as evidence 1 of prohibited activity for the purpose of any 2 Federal correctional facility administrative pro- 3 ceeding. 4 (4) IMPLEMENTATION.—The Attorney General 5 and Bureau of Prisons shall implement this section 6 according to established public health practices in a 7 manner that protects the health, safety, and privacy 8 of incarcerated persons and of correctional facility 9 staff. 10 (c) SENSE OF CONGRESS REGARDING DISTRIBUTION 11 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 12 PRISON SYSTEMS.—It is the sense of the Congress that 13 States should allow for the legal distribution of sexual bar- 14 rier protection devices in State correctional facilities to re- 15 duce the prevalence and spread of STIs in those facilities. 16 (d) SURVEY OF AND REPORT ON CORRECTIONAL FA- 17 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 18 STIS.— 19 (1) SURVEY.—Not later than 180 days after 20 the date of enactment of this Act, and annually 21 thereafter for 5 years, the Attorney General, after 22 consulting with the Secretary of Health and Human 23 Services, State officials, and community organiza- 24 tions, shall, to the maximum extent practicable, con- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 640 •S 3660 IS duct a survey of all Federal and State correctional 1 facilities, to determine the following: 2 (A) COUNSELING, TREATMENT, AND SUP- 3 PORTIVE SERVICES.—Whether the correctional 4 facility— 5 (i) requires incarcerated persons to 6 participate in counseling, treatment, and 7 supportive services related to STIs or 8 (ii) offers such programs to incarcer- 9 ated persons. 10 (B) ACCESS TO SEXUAL BARRIER PROTEC- 11 TION DEVICES.—Whether incarcerated persons 12 can— 13 (i) possess sexual barrier protection 14 devices; 15 (ii) purchase sexual barrier protection 16 devices; 17 (iii) purchase sexual barrier protection 18 devices at a reduced cost; or 19 (iv) obtain sexual barrier protection 20 devices without cost. 21 (C) INCIDENCE OF SEXUAL VIOLENCE.— 22 The incidence of sexual violence and assault 23 committed by incarcerated persons and by cor- 24 rectional facility staff. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 641 •S 3660 IS (D) PREVENTION EDUCATION OFFERED.— 1 The type of prevention education, information, 2 or training offered to incarcerated persons and 3 correctional facility staff regarding sexual vio- 4 lence and the spread of STIs, including whether 5 such education, information, or training— 6 (i) constitutes comprehensive sexuality 7 education; 8 (ii) is compulsory for new incarcerated 9 persons and for new staff; and 10 (iii) is offered on an ongoing basis. 11 (E) STI TESTING.—Whether the correc- 12 tional facility tests incarcerated persons for 13 STIs or gives them the option to undergo such 14 testing— 15 (i) at intake; 16 (ii) on a regular basis; and 17 (iii) prior to release. 18 (F) STI TEST RESULTS.—The number of 19 incarcerated persons who are tested for STIs 20 and the outcome of such tests at each correc- 21 tional facility, disaggregated to include results 22 for— 23 (i) the type of sexually transmitted in- 24 fection tested for; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 642 •S 3660 IS (ii) the race and ethnicity of individ- 1 uals tested; 2 (iii) the age of individuals tested; and 3 (iv) the gender of individuals tested. 4 (G) PRERELEASE 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) PRERELEASE 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 subparagraph (G) to entities 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 643 •S 3660 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 HIV, that 4 have been reinstated; 5 (ii) a list of obstacles to reinstating 6 enrollment or to making determinations of 7 eligibility for reinstatement, if any; and 8 (iii) the number of individuals denied 9 enrollment. 10 (J) OTHER ACTIONS TAKEN.—Whether the 11 correctional facility has taken any other action, 12 in conjunction with community organizations or 13 otherwise, to reduce the prevalence and spread 14 of STIs in that facility. 15 (2) PRIVACY.—In conducting the survey under 16 paragraph (1), the Attorney General shall not re- 17 quest or retain the identity of any person who has 18 sought or been offered counseling, treatment, test- 19 ing, or prevention education information regarding 20 an STI (including information about sexual barrier 21 protection devices), or who has tested positive for an 22 STI. 23 (3) REPORT.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 644 •S 3660 IS (A) IN GENERAL.—The Attorney General 1 shall transmit to Congress and make publicly 2 available the results of the survey required 3 under paragraph (1), both for the United 4 States as a whole and disaggregated as to each 5 State and each correctional facility. 6 (B) DEADLINES.—To the maximum extent 7 possible, the Attorney General shall— 8 (i) issue the first report under sub- 9 paragraph (A) not later than 1 year after 10 the date of enactment of this Act; and 11 (ii) issue reports under subparagraph 12 (A) annually thereafter for 5 years. 13 (e) STRATEGY.— 14 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 15 Attorney General, in consultation with the Secretary 16 of Health and Human Services, State officials, and 17 community organizations, shall develop and imple- 18 ment a 5-year strategy to reduce the prevalence and 19 spread of STIs in Federal and State correctional fa- 20 cilities. To the maximum extent possible, the strat- 21 egy shall be developed, transmitted to Congress, and 22 made publicly available no later than 180 days after 23 the transmission of the first report required under 24 subsection (d)(3). 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 645 •S 3660 IS (2) CONTENTS OF STRATEGY.—The strategy 1 developed under paragraph (1) shall include the fol- 2 lowing: 3 (A) PREVENTION EDUCATION.—A plan for 4 improving prevention education, information, 5 and training offered to incarcerated persons 6 and correctional facility staff, including infor- 7 mation and training on sexual violence and the 8 spread of STIs, and comprehensive sexuality 9 education. 10 (B) SEXUAL BARRIER PROTECTION DEVICE 11 ACCESS.—A plan for expanding access to sexual 12 barrier protection devices in correctional facili- 13 ties. 14 (C) SEXUAL VIOLENCE REDUCTION.—A 15 plan for reducing the incidence of sexual vio- 16 lence among incarcerated persons and correc- 17 tional facility staff, developed in consultation 18 with the National Prison Rape Elimination 19 Commission. 20 (D) COUNSELING AND SUPPORTIVE SERV- 21 ICES.—A plan for expanding access to coun- 22 seling and supportive services related to STIs in 23 correctional facilities. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 646 •S 3660 IS (E) TESTING.—A plan for testing incarcer- 1 ated persons for STIs during intake, during 2 regular health exams, and prior to release, and 3 that— 4 (i) is conducted in accordance with 5 guidelines established by the Centers for 6 Disease Control and Prevention; 7 (ii) includes pretest counseling; 8 (iii) requires that incarcerated persons 9 are notified of their option to decline test- 10 ing at any time; 11 (iv) requires that incarcerated persons 12 are confidentially notified of their test re- 13 sults in a timely manner; and 14 (v) ensures that incarcerated persons 15 testing positive for STIs receive post-test 16 counseling, care, treatment, and supportive 17 services. 18 (F) TREATMENT.—A plan for ensuring 19 that correctional facilities have the necessary 20 medicine and equipment to treat and monitor 21 STIs and for ensuring that incarcerated per- 22 sons living with or testing positive for STIs re- 23 ceive and have access to care and treatment 24 services. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 647 •S 3660 IS (G) STRATEGIES FOR DEMOGRAPHIC 1 GROUPS.—A plan for developing and imple- 2 menting culturally appropriate, sensitive, and 3 specific strategies to reduce the spread of STIs 4 among demographic groups heavily impacted by 5 STIs. 6 (H) LINKAGES WITH COMMUNITIES AND 7 FACILITIES.—A plan for establishing and 8 strengthening linkages to local communities and 9 health facilities that— 10 (i) provide counseling, testing, care, 11 and treatment services; 12 (ii) may receive persons recently re- 13 leased from incarceration who are living 14 with STIs; and 15 (iii) accept payment through the State 16 Medicaid program. 17 (I) ENROLLMENT IN STATE MEDICAID 18 PROGRAMS.—Plans to ensure that— 19 (i) incarcerated persons who were en- 20 rolled in their State Medicaid program 21 prior to incarceration in a correctional fa- 22 cility are automatically reenrolled in such 23 program upon their release; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 648 •S 3660 IS (ii) incarcerated persons who were not 1 enrolled in their State Medicaid program 2 prior to incarceration, and who are diag- 3 nosed with HIV while incarcerated in a 4 correctional facility, are automatically en- 5 rolled in such program upon their release. 6 (J) OTHER PLANS.—Any other plans de- 7 veloped by the Attorney General for reducing 8 the spread of STIs or improving the quality of 9 health care in correctional facilities. 10 (K) MONITORING SYSTEM.—A monitoring 11 system that establishes performance goals re- 12 lated to reducing the prevalence and spread of 13 STIs in correctional facilities and which, where 14 feasible, expresses such goals in quantifiable 15 form. 16 (L) MONITORING SYSTEM PERFORMANCE 17 INDICATORS.—Performance indicators that 18 measure or assess the achievement of the per- 19 formance goals described in subparagraph (K). 20 (M) COST ESTIMATE.—A detailed estimate 21 of the funding necessary to implement the 22 strategy at the Federal and State levels for all 23 5 years, including the amount of funds required 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 649 •S 3660 IS by community organizations to implement the 1 parts of the strategy in which they take part. 2 (3) REPORT.—The Attorney General shall 3 transmit to Congress and make publicly available an 4 annual progress report regarding the implementation 5 and effectiveness of the strategy described in para- 6 graph (1). The progress report shall include an eval- 7 uation of the implementation of the strategy using 8 the monitoring system and performance indicators 9 provided for in subparagraphs (K) and (L) of para- 10 graph (2). 11 (f) AUTHORIZATION OF APPROPRIATIONS.— 12 (1) IN GENERAL.—There are authorized to be 13 appropriated such sums as may be necessary to 14 carry out this section for each of fiscal years 2019 15 through 2023. 16 (2) AVAILABILITY OF FUNDS.—Amounts made 17 available under paragraph (1) are authorized to re- 18 main available until expended. 19 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 650 •S 3660 IS SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 1 IN MEDICAID FOR PEOPLE WHO TEST POSI- 2 TIVE FOR HIV BEFORE REENTERING COMMU- 3 NITIES. 4 (a) IN GENERAL.—Section 1902(e) of the Social Se- 5 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 6 the end the following: 7 ‘‘(16) ENROLLMENT OF EX-OFFENDERS.— 8 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 9 STATEMENT.— 10 ‘‘(i) IN GENERAL.—The State plan 11 shall provide for the automatic enrollment 12 or reinstatement of enrollment of an eligi- 13 ble individual— 14 ‘‘(I) if such individual is sched- 15 uled to be released from a public insti- 16 tution due to the completion of sen- 17 tence, not less than 30 days prior to 18 the scheduled date of the release; and 19 ‘‘(II) if such individual is to be 20 released from a public institution on 21 parole or on probation, as soon as 22 possible after the date on which the 23 determination to release such indi- 24 vidual was made, and before the date 25 such individual is released. 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 651 •S 3660 IS ‘‘(ii) EXCEPTION.—If a State makes a 1 determination that an individual is not eli- 2 gible to be enrolled under the State plan— 3 ‘‘(I) on or before the date by 4 which the individual would be enrolled 5 under clause (i), such clause shall not 6 apply to such individual; or 7 ‘‘(II) after such date, the State 8 may terminate the enrollment of such 9 individual. 10 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 11 PAYMENT FOR SERVICES.— 12 ‘‘(i) IN GENERAL.—Subject to sub- 13 paragraph (A)(ii), an eligible individual 14 who is enrolled, or whose enrollment is re- 15 instated, under subparagraph (A) shall be 16 eligible for all services for which medical 17 assistance is provided under the State plan 18 after the date that the eligible individual is 19 released from the public institution. 20 ‘‘(ii) RELATIONSHIP TO PAYMENT 21 PROHIBITION FOR INMATES.—No provision 22 of this paragraph may be construed to per- 23 mit payment for care or services for which 24 payment is excluded under subdivision (A) 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 652 •S 3660 IS following paragraph (29) of section 1 1905(a). 2 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 3 BILITY.— 4 ‘‘(i) SUSPENSION FOR INMATES.—Any 5 period of continuous eligibility under this 6 title shall be suspended on the date an in- 7 dividual enrolled under this title becomes 8 an inmate of a public institution (except as 9 a patient of a medical institution). 10 ‘‘(ii) DETERMINATION OF REMAINING 11 PERIOD.—Notwithstanding any changes to 12 State law related to continuous eligibility 13 during the time that an individual is an in- 14 mate of a public institution (except as a 15 patient of a medical institution), subject to 16 clause (iii), with respect to an eligible indi- 17 vidual who was subject to a suspension 18 under clause (i), on the date that such in- 19 dividual is released from a public institu- 20 tion the suspension of continuous eligibility 21 under such clause shall be lifted for a pe- 22 riod that is equal to the time remaining in 23 the period of continuous eligibility for such 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 653 •S 3660 IS individual on the date that such period was 1 suspended under such clause. 2 ‘‘(iii) EXCEPTION.—If a State makes 3 a determination that an individual is not 4 eligible to be enrolled under the State 5 plan— 6 ‘‘(I) on or before the date that 7 the suspension of continuous eligibility 8 is lifted under clause (ii), such clause 9 shall not apply to such individual; or 10 ‘‘(II) after such date, the State 11 may terminate the enrollment of such 12 individual. 13 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 14 STATEMENT OF ENROLLMENT DEFINED.—For 15 purposes of this paragraph, the term ‘automatic 16 enrollment or reinstatement of enrollment’ 17 means that the State determines eligibility for 18 medical assistance under the State plan without 19 a program application from, or on behalf of, the 20 eligible individual, but an individual can only be 21 automatically enrolled in the State Medicaid 22 plan if the individual affirmatively consents to 23 being enrolled through affirmation in writing, 24 by telephone, orally, through electronic signa- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 654 •S 3660 IS ture, or through any other means specified by 1 the Secretary. 2 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 3 For purposes of this paragraph, the term ‘eligi- 4 ble individual’ means an individual who is an 5 inmate of a public institution (except as a pa- 6 tient in a medical institution)— 7 ‘‘(i) who was enrolled under the State 8 plan for medical assistance immediately be- 9 fore becoming an inmate of such an insti- 10 tution; or 11 ‘‘(ii) who is diagnosed with human im- 12 munodeficiency virus.’’. 13 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 14 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 15 ICAID BENEFITS.— 16 (1) IN GENERAL.—Subject to paragraphs (3), 17 with respect to a State, for each of the first 4 cal- 18 endar quarters in which the State plan meets the re- 19 quirements of paragraph (16) of section 1902(e) of 20 the Social Security Act (42 U.S.C. 1396a(e)) (as 21 added by subsection (a)), the Federal matching pay- 22 ments (including payments based on the Federal 23 medical assistance percentage) made to such State 24 under section 1903 of the Social Security Act (42 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 655 •S 3660 IS U.S.C. 1396b) for the State expenditures described 1 in paragraph (2) shall be increased by 5 percentage 2 points. 3 (2) EXPENDITURES.—The expenditures de- 4 scribed in this paragraph are the following: 5 (A) Expenditures for which payment is 6 available under section 1903 of the Social Secu- 7 rity Act (42 U.S.C. 1396b) and which are at- 8 tributable to strengthening the State’s enroll- 9 ment and administrative resources for the pur- 10 pose of improving processes for enrolling (or re- 11 instating the enrollment of) eligible individuals 12 (as such term is defined in subparagraph (E) of 13 paragraph (16) of section 1902(e) of the Social 14 Security Act (42 U.S.C. 1396a(e)) (as amended 15 by subsection (a)). 16 (B) Expenditures for medical assistance 17 (as such term is defined in section 1905(a) of 18 the Social Security Act (42 U.S.C. 1396d(a))) 19 provided to such eligible individuals. 20 (3) REQUIREMENTS; LIMITATION.— 21 (A) REPORT.—A State is not eligible for 22 an increase in its Federal matching payments 23 under paragraph (1) unless the State agrees to 24 submit to the Secretary of Health and Human 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 656 •S 3660 IS Services, and make publicly available, a report 1 that contains the information required under 2 paragraph (4) by the end of the 1-year period 3 during which the State receives increased Fed- 4 eral matching payments in accordance with that 5 paragraph. 6 (B) MAINTENANCE OF ELIGIBILITY.— 7 (i) IN GENERAL.—Subject to clause 8 (ii), a State is not eligible for an increase 9 in its Federal matching payments under 10 paragraph (1) if eligibility standards, 11 methodologies, or procedures under its 12 State plan under title XIX of the Social 13 Security Act (42 U.S.C. 1396 et seq.), or 14 waiver of such a plan, are more restrictive 15 than the eligibility standards, methodolo- 16 gies, or procedures, respectively, under 17 such plan or waiver as in effect on the date 18 of enactment of this Act. 19 (ii) STATE REINSTATEMENT OF ELIGI- 20 BILITY PERMITTED.—A State that has re- 21 stricted eligibility standards, methodolo- 22 gies, or procedures under its State plan 23 under title XIX of the Social Security Act 24 (42 U.S.C. 1396 et seq.), or a waiver of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 657 •S 3660 IS such plan, after the date of enactment of 1 this Act, is no longer ineligible under 2 clause (i) beginning with the first calendar 3 quarter in which the State has reinstated 4 eligibility standards, methodologies, or pro- 5 cedures that are no more restrictive than 6 the eligibility standards, methodologies, or 7 procedures, respectively, under such plan 8 (or waiver) as in effect on such date. 9 (C) LIMITATION OF MATCHING PAYMENTS 10 TO 100 PERCENT.—In no case shall an increase 11 in Federal matching payments under paragraph 12 (1) result in Federal matching payments that 13 exceed 100 percent of State expenditures. 14 (4) REQUIRED REPORT INFORMATION.—The in- 15 formation that is required in the report under para- 16 graph (3)(A) shall include— 17 (A) the results of an evaluation of the im- 18 pact of the implementation of the requirements 19 of paragraph (16) of section 1902(e) of the So- 20 cial Security Act (42 U.S.C. 1396a(e)) on im- 21 proving the State’s processes for enrolling indi- 22 viduals who are released from public institu- 23 tions under the State Medicaid plan; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 658 •S 3660 IS (B) the number of individuals who were 1 automatically enrolled (or whose enrollment was 2 reinstated) under such paragraph during the 1- 3 year period during which the State received in- 4 creased payments under this subsection; and 5 (C) any other information that is required 6 by the Secretary of Health and Human Serv- 7 ices. 8 (c) EFFECTIVE DATE.— 9 (1) IN GENERAL.—Except as provided in para- 10 graph (2), the amendments made by subsection (a) 11 shall take effect 180 days after the date of the en- 12 actment of this Act. 13 (2) RULE FOR CHANGES REQUIRING STATE 14 LEGISLATION.—In the case of a State plan for med- 15 ical assistance under title XIX of the Social Security 16 Act (42 U.S.C. 1396 et seq.) which the Secretary of 17 Health and Human Services determines requires 18 State legislation (other than legislation appro- 19 priating funds) in order for the plan to meet the ad- 20 ditional requirement imposed by the amendments 21 made by subsection (a), the State plan shall not be 22 regarded as failing to comply with the requirements 23 of such title solely on the basis of its failure to meet 24 this additional requirement before the first day of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 659 •S 3660 IS the first calendar quarter beginning after the close 1 of the first regular session of the State legislature 2 that begins after the date of the enactment of this 3 Act. For purposes of the previous sentence, in the 4 case of a State that has a 2-year legislative session, 5 each year of such session shall be deemed to be a 6 separate regular session of the State legislature. 7 SEC. 758. STOP AIDS IN PRISON. 8 (a) SHORT TITLE.—This section may be cited as the 9 ‘‘Stop AIDS in Prison Act’’. 10 (b) IN GENERAL.—The Director of the Bureau of 11 Prisons (referred to in this section as the ‘‘Director’’) shall 12 develop a comprehensive policy to provide HIV testing, 13 treatment, and prevention for inmates within the correc- 14 tional setting and upon reentry. 15 (c) PURPOSE.—The purposes of the policy required 16 to be developed under subsection (b) shall be as follows: 17 (1) To stop the spread of HIV/AIDS among in- 18 mates. 19 (2) To protect prison guards and other per- 20 sonnel from HIV/AIDS infection. 21 (3) To provide comprehensive medical treat- 22 ment to inmates who are living with HIV/AIDS. 23 (4) To promote HIV/AIDS awareness and pre- 24 vention among inmates. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 660 •S 3660 IS (5) To encourage inmates to take personal re- 1 sponsibility for their health. 2 (6) To reduce the risk that inmates will trans- 3 mit HIV/AIDS to other persons in the community 4 following their release from prison. 5 (d) CONSULTATION.—The Director shall consult with 6 appropriate officials of the Department of Health and 7 Human Services, the Office of National Drug Control Pol- 8 icy, the Office of National AIDS Policy, and the Centers 9 for Disease Control and Prevention regarding the develop- 10 ment of the policy required under subsection (b). 11 (e) TIME LIMIT.—Not later than 1 year after the 12 date of enactment of this Act, the Director shall draft ap- 13 propriate regulations to implement the policy required to 14 be developed under subsection (b). 15 (f) REQUIREMENTS FOR POLICY.—The policy re- 16 quired to be developed under subsection (b) shall provide 17 for the following: 18 (1) TESTING AND COUNSELING UPON IN- 19 TAKE.— 20 (A) Health care personnel shall provide 21 routine HIV testing to all inmates as a part of 22 a comprehensive medical examination imme- 23 diately following admission to a facility. Health 24 care personnel need not provide routine HIV 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 661 •S 3660 IS testing to an inmate who is transferred to a fa- 1 cility from another facility if the inmate’s med- 2 ical records are transferred with the inmate and 3 indicate that the inmate has been tested pre- 4 viously. 5 (B) To all inmates admitted to a facility 6 prior to the effective date of this policy, health 7 care personnel shall provide routine HIV testing 8 within no more than 6 months. HIV testing for 9 these inmates may be performed in conjunction 10 with other health services provided to these in- 11 mates by health care personnel. 12 (C) All HIV tests under this paragraph 13 shall comply with the opt-out provision. 14 (2) PRE-TEST AND POST-TEST COUNSELING.— 15 Health care personnel shall provide confidential pre- 16 test and post-test counseling to all inmates who are 17 tested for HIV. Counseling may be included with 18 other general health counseling provided to inmates 19 by health care personnel. 20 (3) HIV/AIDS PREVENTION EDUCATION.— 21 (A) Health care personnel shall improve 22 HIV/AIDS awareness through frequent edu- 23 cational programs for all inmates. HIV/AIDS 24 educational programs may be provided by com- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 662 •S 3660 IS munity-based organizations, local health depart- 1 ments, and inmate peer educators. 2 (B) HIV/AIDS educational materials shall 3 be made available to all inmates at orientation, 4 at health care clinics, at regular educational 5 programs, and prior to release. Both written 6 and audiovisual materials shall be made avail- 7 able to all inmates. 8 (C)(i) The HIV/AIDS educational pro- 9 grams and materials under this paragraph shall 10 include information on— 11 (I) modes of transmission, including 12 transmission through tattooing, sexual con- 13 tact, and intravenous drug use; 14 (II) prevention methods; 15 (III) treatment; and 16 (IV) disease progression. 17 (ii) The programs and materials shall be 18 culturally sensitive, written or designed for low- 19 literacy levels, available in a variety of lan- 20 guages, and present scientifically accurate in- 21 formation in a clear and understandable man- 22 ner. 23 (4) HIV TESTING UPON REQUEST.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 663 •S 3660 IS (A) Health care personnel shall allow in- 1 mates to obtain HIV tests upon request once 2 per year or whenever an inmate has a reason to 3 believe the inmate may have been exposed to 4 HIV. Health care personnel shall, both orally 5 and in writing, inform inmates, during orienta- 6 tion and periodically throughout incarceration, 7 of their right to obtain HIV tests. 8 (B) Health care personnel shall encourage 9 inmates to request HIV tests if the inmate is 10 sexually active, has been raped, uses intra- 11 venous drugs, receives a tattoo, or if the inmate 12 is concerned that the inmate may have been ex- 13 posed to HIV/AIDS. 14 (C) An inmate’s request for an HIV test 15 shall not be considered an indication that the 16 inmate has put him/herself at risk of infection 17 and/or committed a violation of prison rules. 18 (5) HIV TESTING OF PREGNANT WOMAN.— 19 (A) Health care personnel shall provide 20 routine HIV testing to all inmates who become 21 pregnant. 22 (B) All HIV tests under this paragraph 23 shall comply with the opt-out provision. 24 (6) COMPREHENSIVE TREATMENT.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 664 •S 3660 IS (A) Health care personnel shall provide all 1 inmates who test positive for HIV— 2 (i) timely, comprehensive medical 3 treatment; 4 (ii) confidential counseling on man- 5 aging their medical condition and pre- 6 venting its transmission to other persons; 7 and 8 (iii) voluntary partner notification 9 services. 10 (B) Health care provided under this para- 11 graph shall be consistent with current Depart- 12 ment of Health and Human Services guidelines 13 and standard medical practice. Health care per- 14 sonnel shall discuss treatment options, the im- 15 portance of adherence to antiretroviral therapy, 16 and the side effects of medications with inmates 17 receiving treatment. 18 (C) Health care personnel and pharmacy 19 personnel shall ensure that the facility for- 20 mulary contains all Food and Drug Administra- 21 tion-approved medications necessary to provide 22 comprehensive treatment for inmates living with 23 HIV/AIDS, and that the facility maintains ade- 24 quate supplies of such medications to meet in- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 665 •S 3660 IS mates’ medical needs. Health care personnel 1 and pharmacy personnel shall also develop and 2 implement automatic renewal systems for these 3 medications to prevent interruptions in care. 4 (D) Correctional staff, health care per- 5 sonnel, and pharmacy personnel shall develop 6 and implement distribution procedures to en- 7 sure timely and confidential access to medica- 8 tions. 9 (7) PROTECTION OF CONFIDENTIALITY.— 10 (A) Health care personnel shall develop 11 and implement procedures to ensure the con- 12 fidentiality of inmate tests, diagnoses, and 13 treatment. Health care personnel and correc- 14 tional staff shall receive regular training on the 15 implementation of these procedures. Penalties 16 for violations of inmate confidentiality by health 17 care personnel or correctional staff shall be 18 specified and strictly enforced. 19 (B) HIV testing, counseling, and treat- 20 ment shall be provided in a confidential setting 21 where other routine health services are provided 22 and in a manner that allows the inmate to re- 23 quest and obtain these services as routine med- 24 ical services. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 666 •S 3660 IS (8) TESTING, COUNSELING, AND REFERRAL 1 PRIOR TO REENTRY.— 2 (A) Health care personnel shall provide 3 routine HIV testing to all inmates not earlier 4 than 3 months prior to their release and re- 5 entry into the community. Inmates who are al- 6 ready known to be infected need not be tested 7 again. This requirement may be waived if an in- 8 mate’s release occurs without sufficient notice 9 to the Bureau to allow health care personnel to 10 perform a routine HIV test and notify the in- 11 mate of the results. 12 (B) All HIV tests under this paragraph 13 shall comply with the opt-out provision. 14 (C) To all inmates who test positive for 15 HIV and all inmates who already are known to 16 have HIV/AIDS, health care personnel shall 17 provide— 18 (i) confidential prerelease counseling 19 on managing their medical condition in the 20 community, accessing appropriate treat- 21 ment and services in the community, and 22 preventing the transmission of their condi- 23 tion to family members and other persons 24 in the community; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 667 •S 3660 IS (ii) referrals to appropriate health 1 care providers and social service agencies 2 in the community that meet the inmate’s 3 individual needs, including voluntary part- 4 ner notification services and prevention 5 counseling services for people living with 6 HIV/AIDS; and 7 (iii) a 30-day supply of any medically 8 necessary medications the inmate is cur- 9 rently receiving. 10 (9) OPT-OUT PROVISION.—Inmates shall have 11 the right to refuse routine HIV testing. Inmates 12 shall be informed both orally and in writing of this 13 right. Oral and written disclosure of this right may 14 be included with other general health information 15 and counseling provided to inmates by health care 16 personnel. If an inmate refuses a routine test for 17 HIV, health care personnel shall make a note of the 18 inmate’s refusal in the inmate’s confidential medical 19 records. However, the inmate’s refusal shall not be 20 considered a violation of prison rules or result in dis- 21 ciplinary action. Any reference in this section to the 22 ‘‘opt-out provision’’ shall be deemed a reference to 23 the requirement of this paragraph. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 668 •S 3660 IS (10) EXCLUSION OF TESTS PERFORMED UNDER 1 SECTION 4014(b) FROM THE DEFINITION OF ROU- 2 TINE HIV TESTING.—HIV testing of an inmate 3 under section 4014(b) of title 18, United States 4 Code, is not routine HIV testing for the purposes of 5 the opt-out provision. Health care personnel shall 6 document the reason for testing under section 7 4014(b) of title 18, United States Code, in the in- 8 mate’s confidential medical records. 9 (11) TIMELY NOTIFICATION OF TEST RE- 10 SULTS.—Health care personnel shall provide timely 11 notification to inmates of the results of HIV tests. 12 (g) CHANGES IN EXISTING LAW.— 13 (1) SCREENING IN GENERAL.—Section 4014(a) 14 of title 18, United States Code, is amended— 15 (A) by striking ‘‘for a period of 6 months 16 or more’’; 17 (B) by striking ‘‘, as appropriate,’’; and 18 (C) by striking ‘‘if such individual is deter- 19 mined to be at risk for infection with such virus 20 in accordance with the guidelines issued by the 21 Bureau of Prisons relating to infectious disease 22 management’’ and inserting ‘‘unless the indi- 23 vidual declines. The Attorney General shall also 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 669 •S 3660 IS cause such individual to be so tested before re- 1 lease unless the individual declines.’’. 2 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 3 CIVIL AND CRIMINAL PROCEEDINGS.—Section 4 4014(d) of title 18, United States Code, is amended 5 by inserting ‘‘or under the Stop AIDS in Prison 6 Act’’ after ‘‘under this section’’. 7 (3) SCREENING AS PART OF ROUTINE SCREEN- 8 ING.—Section 4014(e) of title 18, United States 9 Code, is amended by adding at the end the fol- 10 lowing: ‘‘Such rules shall also provide that the initial 11 test under this section be performed as part of the 12 routine health screening conducted at intake.’’. 13 (h) REPORTING REQUIREMENTS.— 14 (1) REPORT ON HEPATITIS, LIVER, AND OTHER 15 DISEASES.—Not later than 1 year after the date of 16 enactment of this Act, the Director shall provide a 17 report to the Congress on the policies and proce- 18 dures of the Bureau of Prisons to provide testing, 19 treatment, and prevention education programs for 20 hepatitis, liver failure, and other liver-related dis- 21 eases transmitted through sexual activity, intra- 22 venous drug use, or other means. The Director shall 23 consult with appropriate officials of the Department 24 of Health and Human Services, the Office of Na- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 670 •S 3660 IS tional Drug Control Policy, the Office of National 1 AIDS Policy, and the Centers for Disease Control 2 and Prevention regarding the development of this re- 3 port. 4 (2) ANNUAL REPORTS.— 5 (A) GENERALLY.—Not later than 2 years 6 after the date of enactment of this Act, and 7 then annually thereafter, the Director shall re- 8 port to Congress on the incidence among in- 9 mates of diseases transmitted through sexual 10 activity and intravenous drug use. 11 (B) MATTERS PERTAINING TO VARIOUS 12 DISEASES.—Each report under paragraph (1) 13 shall discuss— 14 (i) the incidence among inmates of 15 HIV/AIDS, hepatitis, and other diseases 16 transmitted through sexual activity and in- 17 travenous drug use; and 18 (ii) updates on the testing, treatment, 19 and prevention education programs for 20 these diseases conducted by the Bureau of 21 Prisons. 22 (C) MATTERS PERTAINING TO HIV/AIDS 23 ONLY.—Each report under paragraph (1) shall 24 also include— 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 671 •S 3660 IS (i) the number of inmates who tested 1 positive for HIV upon intake; 2 (ii) the number of inmates who tested 3 positive prior to reentry; 4 (iii) the number of inmates who were 5 not tested prior to reentry because they 6 were released without sufficient notice; 7 (iv) the number of inmates who opted- 8 out of taking the test; 9 (v) the number of inmates who were 10 tested under section 4014(b) of title 18, 11 United States Code; and 12 (vi) the number of inmates under 13 treatment for HIV/AIDS. 14 (D) CONSULTATION.—The Director shall 15 consult with appropriate officials of the Depart- 16 ment of Health and Human Services, the Office 17 of National Drug Control Policy, the Office of 18 National AIDS Policy, and the Centers for Dis- 19 ease Control and Prevention regarding the de- 20 velopment of each report under paragraph (1). 21 SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICA- 22 TORS FOR MONITORING HIV CARE. 23 The Secretary of Health and Human Services, in col- 24 laboration with the Assistant Secretary for Health, the Di- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 672 •S 3660 IS rector of the Office of HIV/AIDS and Infectious Disease 1 Policy, the Director of the Centers for Disease Control and 2 Prevention, the Assistant Secretary for Mental Health and 3 Substance Use, the Director of the Department of Hous- 4 ing and Urban Development, the Director of the Office 5 of AIDS Research, the Administrator of the Health Re- 6 sources and Services Administration, and the Adminis- 7 trator of the Centers for Medicare & Medicaid Services, 8 shall expand and coordinate efforts to align metrics across 9 agencies and modify Federal data systems, to— 10 (1) adopt the National Academy of Medicine’s 11 clinical HIV care indicators as the core metrics for 12 monitoring the quality of HIV care, mental health, 13 substance abuse, and supportive services; 14 (2) better enable assessment of the impact of 15 the National HIV/AIDS Strategy and the Patient 16 Protection and Affordable Care Act (Public Law 17 111–148) on improving HIV/AIDS care and access 18 to supportive services for individuals with HIV; 19 (3) expand the demographic data elements to be 20 captured by Federal data systems relevant to HIV 21 care to permit calculation of the indicators for sub- 22 groups of the population of people with diagnosed 23 HIV infection, including— 24 (A) age; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 673 •S 3660 IS (B) race; 1 (C) ethnicity; 2 (D) sex (assigned at birth); 3 (E) gender identity; 4 (F) sexual orientation; 5 (G) current geographic marker of resi- 6 dence; 7 (H) income or poverty level; and 8 (I) primary means of reimbursement for 9 medical services (including a State Medicaid 10 program, the Medicare program, the Ryan 11 White HIV/AIDS Program, private insurance, 12 health maintenance organizations, and no cov- 13 erage); and 14 (4) streamline data collection and systematically 15 review all existing reporting requirements for feder- 16 ally funded HIV/AIDS programs to ensure that only 17 essential data are collected. 18 SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 19 NATIONAL HIV/AIDS STRATEGY. 20 Title II of the Public Health Service Act (42 U.S.C. 21 202 et seq.) is amended by inserting after section 241 the 22 following: 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 674 •S 3660 IS ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 1 OF NATIONAL HIV/AIDS STRATEGY. 2 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 3 tionary appropriations made available to the Department 4 of Health and Human Services for any fiscal year for pro- 5 grams and activities that, as determined by the Secretary, 6 pertain to HIV/AIDS, the Secretary, in coordination with 7 the Director of the Office of National HIV/AIDS Policy, 8 may transfer up to 1 percent of such appropriations to 9 the Office of the Assistant Secretary for Health for imple- 10 mentation of the National HIV/AIDS Strategy. 11 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 12 30 days before making any transfer under this section, 13 the Secretary shall give notice of the transfer to the Con- 14 gress. 15 ‘‘(c) DEFINITIONS.—In this section: 16 ‘‘(1) HIV/AIDS.—The term ‘HIV/AIDS’ has 17 the meaning given to such term in section 2689. 18 ‘‘(2) NATIONAL HIV/AIDS STRATEGY.—The 19 term ‘National HIV/AIDS Strategy’ means the Na- 20 tional HIV/AIDS Strategy for the United States 21 issued by the President in July 2010 and includes 22 any subsequent revisions to such Strategy.’’. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 675 •S 3660 IS SEC. 761. REPORT ON THE IMPLEMENTATION OF GOAL 4 1 (IMPROVED COORDINATION) OF THE NA- 2 TIONAL HIV/AIDS STRATEGY. 3 (a) REPORT REQUIRED.—The President, in consulta- 4 tion with the heads of all relevant Federal departments 5 and agencies including the Department of Education, the 6 Department of Health and Human Services, the Depart- 7 ment of Housing and Urban Development, the Depart- 8 ment of Justice, the Department of Labor, the Depart- 9 ment of Veteran Affairs, and the Social Security Adminis- 10 tration, shall transmit to Congress and make publicly 11 available a report on the status of implementation of Goal 12 4 of the National HIV/AIDS Strategy. 13 (b) CONTENTS.—The report required by subsection 14 (a) shall include a description, an analysis, and an evalua- 15 tion of— 16 (1) the extent to which the National HIV/AIDS 17 Strategy has improved coordination of efforts, en- 18 hanced capacity, and strengthened infrastructure in 19 order to maximize the effective delivery of HIV/ 20 AIDS prevention, care, and treatment services at the 21 community level, including coordination— 22 (A) within and among Federal agencies 23 and departments; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 676 •S 3660 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; and 10 (2) 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 (c) DEFINITION.—In this section, the term ‘‘National 17 HIV/AIDS Strategy’’ means the National HIV/AIDS 18 Strategy for the United States issued by the President in 19 July 2010, the revision to such Strategy issued in July 20 2015, and any subsequent revisions to such Strategy. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 677 •S 3660 IS Subtitle F—Diabetes 1 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 2 Subpart 3 of part C of title IV of the Public Health 3 Service Act (42 U.S.C. 285c et seq.) is amended by adding 4 at the end the following new section: 5 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 6 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 7 pand, intensify, and support ongoing research and other 8 activities with respect to prediabetes and diabetes, particu- 9 larly type 2, in minority populations. 10 ‘‘(b) RESEARCH.— 11 ‘‘(1) DESCRIPTION.—Research under subsection 12 (a) shall include investigation into— 13 ‘‘(A) the causes of diabetes, including so- 14 cioeconomic, geographic, clinical, environmental, 15 genetic, and other factors that may contribute 16 to increased rates of diabetes in minority popu- 17 lations; and 18 ‘‘(B) the causes of increased incidence of 19 diabetes complications in minority populations, 20 and possible interventions to decrease such inci- 21 dence. 22 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 23 In conducting and supporting research described in 24 subsection (a), the Director of NIH shall seek to in- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 678 •S 3660 IS clude minority participants as study subjects in clin- 1 ical trials. 2 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 3 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 4 Interagency Coordinating Committee shall— 5 ‘‘(A) prepare and submit to the Congress, 6 not later than 6 months after the date of enact- 7 ment of this section, a report on Federal re- 8 search and public health activities with respect 9 to prediabetes and diabetes in minority popu- 10 lations; and 11 ‘‘(B) develop and submit to Congress, not 12 later than 1 year after the date of enactment of 13 this section, an effective and comprehensive 14 Federal plan (including all appropriate Federal 15 health programs) to address prediabetes and di- 16 abetes in minority populations. 17 ‘‘(2) CONTENTS.—The report under paragraph 18 (1)(A) shall at minimum address each of the fol- 19 lowing: 20 ‘‘(A) Research on diabetes and prediabetes 21 in minority populations, including such research 22 on— 23 ‘‘(i) genetic, behavioral, and environ- 24 mental factors; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 679 •S 3660 IS ‘‘(ii) prevention and complications 1 among individuals within these populations 2 who have already developed diabetes. 3 ‘‘(B) Surveillance and data collection on 4 diabetes and prediabetes in minority popu- 5 lations, including with respect to— 6 ‘‘(i) efforts to better determine the 7 prevalence of diabetes among Asian-Amer- 8 ican and Pacific Islander subgroups; and 9 ‘‘(ii) efforts to coordinate data collec- 10 tion on the American Indian population. 11 ‘‘(C) Community-based interventions to ad- 12 dress diabetes and prediabetes targeting minor- 13 ity populations, including— 14 ‘‘(i) the evidence base for such inter- 15 ventions; 16 ‘‘(ii) the cultural appropriateness of 17 such interventions; and 18 ‘‘(iii) efforts to educate the public on 19 the causes and consequences of diabetes. 20 ‘‘(D) Education and training programs for 21 health professionals (including community 22 health workers) on the prevention and manage- 23 ment of diabetes and its related complications 24 that is supported by the Health Resources and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 680 •S 3660 IS Services Administration, including such pro- 1 grams supported by— 2 ‘‘(i) the National Health Service 3 Corps; or 4 ‘‘(ii) the community health centers 5 program under section 330. 6 ‘‘(d) EDUCATION.—The Director of NIH shall— 7 ‘‘(1) through the National Institute on Minority 8 Health and Health Disparities and the National Di- 9 abetes Education Program— 10 ‘‘(A) make grants to programs funded 11 under section 464z–4 for the purpose of estab- 12 lishing a mentoring program for health care 13 professionals to be more involved in weight 14 counseling, obesity research, and nutrition; and 15 ‘‘(B) provide for the participation of mi- 16 nority health professionals in diabetes-focused 17 research programs; and 18 ‘‘(2) make grants for programs to establish a 19 pipeline from high school to professional school that 20 will increase minority representation in diabetes-fo- 21 cused health fields by expanding Minority Access to 22 Research Careers program internships and men- 23 toring opportunities for recruitment. 24 ‘‘(e) DEFINITIONS.—For purposes of this section: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 681 •S 3660 IS ‘‘(1) DIABETES MELLITUS INTERAGENCY CO- 1 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 2 Interagency Coordinating Committee’ means the Di- 3 abetes Mellitus Interagency Coordinating Committee 4 established under section 429. 5 ‘‘(2) MINORITY POPULATION.—The term ‘mi- 6 nority population’ means a racial and ethnic minor- 7 ity group, as defined in section 1707.’’. 8 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 9 Part B of title III of the Public Health Service Act 10 (42 U.S.C. 243 et seq.), as amended by section 721, is 11 further amended by inserting after section 317X the fol- 12 lowing section: 13 ‘‘SEC. 317Y. DIABETES IN MINORITY POPULATIONS. 14 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, shall conduct and support 18 research and public health activities with respect to 19 diabetes in minority populations. 20 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 21 paragraph (1) regarding diabetes in minority popu- 22 lations shall include the following: 23 ‘‘(A) Further enhancing the National 24 Health and Nutrition Examination Survey by 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 682 •S 3660 IS oversampling Asian American, Native Hawai- 1 ian, and Pacific Islanders in appropriate geo- 2 graphic areas to better determine the preva- 3 lence of diabetes in such populations as well as 4 to improve the data collection of diabetes pene- 5 tration disaggregated into major ethnic groups 6 within such populations. The Secretary shall en- 7 sure that any such oversampling does not re- 8 duce the oversampling of other minority popu- 9 lations including African-American and Latino 10 populations. 11 ‘‘(B) Through the Division of Diabetes 12 Translation— 13 ‘‘(i) providing for prevention research 14 to better understand how to influence 15 health care systems changes to improve 16 quality of care being delivered to such pop- 17 ulations; 18 ‘‘(ii) carrying out model demonstra- 19 tion projects to design, implement, and 20 evaluate effective diabetes prevention and 21 control interventions for minority popu- 22 lations, including culturally appropriate 23 community-based interventions; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 683 •S 3660 IS ‘‘(iii) developing and implementing a 1 strategic plan to reduce diabetes in minor- 2 ity populations through applied research to 3 reduce disparities and culturally and lin- 4 guistically appropriate community-based 5 interventions; 6 ‘‘(iv) supporting, through the national 7 diabetes prevention program under section 8 399V–3, diabetes prevention program sites 9 in underserved regions highly impacted by 10 diabetes; and 11 ‘‘(v) implementing, through the na- 12 tional diabetes prevention program under 13 section 399V–3, a demonstration program 14 developing new metrics measuring health 15 outcomes related to diabetes that can be 16 stratified by specific minority populations. 17 ‘‘(b) EDUCATION.—The Secretary, acting through 18 the Director of the Centers for Disease Control and Pre- 19 vention, shall direct the Division of Diabetes Translation 20 to conduct and support both programs to educate the pub- 21 lic on diabetes in minority populations and programs to 22 educate minority populations about the causes and effects 23 of diabetes. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 684 •S 3660 IS ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 1 ACTIVITIES, AND ACCESS.—The Secretary, acting through 2 the Director of the Centers for Disease Control and Pre- 3 vention and the National Diabetes Education Program, 4 shall conduct and support programs to educate specific 5 minority populations through culturally appropriate and 6 linguistically appropriate information campaigns about 7 prevention of, and managing, diabetes. 8 ‘‘(d) DEFINITION.—For purposes of this section, the 9 term ‘minority population’ means a racial and ethnic mi- 10 nority group, as defined in section 1707.’’. 11 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 12 Part P of title III of the Public Health Service Act 13 (42 U.S.C. 280g et seq.), as amended by section 733, is 14 further amended by adding at the end the following new 15 section: 16 ‘‘SEC. 399V–9. PROGRAMS TO EDUCATE HEALTH PRO- 17 VIDERS ON THE CAUSES AND EFFECTS OF DI- 18 ABETES IN MINORITY POPULATIONS. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Director of the Health Resources and Services Admin- 21 istration, shall conduct and support programs described 22 in subsection (b) to educate health professionals on the 23 causes and effects of diabetes in minority populations. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 685 •S 3660 IS ‘‘(b) PROGRAMS.—Programs described in this sub- 1 section, with respect to education on diabetes in minority 2 populations, shall include the following: 3 ‘‘(1) Giving priority, under the primary care 4 training and enhancement program under section 5 747— 6 ‘‘(A) to awarding grants to focus on or ad- 7 dress diabetes; and 8 ‘‘(B) to adding minority populations to the 9 list of vulnerable populations that should be 10 served by such grants. 11 ‘‘(2) Providing additional funds for the Health 12 Careers Opportunity Program, the Centers for Ex- 13 cellence, and the Minority Faculty Fellowship Pro- 14 gram to partner with the Office of Minority Health 15 under section 1707 and the National Institutes of 16 Health to strengthen programs for career opportuni- 17 ties focused on diabetes treatment and care within 18 underserved regions highly impacted by diabetes. 19 ‘‘(3) Developing a diabetes focus within, and 20 providing additional funds for, the National Health 21 Service Corps scholarship program— 22 ‘‘(A) to place individuals in areas that are 23 disproportionately affected by diabetes and to 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 686 •S 3660 IS provide diabetes treatment and care in such 1 areas; and 2 ‘‘(B) to provide such individuals continuing 3 medical education specific to diabetes care.’’. 4 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 5 Part P of title III of the Public Health Service Act 6 (42 U.S.C. 280g et seq.), as amended by section 773, is 7 further amended by adding at the end the following sec- 8 tion: 9 ‘‘SEC. 399V–10. RESEARCH, EDUCATION, AND OTHER ACTIVI- 10 TIES REGARDING DIABETES IN AMERICAN IN- 11 DIAN POPULATIONS. 12 ‘‘In addition to activities under sections 399V–6 and 13 434B, the Secretary, acting through the Indian Health 14 Service and in collaboration with other appropriate Fed- 15 eral agencies, shall— 16 ‘‘(1) conduct and support research and other 17 activities with respect to diabetes; and 18 ‘‘(2) coordinate the collection of data on clini- 19 cally and culturally appropriate diabetes treatment, 20 care, prevention, and services by health care profes- 21 sionals to the American Indian population.’’. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 687 •S 3660 IS SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 1 The Secretary of Health and Human Services shall 2 seek to enter into an arrangement with the National Acad- 3 emy of Medicine under which the National Academy will— 4 (1) not later than 1 year after the date of en- 5 actment of this Act, submit to Congress an updated 6 version of the 2002 report entitled ‘‘Unequal Treat- 7 ment: Confronting Racial and Ethnic Disparities in 8 Health Care’’; and 9 (2) in such updated version, address how racial 10 and ethnic health disparities have changed since the 11 publication of the original report. 12 Subtitle G—Lung Disease 13 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU- 14 CATION AND PREVENTION PROGRAM. 15 (a) FINDINGS.—Congress finds as follows: 16 (1) The prevalence of asthma has increased 17 since 1980 and affects more than 26,000,000 people 18 in the United States. 19 (2) Significant disparities in asthma morbidity 20 and mortality exist for both adults and children par- 21 ticularly for low-income and minority populations, 22 particularly African Americans and Puerto Ricans. 23 (3) African-American children are twice as like- 24 ly to have asthma as White children. 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 688 •S 3660 IS (4) In 2016, almost 4,500,000 non-Hispanic 1 African Americans reported having asthma. African 2 Americans with asthma are 3 times as likely to visit 3 the emergency department and twice as likely to get 4 hospitalized as White patients with asthma. 5 (5) Puerto Ricans are 3.4 times as likely to die 6 from asthma compared with all other Hispanic or 7 Latino groups. Overall Hispanic Americans are 30 8 percent more likely to be hospitalized for asthma 9 than non-Hispanic Whites. 10 (6) The majority of adults with asthma are 11 women. 12 (b) IN GENERAL.—Not later than 2 years after the 13 date of the enactment of this Act, the Secretary of Health 14 and Human Services shall convene a working group com- 15 prised of patient groups, nonprofit organizations, medical 16 societies, and other relevant governmental and nongovern- 17 mental entities, including those that participate in the Na- 18 tional Asthma Education and Prevention Program, to de- 19 velop a report to Congress that— 20 (1) catalogs, with respect to asthma prevention, 21 management, and surveillance— 22 (A) the activities of the Federal Govern- 23 ment, including identifying all Federal pro- 24 grams that carry out asthma-related activities, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 689 •S 3660 IS as well as assessment of the progress of the 1 Federal Government and States, with respect to 2 achieving the goals of Healthy People 2020; 3 and 4 (B) the activities of other entities that par- 5 ticipate in the program, including nonprofit or- 6 ganizations, patient advocacy groups, and med- 7 ical societies; and 8 (2) makes recommendations for the future di- 9 rection of asthma activities, in consultation with re- 10 searchers from the National Institutes of Health and 11 other member bodies of the National Asthma Edu- 12 cation and Prevention Program who are qualified to 13 review and analyze data and evaluate interventions, 14 including— 15 (A) a description of how the Federal Gov- 16 ernment may better coordinate and improve its 17 response to asthma including identifying any 18 barriers that may exist; 19 (B) a description of how the Federal Gov- 20 ernment may continue, expand, and improve its 21 private-public partnerships with respect to asth- 22 ma including identifying any barriers that may 23 exist; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 690 •S 3660 IS (C) identification of steps that may be 1 taken to reduce the— 2 (i) morbidity, mortality, and overall 3 prevalence of asthma; 4 (ii) financial burden of asthma on so- 5 ciety; 6 (iii) burden of asthma on dispropor- 7 tionately affected areas, particularly those 8 in medically underserved populations (as 9 defined in section 330(b)(3) of the Public 10 Health Service Act (42 U.S.C. 11 254b(b)(3))); and 12 (iv) burden of asthma as a chronic 13 disease; 14 (D) identification of programs and policies 15 that have achieved the steps described in sub- 16 paragraph (C), and steps that may be taken to 17 expand such programs and policies to benefit 18 larger populations; and 19 (E) recommendations for future research 20 and interventions. 21 (c) REPORT TO CONGRESS.—At the end of the 5-year 22 period following the submission of the report under this 23 section, the National Asthma Education and Prevention 24 Program shall evaluate the analyses and recommendations 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 691 •S 3660 IS under such report and determine whether a new report 1 to the Congress is necessary, and make appropriate rec- 2 ommendations to the Congress. 3 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 4 FOR DISEASE CONTROL AND PREVENTION. 5 Section 317I of the Public Health Service Act (42 6 U.S.C. 247b–10) is amended to read as follows: 7 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 8 FOR DISEASE CONTROL AND PREVENTION. 9 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 10 EDUCATION TO THE PUBLIC.—The Secretary, acting 11 through the Director of the Centers for Disease Control 12 and Prevention, shall collaborate with State and local 13 health departments to conduct activities, including the 14 provision of information and education to the public re- 15 garding asthma including— 16 ‘‘(1) deterring the harmful consequences of un- 17 controlled asthma; and 18 ‘‘(2) disseminating health education and infor- 19 mation regarding prevention of asthma episodes and 20 strategies for managing asthma. 21 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 22 The Secretary, acting through the Director of the Centers 23 for Disease Control and Prevention, shall collaborate with 24 State and local health departments to develop State plans 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 692 •S 3660 IS incorporating public health responses to reduce the burden 1 of asthma, particularly regarding disproportionately af- 2 fected populations. 3 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 4 through the Director of the Centers for Disease Control 5 and Prevention, shall, in cooperation with State and local 6 public health officials— 7 ‘‘(1) conduct asthma surveillance activities to 8 collect data on the prevalence and severity of asth- 9 ma, the effectiveness of public health asthma inter- 10 ventions, and the quality of asthma management, in- 11 cluding— 12 ‘‘(A) collection of household data on the 13 local burden of asthma; 14 ‘‘(B) surveillance of health care facilities; 15 and 16 ‘‘(C) collection of data not containing indi- 17 vidually identifiable information from electronic 18 health records or other electronic communica- 19 tions; 20 ‘‘(2) compile and annually publish data regard- 21 ing the prevalence and incidence of childhood asth- 22 ma, the child mortality rate, and the number of hos- 23 pital admissions and emergency department visits by 24 children associated with asthma nationally and in 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 693 •S 3660 IS each State and at the county level by age, sex, race, 1 and ethnicity, as well as lifetime and current preva- 2 lence; and 3 ‘‘(3) compile and annually publish data regard- 4 ing the prevalence and incidence of adult asthma, 5 the adult mortality rate, and the number of hospital 6 admissions and emergency department visits by 7 adults associated with asthma nationally and in each 8 State and at the county level by age, sex, race, eth- 9 nicity, industry, and occupation, as well as lifetime 10 and current prevalence. 11 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 12 Director of the Centers for Disease Control and Preven- 13 tion, in conjunction with State and local health depart- 14 ments, shall coordinate data collection activities under 15 subsection (c)(2) so as to maximize comparability of re- 16 sults. 17 ‘‘(e) COLLABORATION.—The Centers for Disease 18 Control and Prevention are encouraged to collaborate with 19 national, State, and local nonprofit organizations to pro- 20 vide information and education about asthma, and to 21 strengthen such collaborations when possible. 22 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 23 other authorization of appropriations that is available to 24 the Centers for Disease Control and Prevention for the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 694 •S 3660 IS purpose of carrying out this section, there are authorized 1 to be appropriated to such Centers such sums as may be 2 necessary for each of fiscal years 2019 through 2023 for 3 the purpose of carrying out this section.’’. 4 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM- 5 PAIGN. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services shall— 8 (1) enhance the annual campaign by the De- 9 partment of Health and Human Services to increase 10 the number of people vaccinated each year for influ- 11 enza and pneumonia; and 12 (2) include in such campaign the use of written 13 educational materials, public service announcements, 14 physician education, and any other means which the 15 Secretary deems effective. 16 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 17 out the annual campaign described in subsection (a), the 18 Secretary of Health and Human Services shall ensure 19 that— 20 (1) educational materials and public service an- 21 nouncements are readily and widely available in 22 communities experiencing disparities in the incidence 23 and mortality rates of influenza and pneumonia; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 695 •S 3660 IS (2) the campaign uses targeted, culturally ap- 1 propriate messages and messengers to reach under- 2 served communities. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2019 through 2023. 7 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 8 ACTION PLAN. 9 (a) FINDINGS.—Congress finds as follows: 10 (1) Chronic obstructive pulmonary disease (re- 11 ferred to in this subsection as ‘‘COPD’’) refers to 12 chronic bronchitis and emphysema, incurable dis- 13 eases that make it difficult to exhale all the air from 14 one’s lungs, and that can cause persistent coughing, 15 shortness of breath, and sputum. 16 (2) COPD exacerbations—episodes of acute dif- 17 ficulty breathing and moderate to severe fatigue— 18 are dangerous, and their treatment often requires 19 hospitalization. 20 (3) While smoking is the primary risk factor for 21 COPD, other risk factors include air pollution, occu- 22 pational exposures, heredity, a history of childhood 23 respiratory infections, and socioeconomic status. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 696 •S 3660 IS (4) It is estimated that over 13,500,000 adults 1 in the United States have COPD. 2 (5) COPD is the third-leading cause of death in 3 the United States, claiming over 134,000 lives in 4 2010. 5 (6) Since 2000, deaths for women with COPD 6 have exceeded deaths in men. 7 (7) Although African Americans have a lower 8 prevalence of COPD in the United States, research- 9 ers have shown that African Americans may be 10 underdiagnosed. Furthermore, research has shown 11 that African Americans develop COPD with less cu- 12 mulative smoke exposure and at a younger age. 13 (b) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention shall conduct, support, 15 and expand public health strategies, prevention, diagnosis, 16 surveillance, and public and professional awareness activi- 17 ties regarding chronic obstructive pulmonary disease. 18 (c) NATIONAL ACTION PLAN.— 19 (1) DEVELOPMENT.—Not later than 2 years 20 after the date of the enactment of this Act, the Di- 21 rector of the National Heart, Lung, and Blood Insti- 22 tute, in consultation with the Director of the Centers 23 for Disease Control and Prevention, shall develop a 24 national action plan to address chronic obstructive 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 697 •S 3660 IS pulmonary disease in the United States with partici- 1 pation from patients, caregivers, health profes- 2 sionals, patient advocacy organizations, researchers, 3 providers, public health professionals, and other 4 stakeholders. 5 (2) CONTENTS.—At a minimum, such plan 6 shall include recommendations for— 7 (A) public health interventions for the pur- 8 pose of implementation of the national plan; 9 (B) biomedical, health services, and public 10 health research on chronic obstructive pul- 11 monary disease; and 12 (C) inclusion of chronic obstructive pul- 13 monary disease in the health data collections of 14 all Federal agencies. 15 (3) CONSIDERATION.—In developing such plan, 16 the Director of the National Heart, Lung, and Blood 17 Institute shall consider the recommendations and 18 findings of the National Academy of Medicine in the 19 report entitled ‘‘A Nationwide Framework for Sur- 20 veillance of Cardiovascular and Chronic Lung Dis- 21 eases’’ (July 22, 2011). 22 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 23 The Director of the National Heart, Lung, and Blood In- 24 stitute shall carry out the following: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 698 •S 3660 IS (1) Conduct public education and awareness ac- 1 tivities with patient and professional organizations 2 to stimulate earlier diagnosis and improve patient 3 outcomes from treatment of chronic obstructive pul- 4 monary disease. To the extent known and relevant, 5 such public education and awareness activities shall 6 reflect differences in chronic obstructive pulmonary 7 disease by cause (tobacco, environmental, occupa- 8 tional, biological, and genetic) and include a focus 9 on outreach to undiagnosed and, as appropriate, mi- 10 nority populations. 11 (2) Supplement and expand upon the activities 12 of the National Heart, Lung, and Blood Institute by 13 making grants to nonprofit organizations, State and 14 local jurisdictions, and Indian tribes for the purpose 15 of reducing the burden of chronic obstructive pul- 16 monary disease, especially in disproportionately im- 17 pacted communities, through public health interven- 18 tions and related activities. 19 (3) Coordinate with the Centers for Disease 20 Control and Prevention, the Indian Health Service, 21 the Health Resources and Services Administration, 22 and the Department of Veterans Affairs to develop 23 pilot programs to demonstrate best practices for the 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 699 •S 3660 IS diagnosis and management of chronic obstructive 1 pulmonary disease. 2 (4) Develop improved techniques and identify 3 best practices, in coordination with the Secretary of 4 Veterans Affairs, for assisting chronic obstructive 5 pulmonary disease patients to successfully stop 6 smoking, including identification of subpopulations 7 with different needs. Initiatives under this para- 8 graph may include research to determine whether 9 successful smoking cessation strategies are different 10 for chronic obstructive pulmonary disease patients 11 compared to such strategies for patients with other 12 chronic diseases. 13 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 14 PROGRAMS.—The Director of the Centers for Disease 15 Control and Prevention shall— 16 (1) support research into the environmental and 17 occupational causes and biological mechanisms that 18 contribute to chronic obstructive pulmonary disease; 19 and 20 (2) develop and disseminate public health inter- 21 ventions that will lessen the impact of environmental 22 and occupational causes of chronic obstructive pul- 23 monary disease. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 700 •S 3660 IS (f) DATA COLLECTION.—Not later than 180 days 1 after the enactment of this Act, the Director of the Na- 2 tional Heart, Lung, and Blood Institute and the Director 3 of the Centers for Disease Control and Prevention, acting 4 jointly, shall assess the depth and quality of information 5 on chronic obstructive pulmonary disease that is collected 6 in surveys and population studies conducted by the Cen- 7 ters for Disease Control and Prevention, including wheth- 8 er there are additional opportunities for information to be 9 collected in the National Health and Nutrition Examina- 10 tion Survey, the National Health Interview Survey, and 11 the Behavioral Risk Factors Surveillance System surveys. 12 The Director of the National Heart, Lung, and Blood In- 13 stitute shall include the results of such assessment in the 14 national action plan under subsection (c). 15 (g) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2019 through 2023. 19 Subtitle H—Tuberculosis 20 SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 21 (a) SHORT TITLE.—This subtitle may be cited as the 22 ‘‘End Tuberculosis Act’’. 23 (b) FINDINGS.—Congress makes the following find- 24 ings: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 701 •S 3660 IS (1) In the United States, 9,272 people were di- 1 agnosed with tuberculosis (referred to in this section 2 as ‘‘TB’’) in 2016. 3 (2) Disparities in TB exist and significantly im- 4 pact minority communities in the United States. The 5 Centers for Disease Control and Prevention (re- 6 ferred to in this section as ‘‘CDC’’) finds that 87 7 percent of people diagnosed with TB in 2016 self- 8 identified as racial and ethnic minorities. 9 (3) African Americans comprised 21 percent of 10 people diagnosed with TB during 2016. The popu- 11 lation-adjusted rate of TB among African Americans 12 is 1.7 times higher than the national total, and 8.2 13 times higher than among Whites. 14 (4) Asian Americans, Native Hawaiians, and 15 other Pacific Islanders comprised 35 percent of peo- 16 ple diagnosed with TB during 2016. The population- 17 adjusted rate of TB among Asian Americans is 6.2 18 times higher than the national total, and 30 times 19 higher than among Whites. The population-adjusted 20 rate of TB among Native Hawaiians and other Pa- 21 cific Islanders is 4.8 times higher than the national 22 total, and 23.2 times higher than among Whites. 23 (5) Hispanics and Latinos comprised 28 per- 24 cent of people diagnosed with TB during 2016. The 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 702 •S 3660 IS population-adjusted rate of TB among Hispanics 1 and Latinos is 1.6 times higher than the national 2 total, and 7.5 times higher than among Whites. 3 (6) TB is both preventable and curable, but the 4 current rate of decline of TB in the United States 5 remains too slow to achieve TB elimination in this 6 century. 7 (7) TB is transmitted through the air when a 8 person who has TB disease in their lungs coughs or 9 sneezes. People who are in close proximity to the 10 person with TB can breathe in the TB bacteria, and 11 the bacteria will initially settle in their lungs. With- 12 out proper and timely diagnosis and access to treat- 13 ment, the TB bacteria may grow and spread to 14 other parts of their body. 15 (8) As many as 13,000,000 people in the 16 United States may have latent TB Infection (re- 17 ferred to in this section as ‘‘LTBI’’). People with 18 LTBI have TB bacteria in their bodies, but their 19 immune system is containing the bacteria, and they 20 are not sick, nor do they have any current risk of 21 spreading TB to others. LTBI can activate into in- 22 fectious, life-threatening TB if not treated. Modeling 23 has shown that eliminating TB is not possible with- 24 out addressing LTBI. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 703 •S 3660 IS (9) Comorbidities associated with TB include 1 cancer, diabetes mellitus, and HIV. People with 2 these medical conditions and compromised immune 3 systems are more likely to develop active TB disease 4 and to have worse outcomes from TB. 5 (10) Forms of active TB that do not show drug 6 resistance are classified as drug-susceptible TB (re- 7 ferred to in this section as ‘‘DS–TB’’). Drug-resist- 8 ant TB (referred to in this section as ‘‘DR–TB’’) is 9 a rising threat to the public health of the United 10 States. DR–TB that exhibits resistance to two or 11 more first-line drugs is referred to as multi-drug re- 12 sistant TB (referred to in this section as ‘‘MDR– 13 TB’’). MDR–TB that also is resistant to at least 14 one injectable second-line medication and at least 15 one fluoroquinolone is classified as extensively drug- 16 resistant TB (referred to in this section as ‘‘XDR– 17 TB’’). 18 (11) Approximately 78 people in the United 19 States were diagnosed with MDR–TB in 2016. One 20 person was diagnosed with XDR–TB in the same 21 year. 22 (12) In the United States, direct treatment 23 costs average $17,000 to treat a patient with DS– 24 TB, $150,000 to treat a patient with MDR–TB, and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 704 •S 3660 IS $482,000 to treat a patient with XDR–TB. When 1 factoring in productivity losses during treatment, 2 DS–TB averages $46,000, MDR–TB averages 3 $294,000 and XDR–TB averages $694,000. Treat- 4 ment is often difficult, with daily complex multi-pill 5 regimens and injections, with side-effects ranging 6 from hearing and vision loss to mental health issues. 7 (13) Recognizing the public health, economic 8 and societal costs to the threat of MDR–TB, the 9 National Action Plan to Combat MDR–TB was de- 10 veloped by the White House to provide the United 11 States with a comprehensive three-pronged strategy 12 to address MDR–TB by strengthening domestic ca- 13 pacity to combat MDR–TB; improve international 14 capacity and cooperation to combat MDR–TB; accel- 15 erate basic and applied research and development 16 for new therapies, diagnostics and prevention strate- 17 gies to combat MDR–TB. 18 (14) Additional Federal support is necessary to 19 expand TB control efforts in case finding and treat- 20 ment to address LTBI in a national prevention ini- 21 tiative. Key policy and research breakthroughs in- 22 crease the success of a TB prevention initiative: the 23 U.S. Preventative Services Task Force recommenda- 24 tion’s ‘‘B’’ rating, screening for LTBI among high- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 705 •S 3660 IS risk adults as a covered service increases the likeli- 1 hood that impacted racial and ethnic minority 2 groups can get tested for TB; a new, shorter course 3 treatment regimen reduces the length of treatment 4 for LTBI from every day for 6 to 9 months to one 5 dose per week for 12 weeks, increasing likelihood of 6 treatment completion; and the use of blood-based di- 7 agnostic tests, Interferon-gamma release assays or 8 IGRAs, increases ability to detect LTBI among pa- 9 tients in affected communities. 10 SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM- 11 BATING AND ELIMINATING TUBERCULOSIS. 12 Section 317E(h) of the Public Health Act (42 U.S.C. 13 247b–6(h)) is amended by adding at the end the following: 14 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN 15 COMBATING AND ELIMINATING TUBERCULOSIS.—In 16 addition to amounts otherwise authorized to be ap- 17 propriated to carry out this section, there are au- 18 thorized to be appropriated such sums as may be 19 necessary to carry out section 317 for each of fiscal 20 years 2019 through 2021.’’. 21 SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 22 FOR TUBERCULOSIS. 23 (a) IN GENERAL.—The Secretary of Health and 24 Human Services shall expand and intensify support for 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 706 •S 3660 IS current and prospective research activities of the National 1 Institutes of Health, the Biomedical Advanced Research 2 and Development Authority, and the Centers for Disease 3 Control and Prevention Division of Tuberculosis Elimi- 4 nation to develop new therapeutics, diagnostics, vaccines, 5 and other prevention modalities in addressing all forms 6 of tuberculosis (referred to in this section as ‘‘TB’’). 7 (b) INCLUDED RESEARCH ACTIVITIES.—Research 8 activities under subsection (a) shall include— 9 (1) research to develop novel, safe drugs and 10 drug regimens for the treatment of TB, including in 11 adolescent and pediatric populations and in pregnant 12 and lactating women; 13 (2) research to develop rapid diagnostic tests 14 for all forms of TB, including diagnostics that can 15 be used for pediatric populations and people living 16 with HIV, diagnostics that can detect extra pul- 17 monary TB and drug resistance, and diagnostics 18 that can be used at the point of care; 19 (3) research to advance basic knowledge of the 20 pathogenesis of TB and its major comorbidities, in- 21 cluding HIV and diabetes mellitus; 22 (4) research to improve knowledge and under- 23 standings of the role of latency in TB and the fac- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 707 •S 3660 IS tors that increase the risk of latent TB infection 1 progressing to active, symptomatic TB disease; 2 (5) awarding grants and contracts to specifi- 3 cally develop new and needed vaccines to address 4 TB; 5 (6) awarding grants and contracts to support 6 the training and development of clinical researchers 7 whose research improves the landscape of tools to 8 combat TB; and 9 (7) awarding grants and contracts to support 10 capacity-building and develop clinical trial site infra- 11 structure in the United States and in TB endemic 12 countries to support the aforementioned research ac- 13 tivities. 14 Subtitle I—Osteoarthritis and 15 Musculoskeletal Diseases 16 SEC. 785. FINDINGS. 17 Congress finds as follows: 18 (1) Eighty percent of African-American women 19 and nearly 74 percent of Hispanic men are either 20 overweight or obese, speeding the onset and progres- 21 sion of arthritis. 22 (2) Arthritis affects 46,000,000 people in the 23 United States, and that number will rise to 24 67,000,000 by the year 2030. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 708 •S 3660 IS (3) Twenty-seven million people in the United 1 States suffer from osteoarthritis, the most common 2 form of arthritis, making it the leading cause of dis- 3 ability in the United States. Osteoarthritis is some- 4 times referred to as degenerative joint disease. 5 (4) Obesity accelerates the onset of arthritis: 70 6 percent of obese adults with mild osteoarthritis of 7 the knee at age 60 will develop advanced end-stage 8 disease by age 80. In contrast, just 43 percent of 9 non-obese adults will have end-stage disease over the 10 same time period. 11 (5) Arthritis affects 1 in 5 people in the United 12 States and is the single greatest cause of chronic 13 pain and disability in the United States. 14 (6) Women, African Americans, and Hispanics 15 have more severe arthritis and functional limitations. 16 These same individuals are more likely to be obese, 17 diabetic, and have higher incidence of heart dis- 18 ease—medical conditions that can be improved with 19 physical activity. Instead of moving; however, these 20 groups have an inactivity rate of 40 to 50 percent, 21 which continues to increase. 22 (7) Arthritis costs $128,000,000,000 a year, in- 23 cluding $81,000,000,000 in direct costs (medical) 24 and $47,000,000,000 in indirect costs (lost earn- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 709 •S 3660 IS ings). Each year, $309,000,000,000 in direct and in- 1 direct costs is lost due to disparities in osteoarthritis 2 and musculoskeletal diseases. 3 (8) Obesity and other chronic health conditions 4 exacerbate the debilitating impact of arthritis, lead- 5 ing to inactivity, loss of independence, and a per- 6 petual cycle of comorbid chronic conditions. 7 (9) Sixty-one percent of arthritis sufferers are 8 women, and women represent 64 percent of an esti- 9 mated 43,000,000 annual visits to physicians’ offices 10 and outpatient clinics where arthritis was the pri- 11 mary diagnosis. Women also represented 60 percent 12 of approximately 1,000,000 hospitalizations that oc- 13 curred in 2003 for which arthritis was the primary 14 diagnosis. 15 (10) Women ages 65 and older have up to 21⁄2 16 times more disabilities than men of the same age. 17 Higher rates of obesity and arthritis among this 18 group explained up to 48 percent of the gender gap 19 in disability, above all other common chronic health 20 conditions. 21 (11) The primary indication for total knee 22 arthroplasty (referred to in this section as ‘‘TKA’’), 23 also known as knee replacement, is relief of signifi- 24 cant, disabling pain caused by severe arthritis. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 710 •S 3660 IS (12) Knee replacement is surgery for people 1 with severe knee damage. Knee replacement can re- 2 lieve pain and allow you to be more active. When 3 you have a total knee replacement, the surgeon re- 4 moves damaged cartilage and bone from the surface 5 of your knee joint and replaces them with a man- 6 made surface of metal and plastic. In a partial knee 7 replacement, the surgeon only replaces one part of 8 your knee joint. 9 (13) Total hip replacement, also called total hip 10 arthroplasty (referred to in this section as ‘‘THA’’), 11 is used if your hip pain interferes with daily activi- 12 ties and more conservative treatments have not 13 helped. Arthritis damage is the most common reason 14 to need hip replacement. 15 (14) The odds of a family practice physician 16 recommending TKA to a male patient with moderate 17 arthritis are twice that of a female patient, while the 18 odds of an orthopaedic surgeon recommending TKA 19 to a male patient with moderate arthritis are 22 20 times that of a female patient. 21 (15) African Americans with doctor-diagnosed 22 arthritis have a higher prevalence of severe pain at- 23 tributable to arthritis, compared with Whites (34.0 24 percent versus 22.6 percent). African Americans, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 711 •S 3660 IS compared to Whites, report a higher proportion of 1 work limitations (39.5 percent versus 28.0 percent) 2 and a higher prevalence of arthritis-attributable 3 work limitation (6.6 percent versus 4.6 percent). 4 (16) Hispanics are 50 percent more likely than 5 non-Hispanic Whites to report needing assistance 6 with at least one instrumental activity of daily living 7 and to have difficulty walking. 8 (17) African Americans and Hispanics were 1.3 9 times more likely to have activity limitation, 1.6 10 times more likely to have work limitations, and 1.9 11 times more likely to have severe joint pain than 12 Whites. 13 (18) In 2003, the National Academy of Medi- 14 cine reported that the rates of TKA and THA 15 among African-American and Hispanic patients are 16 significantly lower than for Whites—even for those 17 with equitable health care coverage such as through 18 Medicare or the Department of Veterans Affairs. 19 (19) According to the Centers for Disease Con- 20 trol and Prevention, in 2000, African-American 21 Medicare enrollees were 37 percent less likely than 22 White Medicare enrollees to undergo total knee re- 23 placements. In 2006, the disparity increased to 39 24 percent. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 712 •S 3660 IS (20) Even after adjusting for insurance and 1 health access, Hispanics and African Americans are 2 almost 50 percent less likely to undergo total knee 3 replacement than Whites. 4 SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULO- 5 SKELETAL HEALTH-RELATED ACTIVITIES OF 6 THE CENTERS FOR DISEASE CONTROL AND 7 PREVENTION. 8 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 9 Secretary of Health and Human Services, acting through 10 the Director of the Centers for Disease Control and Pre- 11 vention, shall direct the National Center for Chronic Dis- 12 ease Prevention and Health Promotion to conduct and ex- 13 pand the Health Community Program and Arthritis Pro- 14 gram to educate the public on— 15 (1) the causes of, preventive health actions for, 16 and effects of arthritis and other musculoskeletal 17 conditions in minority patient populations; and 18 (2) the effects of such conditions on other 19 comorbidities including obesity, hypertension, and 20 cardiovascular disease. 21 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 22 SKELETAL CONDITIONS.—Education and awareness pro- 23 grams of the Centers for Disease Control and Prevention 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 713 •S 3660 IS on arthritis and other musculoskeletal conditions in minor- 1 ity communities shall— 2 (1) be culturally and linguistically appropriate 3 to minority patients, targeting musculoskeletal 4 health promotion and prevention programs of each 5 major ethnic group, including— 6 (A) Native Americans and Alaska Natives; 7 (B) Asian Americans; 8 (C) African Americans and Blacks; 9 (D) Hispanic and Latino Americans; and 10 (E) Native Hawaiians and Pacific Island- 11 ers; and 12 (2) include public awareness campaigns directed 13 toward these patient populations that emphasize the 14 importance of musculoskeletal health, physical activ- 15 ity, diet and healthy lifestyle, and weight reduction 16 for overweight and obese patients. 17 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as are necessary for fiscal year 2019 and each 20 subsequent fiscal year. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 714 •S 3660 IS SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 1 AND MUSCULOSKELETAL DISEASE HEALTH 2 EDUCATION WITHIN HEALTH PROFESSIONS 3 SCHOOLS. 4 (a) PROGRAM AUTHORIZED.—The Secretary of 5 Health and Human Services (in this section referred to 6 as the ‘‘Secretary’’), in coordination with the Secretary of 7 Education, shall award grants, on a competitive basis, to 8 academic health science centers, health professions 9 schools, and other institutions of higher education to en- 10 able such institutions to provide people with comprehen- 11 sive education on arthritis and musculoskeletal health, 12 particularly— 13 (1) obesity-related musculoskeletal diseases; 14 (2) arthritis and osteoarthritis; 15 (3) arthritis and musculoskeletal health dispari- 16 ties; and 17 (4) the relationship between arthritis and mus- 18 culoskeletal diseases and metabolic activity, psycho- 19 logical health, and comorbidities such as diabetes, 20 cardiovascular disease, and hypertension. 21 (b) DURATION.—Grants awarded under this section 22 shall be for a period of 5 years. 23 (c) APPLICATIONS.—An academic health science cen- 24 ter, health professions school, or other institution of high- 25 er education seeking a grant under this section shall sub- 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 715 •S 3660 IS mit an application to the Secretary at such time, in such 1 manner, and containing such information as the Secretary 2 may require. 3 (d) PRIORITY.—In awarding grants under this sec- 4 tion, the Secretary shall give priority to an institution of 5 higher education that— 6 (1) has an enrollment of needy students, as de- 7 fined in section 318(b) of the Higher Education Act 8 of 1965 (20 U.S.C. 1059e(b)); 9 (2) is a Hispanic-serving institution, as defined 10 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 11 (3) is a Tribal College or University, as defined 12 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 13 (4) is an Alaska Native-serving institution, as 14 defined in section 317(b) of such Act (20 U.S.C. 15 1059d(b)); 16 (5) is a Native Hawaiian-serving institution, as 17 defined in section 317(b) of such Act (20 U.S.C. 18 1059d(b)); 19 (6) is a Predominately Black Institution, as de- 20 fined in section 318(b) of such Act (20 U.S.C. 21 1059e(b)); 22 (7) is a Native American-serving, non-Tribal in- 23 stitution, as defined in section 319(b) of such Act 24 (20 U.S.C. 1059f(b)); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 716 •S 3660 IS (8) is an Asian-American and Native American 1 Pacific Islander-serving institution, as defined in 2 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 3 (9) is a minority institution, as defined in sec- 4 tion 365 of such Act (20 U.S.C. 1067k), with an en- 5 rollment of needy students, as defined in section 312 6 of such Act (20 U.S.C. 1058). 7 (e) USES OF FUNDS.—An institution of higher edu- 8 cation receiving a grant under this section may use grant 9 funds to integrate issues relating to comprehensive arthri- 10 tis and musculoskeletal health into the academic or sup- 11 port sectors of the institution in order to reach a large 12 number of students, by carrying out 1 or more of the fol- 13 lowing activities: 14 (1) Developing educational content for issues 15 relating to comprehensive arthritis and musculo- 16 skeletal health education that will be incorporated 17 into first-year orientation or core courses. 18 (2) Creating innovative technology-based ap- 19 proaches to deliver arthritis and musculoskeletal 20 health education to students, faculty, and staff. 21 (3) Developing and employing peer-outreach 22 and education programs to generate discussion, edu- 23 cate, and raise awareness among students about 24 issues relating to arthritis and musculoskeletal 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 717 •S 3660 IS health disorders, and their relationship to diabetes, 1 hypertension, cardiovascular disease, psychological 2 health, and other comorbid conditions. 3 (f) REPORT TO CONGRESS.— 4 (1) IN GENERAL.—Not later than 1 year after 5 the date of the enactment of this Act, and annually 6 thereafter for a period of 5 years, the Secretary shall 7 prepare and submit to the appropriate committees of 8 Congress a report on the activities to provide health 9 professions students with comprehensive arthritis 10 and musculoskeletal health education funded under 11 this section. 12 (2) REPORT ELEMENTS.—The report described 13 in paragraph (1) shall include information about— 14 (A) the number of entities that are receiv- 15 ing grant funds; 16 (B) the specific activities supported by 17 grant funds; 18 (C) the number of students served by 19 grant programs; and 20 (D) the status of program evaluations. 21 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 718 •S 3660 IS Subtitle J—Sleep and Circadian 1 Rhythm Disorders 2 SEC. 791. SHORT TITLE; FINDINGS. 3 (a) SHORT TITLE.—This subtitle may be cited as the 4 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 5 ties Act’’. 6 (b) FINDINGS.—Congress finds the following: 7 (1) Decrements in sleep health such as sleep 8 apnea, insufficient sleep time, and insomnia, affect 9 50,000,000 to 70,000,000 adults in the United 10 States. Twelve to eighteen million United States 11 adults have sleep apnea, a chronic disorder charac- 12 terized by one or more pauses in breathing which 13 can last from a few seconds to minutes. They may 14 occur 30 times or more an hour, disrupting sleep 15 and resulting in excessive daytime sleepiness and 16 loss in productivity. 17 (2) Seventy percent of high school students are 18 not getting enough sleep on school nights, while 33 19 percent of people in the United States get fewer 20 than 7 hours of sleep per night, and roughly 6,000 21 fatal motor vehicle crashes are caused by drowsy 22 drivers. 23 (3) Insufficient sleep and insomnia are more 24 prevalent in women. Women who are pregnant and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 719 •S 3660 IS have sleep apnea are at an increased risk of cardio- 1 vascular complications during pregnancy. The im- 2 pact of disparities in sleep health is associated with 3 a growing number of health problems, including the 4 following: 5 (A) Hypertension. 6 (B) Cancer. 7 (C) Stroke. 8 (D) Cardiac arrhythmia. 9 (E) Chronic heart failure and heart dis- 10 ease. 11 (F) Diabetes. 12 (G) Cognitive functioning and behavior. 13 (H) Depression and bipolar disorder. 14 (I) Substance abuse. 15 (4) A sleep disparity exists in that poor sleep 16 quality is strongly associated with poverty and race. 17 Factors such as employment, education, and health 18 status, amongst others, significantly mediated this 19 effect only in poor subjects, suggesting a differential 20 vulnerability to these factors in poor relative to 21 nonpoor individuals in the context of sleep quality. 22 (5) African Americans sleep worse than Cauca- 23 sian Americans. African Americans take longer to 24 fall asleep, report poorer sleep quality, have more 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 720 •S 3660 IS light and less deep sleep, and nap more often and 1 longer. 2 (6) African Americans and individuals in lower 3 socioeconomic status groups may be at an increased 4 risk for sleep disturbances and associated health 5 consequences. 6 (7) Among young African Americans, the likeli- 7 hood of having sleep disordered breathing and exhib- 8 iting risk factors for poor sleep is twice that in 9 young Caucasians. Frequent snoring is more com- 10 mon among African-American and Hispanic women 11 and Hispanic men compared to non-Hispanic Cauca- 12 sians, independent of other factors including obesity. 13 (8) African Americans with sleep-disordered 14 breathing develop symptoms at a younger age than 15 Caucasians but appear less likely to be diagnosed 16 and treated in a timely manner. This delay may at 17 least in part be due to reduced access to care. 18 (9) Sleep loss contributes to increased risk for 19 chronic conditions such as obesity, diabetes, and hy- 20 pertension, all of which have increased prevalence in 21 underserved, underrepresented minorities. Racial 22 and ethnic disparities related to obesity may also 23 contribute to disparities in health outcomes related 24 to sleep-disordered breathing. 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 721 •S 3660 IS (10) Non-Caucasian adults report an insomnia 1 rate of 12.9 percent compared to only 6.6 percent 2 for Caucasians. 3 (11) African-American women have a higher in- 4 cidence of insomnia than African-American men, 5 perhaps related in part to higher risk for chronic 6 persisting symptoms. 7 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 8 SEARCH ACTIVITIES OF THE NATIONAL IN- 9 STITUTES OF HEALTH. 10 (a) IN GENERAL.—The Director of the National In- 11 stitutes of Health, acting through the Director of the Na- 12 tional Heart, Lung, and Blood Institute, shall— 13 (1) continue to expand research activities ad- 14 dressing sleep health disparities; and 15 (2) continue implementation of the NIH Sleep 16 Disorders Research Plan across all institutes and 17 centers of the National Institutes of Health to im- 18 prove treatment and prevention of sleep health dis- 19 parities. 20 (b) REQUIRED RESEARCH ACTIVITIES.—In con- 21 ducting or supporting research relating to sleep and circa- 22 dian rhythm, the Director of the National Heart, Lung, 23 and Blood Institute shall— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 722 •S 3660 IS (1) advance epidemiology and clinical research 1 to achieve a more complete understanding of dispari- 2 ties in domains of sleep health and across population 3 subgroups for which cardiovascular and metabolic 4 health disparities exist, including— 5 (A) prevalence and severity of sleep apnea; 6 (B) habitual sleep duration; 7 (C) sleep timing and regularity; and 8 (D) insomnia; 9 (2) develop study designs and analytical ap- 10 proaches to explain and predict multilevel and life- 11 course determinants of sleep health and to elucidate 12 the sleep-related causes of cardiovascular and meta- 13 bolic health disparities across the age spectrum, in- 14 cluding such determinants and causes that are— 15 (A) environmental; 16 (B) biological or genetic; 17 (C) psychosocial; 18 (D) societal; 19 (E) political; or 20 (F) economic; 21 (3) determine the contribution of sleep impair- 22 ments such as sleep apnea, insufficient sleep dura- 23 tion, irregular sleep schedules, and insomnia to un- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 723 •S 3660 IS explained disparities in cardiovascular and metabolic 1 risk and disease outcomes; 2 (4) develop study designs, data sampling and 3 collection tools, and analytical approaches to opti- 4 mize understanding of mediating and moderating 5 factors, and feedback mechanisms coupling sleep to 6 cardiovascular and metabolic health disparities; 7 (5) advance research to understand cultural 8 and linguistic barriers (on the person, provider, or 9 system level) to access to care, medical diagnosis, 10 and treatment of sleep disorders in diverse popu- 11 lation groups; 12 (6) develop and test multilevel interventions (in- 13 cluding sleep health education in diverse commu- 14 nities) to reduce disparities in sleep health that will 15 impact ability to improve disparities in cardio- 16 vascular and metabolic risk or disease; 17 (7) create opportunities to integrate sleep and 18 health disparity science by strategically utilizing re- 19 sources (existing or anticipated cohorts), exchanging 20 scientific data and ideas (cross-over into scientific 21 meetings), and develop multidisciplinary investi- 22 gator-initiated grant applications; and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 724 •S 3660 IS (8) enhance the diversity and foster career de- 1 velopment of young investigators involved in sleep 2 and health disparities science. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for fiscal year 2019 and 6 each subsequent fiscal year. 7 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 8 PARITIES-RELATED ACTIVITIES OF THE CEN- 9 TERS FOR DISEASE CONTROL AND PREVEN- 10 TION. 11 (a) IN GENERAL.—The Director of the Centers for 12 Disease Control and Prevention shall conduct, support, 13 and expand public health strategies and prevention, diag- 14 nosis, surveillance, and public and professional awareness 15 activities regarding sleep and circadian rhythm disorders. 16 (b) FINDINGS.—Congress finds as follows: 17 (1) Sleep disorders and sleep deficiency unre- 18 lated to a primary sleep disorder are underdiagnosed 19 and are increasingly detrimental to health status. 20 (2) The consequences to society include addi- 21 tional diseases, motor vehicle accidents, decreased 22 longevity, elevated direct medical costs, and indirect 23 costs related to work absenteeism and property dam- 24 age. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 725 •S 3660 IS (c) REQUIRED SURVEILLANCE AND EDUCATION 1 AWARENESS ACTIVITIES.—In conducting or supporting 2 research relating to sleep and circadian rhythm disorders 3 surveillance and education awareness activities, the Direc- 4 tor of the Centers for Disease Control and Prevention 5 shall— 6 (1) ensure that such activities are culturally 7 and linguistically appropriate to minority patients, 8 targeting sleep and circadian rhythm health pro- 9 motion and prevention programs of each major eth- 10 nic group, including— 11 (A) Native Americans and Alaska Natives; 12 (B) Asian Americans; 13 (C) African Americans and Blacks; 14 (D) Hispanic and Latino-Americans; and 15 (E) Native Hawaiians and Pacific Island- 16 ers; 17 (2) collect and compile national and State sur- 18 veillance data on sleep disorders health disparities; 19 (3) continue to develop and implement new 20 sleep questions in public health surveillance systems 21 to increase public awareness of sleep health and 22 sleep disorders and their impact on health; 23 (4) publish monthly reports highlighting geo- 24 graphic, racial, and ethnic disparities in sleep health, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 726 •S 3660 IS as well as relationships between insufficient sleep 1 and chronic disease, health risk behaviors, and other 2 outcomes as determined necessary by the Director; 3 and 4 (5) include public awareness campaigns that in- 5 form patient populations from major ethnic groups 6 about the prevalence of sleep and circadian rhythm 7 disorders and emphasize the importance of sleep 8 health. 9 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 10 out this section, there are authorized to be appropriated 11 such sums as may be necessary for fiscal year 2019 and 12 each subsequent fiscal year. 13 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR- 14 CADIAN HEALTH EDUCATION WITHIN 15 HEALTH PROFESSIONS SCHOOLS. 16 (a) PROGRAM AUTHORIZED.—The Secretary of 17 Health and Human Services (referred to in this section 18 as the ‘‘Secretary’’), in coordination with the Secretary of 19 Education, shall award grants, on a competitive basis, to 20 academic health science centers, health professions 21 schools, and other institutions of higher education to en- 22 able such institutions to provide people with comprehen- 23 sive education on sleep and circadian health, particu- 24 larly— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 727 •S 3660 IS (1) poor sleep health; 1 (2) sleep disorders; 2 (3) sleep health disparities; and 3 (4) the relationship between sleep and circadian 4 health on metabolic activity, neurological activity, 5 comorbidities, and other diseases. 6 (b) DURATION.—Grants awarded under this section 7 shall be for a period of 5 years. 8 (c) APPLICATIONS.—Any academic health science 9 center, health professions school, or other institutions of 10 higher education seeking a grant under this section shall 11 submit an application to the Secretary at such time, in 12 such manner, and containing such information as the Sec- 13 retary may require. 14 (d) PRIORITY.—In awarding grants under this sec- 15 tion, the Secretary shall give priority to an institution 16 that— 17 (1) has an enrollment of needy students, as de- 18 fined in section 318(b) of the Higher Education Act 19 of 1965 (20 U.S.C. 1059e(b)); 20 (2) is a Hispanic-serving institution, as defined 21 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 22 (3) is a Tribal College or University, as defined 23 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 728 •S 3660 IS (4) is an Alaska Native-serving institution, as 1 defined in section 317(b) of such Act (20 U.S.C. 2 1059d(b)); 3 (5) is a Native Hawaiian-serving institution, as 4 defined in section 317(b) of such Act (20 U.S.C. 5 1059d(b)); 6 (6) is a Predominately Black Institution, as de- 7 fined in section 318(b) of such Act (20 U.S.C. 8 1059e(b)); 9 (7) is a Native American-serving, nontribal in- 10 stitution, as defined in section 319(b) of such Act 11 (20 U.S.C. 1059f(b)); 12 (8) is an Asian-American and Native American 13 Pacific Islander-serving institution, as defined in 14 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 15 (9) is a minority institution, as defined in sec- 16 tion 365 of such Act (20 U.S.C. 1067k), with an en- 17 rollment of needy students, as defined in section 312 18 of such Act (20 U.S.C. 1058). 19 (e) USES OF FUNDS.—An institution of higher edu- 20 cation receiving a grant under this section may use grant 21 funds to integrate issues relating to comprehensive sleep 22 and circadian health into the academic or support sectors 23 of the institution in order to reach a large number of stu- 24 dents, by carrying out 1 or more of the following activities: 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 729 •S 3660 IS (1) Developing educational content for issues 1 relating to comprehensive sleep and circadian health 2 education that will be incorporated into first-year 3 orientation or core courses. 4 (2) Creating innovative technology-based ap- 5 proaches to deliver sleep health education to stu- 6 dents, faculty, and staff. 7 (3) Developing and employing peer-outreach 8 and education programs to generate discussion, edu- 9 cate, and raise awareness among students about 10 issues relating to poor quality sleep, sleep and circa- 11 dian disorders, and the role sleep health plays in 12 other diseases and comorbidities. 13 (f) REPORT TO CONGRESS.— 14 (1) IN GENERAL.—Not later than 1 year after 15 the date of the enactment of this Act, and annually 16 thereafter for a period of 5 years, the Secretary shall 17 prepare and submit to the appropriate committees of 18 Congress a report on the activities to provide health 19 professions students with comprehensive sleep and 20 circadian health education funded under this section. 21 (2) REPORT ELEMENTS.—The report described 22 in paragraph (1) shall include information about— 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 730 •S 3660 IS (A) the number of eligible entities and in- 1 stitutions of higher education that are receiving 2 grant funds; 3 (B) the specific activities supported by 4 grant funds; 5 (C) the number of students served by 6 grant programs; and 7 (D) the status of program evaluations. 8 SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 9 HEALTH DISORDERS IN VULNERABLE AND 10 RACIAL/ETHNIC POPULATIONS. 11 (a) IN GENERAL.—Not later than 1 year after the 12 date of enactment of this Act, the Secretary of Health and 13 Human Services shall submit to Congress and the Presi- 14 dent a report on the impact of sleep and circadian health 15 disorders for racial and ethnic minority communities and 16 other vulnerable populations. 17 (b) CONTENTS.—The report under subsection (a) 18 shall include information on the— 19 (1) progress that has been made in reducing 20 the impact of sleep and circadian health disorders in 21 such communities and populations; 22 (2) opportunities that exist to make additional 23 progress in reducing the impact of sleep and circa- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 731 •S 3660 IS dian health disorders in such communities and popu- 1 lations; 2 (3) challenges that may impede such additional 3 progress; and 4 (4) Federal funding necessary to achieve sub- 5 stantial reductions in sleep and circadian health dis- 6 orders in racial and ethnic minority communities. 7 Subtitle K—Sickle Cell Disease Re- 8 search, Surveillance, Preven- 9 tion, and Treatment 10 SEC. 796. SHORT TITLE. 11 This subtitle may be cited as the ‘‘Sickle Cell Disease 12 Research, Surveillance, Prevention, and Treatment Act of 13 2018’’. 14 SEC. 796A. SICKLE CELL DISEASE RESEARCH. 15 Part P of title III of the Public Health Service Act 16 (42 U.S.C. 280g et seq.), as amended by section 774, is 17 further amended by adding at the end the following: 18 ‘‘SEC. 399V–11. NATIONAL SICKLE CELL DISEASE RE- 19 SEARCH, SURVEILLANCE, PREVENTION, AND 20 TREATMENT PROGRAM. 21 ‘‘(a) RESEARCH.—The Secretary may conduct or 22 support research to expand the understanding of the cause 23 of, and to find a cure for, sickle cell disease.’’. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 732 •S 3660 IS SEC. 796B. SICKLE CELL DISEASE SURVEILLANCE. 1 Section 399V–11 of the Public Health Service Act, 2 as added by section 796A, is amended by adding at the 3 end the following: 4 ‘‘(b) SURVEILLANCE.— 5 ‘‘(1) GRANTS.—The Secretary may, for each 6 fiscal year for which appropriations are available to 7 carry out this subsection, make grants— 8 ‘‘(A) to conduct surveillance and maintain 9 data on the prevalence and distribution of sickle 10 cell disease and its associated health outcomes, 11 complications, and treatments; 12 ‘‘(B) to conduct public health initiatives 13 with respect to sickle cell disease, including— 14 ‘‘(i) increasing efforts to improve ac- 15 cess to, and receipt of, high-quality sickle 16 cell disease-related health care, including 17 the use of treatments approved under sec- 18 tion 505 of the Federal Food, Drug, and 19 Cosmetic Act or licensed under section 351 20 of this Act; 21 ‘‘(ii) working with partners to improve 22 health outcomes of people with sickle cell 23 disease over their lifespan by promoting 24 guidelines for sickle cell disease screening, 25 prevention, and treatment, including man- 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 733 •S 3660 IS agement of sickle cell disease complica- 1 tions; 2 ‘‘(iii) providing support to community- 3 based organizations and State and local 4 health departments in conducting sickle 5 cell disease education and training activi- 6 ties for patients, communities, and health 7 care providers; and 8 ‘‘(iv) supporting and training State 9 health departments and regional labora- 10 tories in comprehensive testing to identify 11 specific forms of sickle cell disease in peo- 12 ple of all ages; and 13 ‘‘(C) to identify and evaluate promising 14 strategies for prevention and treatment of sickle 15 cell disease complications, including through— 16 ‘‘(i) improving estimates of the na- 17 tional incidence and prevalence of sickle 18 cell disease, including estimates about the 19 specific types of sickle cell disease; 20 ‘‘(ii) identifying health disparities re- 21 lated to sickle cell disease; 22 ‘‘(iii) assessing the utilization of 23 therapies and strategies to prevent com- 24 plications related to sickle cell disease; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 734 •S 3660 IS ‘‘(iv) evaluating the impact of genetic, 1 environmental, behavioral, and other risk 2 factors that may affect sickle cell disease 3 health outcomes. 4 ‘‘(2) POPULATION INCLUDED.—The Secretary 5 shall, to the extent practicable, award grants under 6 this subsection to States, academic institutions, or 7 nonprofit organizations across the United States so 8 as to include data on the majority of the United 9 States population with sickle cell disease. 10 ‘‘(3) APPLICATION.—To seek a grant under this 11 subsection, a State, academic institution, or non- 12 profit organization shall submit an application to the 13 Secretary at such time, in such manner, and con- 14 taining such information as the Secretary may re- 15 quire.’’. 16 SEC. 796C. SICKLE CELL DISEASE PREVENTION AND 17 TREATMENT. 18 (a) REAUTHORIZATION.—Section 712(c) of the 19 American Jobs Creation Act of 2004 (Public Law 108– 20 357; 42 U.S.C. 300b–1 note) is amended— 21 (1) in paragraph (1)(A), by striking ‘‘grants to 22 up to 40 eligible entities for each fiscal year in which 23 the program is conducted under this section for the 24 purpose of developing and establishing systemic 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 735 •S 3660 IS mechanisms to improve the prevention and treat- 1 ment of Sickle Cell Disease’’ and inserting ‘‘grants 2 to up to 25 eligible entities for each fiscal year in 3 which the program is conducted under this section 4 for the purpose of developing and establishing sys- 5 temic mechanisms to improve the prevention and 6 treatment of sickle cell disease in populations with 7 a high density of sickle cell disease patients’’; 8 (2) by striking ‘‘Sickle Cell Disease’’ each place 9 such term appears and inserting ‘‘sickle cell dis- 10 ease’’; 11 (3) in paragraph (1)(B)— 12 (A) by striking clause (ii) (relating to pri- 13 ority); and 14 (B) by striking ‘‘GRANT AWARD REQUIRE- 15 MENTS’’ and all that follows through ‘‘the ad- 16 ministrator shall’’ and inserting ‘‘GEOGRAPHIC 17 DIVERSITY.—The Administrator shall’’; 18 (4) in paragraph (2), by adding the following 19 new subparagraph at the end: 20 ‘‘(E) To expand, coordinate, and imple- 21 ment transition services for adolescents with 22 sickle cell disease making the transition to adult 23 health care.’’; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 736 •S 3660 IS (5) in paragraph (6), by striking ‘‘$10,000,000 1 for each of fiscal years 2005 through 2009’’ and in- 2 serting ‘‘$4,455,000 for each of fiscal years 2019 3 through 2023’’. 4 (b) TECHNICAL CHANGES.—Subsection (c) of section 5 712 of the American Jobs Creation Act of 2004 (Public 6 Law 108–357; 42 U.S.C. 300b–1 note), as amended by 7 subsection (a), is— 8 (1) transferred to the Public Health Service Act 9 (42 U.S.C. 201 et seq.); and 10 (2) inserted at the end of section 399V–11 of 11 such Act, as added and amended by sections 796A 12 and 796B. 13 SEC. 796D. COLLABORATION WITH COMMUNITY-BASED EN- 14 TITIES. 15 Section 399V–11 of the Public Health Service Act, 16 as amended by section 796C, is further amended by add- 17 ing at the end the following: 18 ‘‘(d) COLLABORATION WITH COMMUNITY-BASED EN- 19 TITIES.—To be eligible to receive a grant or other assist- 20 ance under subsection (b) or (c), an entity shall have in 21 effect a collaborative agreement with a community-based 22 organization with 5 or more years of experience in pro- 23 viding services to sickle cell disease patients.’’. 24 VerDate Sep 11 2014 03:15 Nov 30, 2018 Jkt 089200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 737 •S 3660 IS TITLE VIII—HEALTH 1 INFORMATION TECHNOLOGY 2 SEC. 800. DEFINITIONS. 3 In this title: 4 (1) CERTIFIED ELECTRONIC HEALTH RECORD 5 TECHNOLOGY.—The term ‘‘certified EHR tech- 6 nology’’ has the meaning given such term in section 7 3000 of the Public Health Service Act (42 U.S.C. 8 300jj). 9 (2) EHR.—The term ‘‘EHR’’ means an elec- 10 tronic health record. 11 Subtitle A—Reducing Health 12 Disparities Through Health IT 13 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 14 PROMOTION OF HEALTH IT. 15 The Secretary of Health and Human Services, acting 16 through the Administrator of the Health Resources and 17 Services Administration, shall expand and intensify the 18 programs and activities of the Administration (directly or 19 through grants or contracts) to provide technical assist- 20 ance and resources to health centers (as defined in section 21 330(a) of the Public Health Service Act (42 U.S.C. 22 254b(a))) to adopt and meaningfully use certified EHR 23 technology for the management of chronic diseases and 24 health conditions and reduction of health disparities. 25 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 738 •S 3660 IS SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 1 CIAL AND ETHNIC MINORITY COMMUNITIES; 2 OUTREACH AND ADOPTION OF HEALTH IT IN 3 SUCH COMMUNITIES. 4 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 5 MATION TECHNOLOGY.— 6 (1) IN GENERAL.—The National Coordinator 7 for Health Information Technology (referred to in 8 this section as the ‘‘National Coordinator’’) shall— 9 (A) conduct an evaluation of the level of 10 use and accessibility of electronic health records 11 in racial and ethnic minority communities, fo- 12 cusing on whether patients in such communities 13 have providers who use electronic health 14 records, and indicating whether such pro- 15 viders— 16 (i) are participating in the Medicare 17 program under title XVIII of the Social 18 Security Act (42 U.S.C. 1395 et seq.) or 19 a State plan under title XIX of such Act 20 (42 U.S.C. 1396 et seq.) (or a waiver of 21 such plan); 22 (ii) have received incentive payments 23 or incentive payment adjustments under 24 Medicare and Medicaid Electronic Health 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 739 •S 3660 IS Records Incentive Programs (as defined in 1 subsection (c)(2)); 2 (iii) are MIPS eligible professionals, 3 as defined in paragraph (1)(C) of section 4 1848(q) of the Social Security Act (42 5 U.S.C. 1395w–4(q)), for purposes of the 6 Merit-Based Incentive Payment System 7 under such section; or 8 (iv) have been recruited by any of the 9 Health Information Technology Regional 10 Extension Centers established under sec- 11 tion 3012 of the Public Health Service Act 12 (42 U.S.C. 300jj–32); and 13 (2) publish the results of such evaluation in- 14 cluding the race and ethnicity of such providers and 15 the populations served by such providers. 16 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 17 As soon as practicable after the date of enactment of this 18 Act, the Director of the National Center for Health Statis- 19 tics shall provide to Congress a more detailed analysis of 20 the data presented in National Center for Health Statis- 21 tics data brief entitled ‘‘Adoption of Certified Electronic 22 Health Record Systems and Electronic Information Shar- 23 ing in Physician Offices: United States, 2013 and 2014’’ 24 (NCHS Data Brief No. 236). 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 740 •S 3660 IS (c) CENTERS FOR MEDICARE & MEDICAID SERV- 1 ICES.— 2 (1) IN GENERAL.—As part of the process of 3 collecting information, with respect to a provider, at 4 registration and attestation for purposes of Medicare 5 and Medicaid Electronic Health Records Incentive 6 Programs (as defined in paragraph (2)) or the 7 Merit-Based Incentive Payment System under sec- 8 tion 1848(q) of the Social Security Act (42 U.S.C. 9 1395w–4(q)), the Secretary of Health and Human 10 Services shall collect the race and ethnicity of such 11 provider. 12 (2) MEDICARE AND MEDICAID ELECTRONIC 13 HEALTH RECORDS INCENTIVE PROGRAMS DE- 14 FINED.—For purposes of paragraph (1), the term 15 ‘‘Medicare and Medicaid Electronic Health Records 16 Incentive Programs’’ means the incentive programs 17 under section 1814(l)(3), subsections (a)(7) and (o) 18 of section 1848, subsections (l) and (m) of section 19 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 20 1886, and subsections (a)(3)(F) and (t) of section 21 1903 of the Social Security Act (42 U.S.C. 22 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 23 1396b). 24 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 741 •S 3660 IS (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM- 1 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 2 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 3 amended— 4 (1) in the heading by inserting ‘‘, RACIAL AND 5 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 6 DISPARITIES’’; 7 (2) by inserting ‘‘, in communities with a high 8 proportion of individuals from racial and ethnic mi- 9 nority groups (as defined in section 1707(g)), in- 10 cluding people with disabilities in these groups,’’ 11 after ‘‘communities with health disparities’’; 12 (3) by striking ‘‘The National Coordinator’’ and 13 inserting the following: 14 ‘‘(i) IN GENERAL.—The National Co- 15 ordinator’’; and 16 (4) by adding at the end the following: 17 ‘‘(ii) CRITERIA.—In any publication 18 under clause (i), the National Coordinator 19 shall include best practices for encouraging 20 partnerships between the Federal Govern- 21 ment, States, and private entities to ex- 22 pand outreach for and the adoption of cer- 23 tified EHR technology in communities with 24 a high proportion of individuals from racial 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 742 •S 3660 IS and ethnic minority groups (as so defined), 1 while also maintaining the accessibility re- 2 quirements of section 508 of the Rehabili- 3 tation Act of 1973 to encourage patient in- 4 volvement in patient health care. The Na- 5 tional Coordinator shall— 6 ‘‘(I) not later than 6 months 7 after the submission of the report re- 8 quired under section 822 of the 9 Health Equity and Accountability Act 10 of 2018, establish criteria for evalu- 11 ating the impact of health information 12 technology on communities with a 13 high proportion of individuals from 14 racial and ethnic minority groups (as 15 so defined) taking into account the 16 findings in such report; and 17 ‘‘(II) not later than 1 year after 18 the submission of such report, conduct 19 and publish the results of an evalua- 20 tion of such impact.’’. 21 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 743 •S 3660 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), in the matter preceding 9 paragraph (1), by inserting ‘‘, including with respect 10 to communities with a high proportion of individuals 11 from racial and ethnic minority groups (as defined 12 in section 1707(g))’’ before the colon; and 13 (2) by adding at the end the following new sub- 14 section: 15 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 16 National Coordinator shall report annually to Congress on 17 activities and expenditures under this section.’’. 18 SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE- 19 VELOPMENT OF LOAN PROGRAMS TO FACILI- 20 TATE ADOPTION OF CERTIFIED EHR TECH- 21 NOLOGY BY PROVIDERS SERVING RACIAL 22 AND ETHNIC MINORITY GROUPS. 23 Section 3014(e) of the Public Health Service Act (42 24 U.S.C. 300jj–34(e)) is amended, in the matter preceding 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 744 •S 3660 IS paragraph (1), by inserting ‘‘, including with respect to 1 communities with a high proportion of individuals from 2 racial and ethnic minority groups (as defined in section 3 1707(g))’’ after ‘‘health care provider to’’. 4 SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 5 Section 3018 of the Public Health Service Act (42 6 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 7 2009 through 2013’’ and inserting ‘‘fiscal years 2019 8 through 2024’’. 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 745 •S 3660 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, a Hispanic-serv- 7 ing institution, a tribal college or univer- 8 sity, or an Asian-American-, Native Amer- 9 ican-, or Pacific Islander-serving institu- 10 tion with an accredited public health, 11 health policy, or health services research 12 program.’’. 13 SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 14 IN MEDICALLY UNDERSERVED COMMU- 15 NITIES. 16 (a) IN GENERAL.—Not later than 2 years after the 17 date of enactment of this Act, the Secretary of Health and 18 Human Services shall— 19 (1) enter into an agreement with the National 20 Academies of Sciences, Engineering, and Medicine to 21 conduct a study on the development, implementa- 22 tion, and effectiveness of health information tech- 23 nology within medically underserved areas (as de- 24 scribed in subsection (c)); and 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 746 •S 3660 IS (2) submit a report to Congress describing the 1 results of such study, including any recommenda- 2 tions for legislative or administrative action. 3 (b) STUDY.—The study described in subsection 4 (a)(1) shall— 5 (1) identify barriers to successful implementa- 6 tion of health information technology in medically 7 underserved areas; 8 (2) examine the impact of health information 9 technology on providing quality care and reducing 10 the cost of care to individuals in such areas, includ- 11 ing the impact of such technology on improved 12 health outcomes for individuals, including which 13 technology worked for which population and how it 14 improved health outcomes for that population; 15 (3) examine the impact of health information 16 technology on improving health care-related deci- 17 sions by both patients and providers in such areas; 18 (4) identify specific best practices for using 19 health information technology to foster the con- 20 sistent provision of physical accessibility and reason- 21 able policy accommodations in health care to individ- 22 uals with disabilities in such areas; 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 747 •S 3660 IS (5) assess the feasibility and costs associated 1 with the use of health information technology in 2 such areas; 3 (6) evaluate whether the adoption and use of 4 qualified electronic health records (as defined in sec- 5 tion 3000 of the Public Health Service Act (42 6 U.S.C. 300jj)) is effective in reducing health dispari- 7 ties, including analysis of clinical quality measures 8 reported by providers who are participating in the 9 Medicare program under title XVIII of the Social 10 Security Act (42 U.S.C. 1395 et seq.) or a State 11 plan under title XIX of such Act (42 U.S.C. 1396 12 et seq.) (or a waiver of such plan), pursuant to pro- 13 grams to encourage the adoption and use of certified 14 EHR technology; 15 (7) identify providers in medically underserved 16 areas that are not electing to adopt and use elec- 17 tronic health records and determine what barriers 18 are preventing those providers from adopting and 19 using such records; and 20 (8) examine urban and rural community health 21 systems and determine the impact that health infor- 22 mation technology may have on the capacity of pri- 23 mary health providers in those systems. 24 VerDate Sep 11 2014 22:54 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 748 •S 3660 IS (c) MEDICALLY UNDERSERVED AREA.—The term 1 ‘‘medically underserved area’’ means— 2 (1) a population that has been designated as a 3 medically underserved population under section 4 330(b)(3) of the Public Health Service Act (42 5 U.S.C. 254b(b)(3)); 6 (2) an area that has been designated as a 7 health professional shortage area under section 332 8 of the Public Health Service Act (42 U.S.C. 254e); 9 (3) an area or population that has been des- 10 ignated as a medically underserved community under 11 section 799B of the Public Health Service Act (42 12 U.S.C. 295p); or 13 (4) another area or population that— 14 (A) experiences significant barriers to ac- 15 cessing quality health services; and 16 (B) has a high prevalence of diseases or 17 conditions described in title VII, with such dis- 18 eases or conditions having a disproportionate 19 impact on racial and ethnic minority groups (as 20 defined in section 1707(g) of the Public Health 21 Service Act (42 U.S.C. 300u–6(g))) or a sub- 22 group of people with disabilities who have spe- 23 cific functional impairments. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 749 •S 3660 IS Subtitle D— Closing Gaps in 1 Funding To Adopt Certified EHRs 2 SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY- 3 MENTS TO REHABILITATION FACILITIES, 4 LONG-TERM CARE FACILITIES, AND HOME 5 HEALTH AGENCIES. 6 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So- 7 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend- 8 ed— 9 (1) in clause (i), by striking ‘‘, or’’ and insert- 10 ing a semicolon; 11 (2) in clause (ii), by striking the period at the 12 end and inserting a semicolon; and 13 (3) by inserting after clause (ii) the following 14 new clauses: 15 ‘‘(iii) a rehabilitation facility (as defined in sec- 16 tion 1886(j)(1)) that furnishes acute or subacute re- 17 habilitation services; 18 ‘‘(iv) a long-term care hospital (as defined in 19 section 1886(d)(1)(B)(iv)(I)); or 20 ‘‘(v) a home health agency (as defined in sec- 21 tion 1861(o)).’’. 22 (b) EFFECTIVE DATE.—The amendment made by 23 subsection (a) shall apply with respect to amounts ex- 24 pended under section 1903(a)(3)(F) of the Social Security 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 750 •S 3660 IS Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 1 ginning on or after the date of the enactment of this Act. 2 SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 3 FOR MEDICAID ELECTRONIC HEALTH 4 RECORD INCENTIVE PAYMENTS. 5 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 6 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 7 amended to read as follows: 8 ‘‘(v) physician assistant.’’. 9 (b) EFFECTIVE DATE.—The amendment made by 10 subsection (a) shall apply with respect to amounts ex- 11 pended under section 1903(a)(3)(F) of the Social Security 12 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 13 ginning on or after the date of the enactment of this Act. 14 TITLE IX—ACCOUNTABILITY 15 AND EVALUATION 16 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 17 ASSISTED HEALTH CARE SERVICES AND RE- 18 SEARCH PROGRAMS ON THE BASIS OF SEX, 19 RACE, COLOR, NATIONAL ORIGIN, MARITAL 20 STATUS, FAMILIAL STATUS, SEXUAL ORI- 21 ENTATION, GENDER IDENTITY, OR DIS- 22 ABILITY STATUS. 23 (a) IN GENERAL.—No person in the United States 24 shall, on the basis of sex, race, color, national origin, mar- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 751 •S 3660 IS ital status, familial status, sexual orientation, gender iden- 1 tity, or disability status, be excluded from participation 2 in, be denied the benefits of, or be subjected to discrimina- 3 tion under any health program or activity, including any 4 health research program or activity, receiving Federal fi- 5 nancial assistance. 6 (b) DEFINITION.—In this section, the term ‘‘familial 7 status’’ means, with respect to one or more individuals— 8 (1) being domiciled with any individual related 9 by blood or affinity whose close association with the 10 individual is the equivalent of a family relationship; 11 (2) being in the process of securing legal cus- 12 tody of any individual; or 13 (3) being pregnant. 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 Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 752 •S 3660 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 C the following: 6 ‘‘Subtitle D—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 that receive Federal financial as- 16 sistance are in compliance with title VI of the Civil Rights 17 Act, including through the following activities: 18 ‘‘(1) The development and implementation of 19 an action plan to address racial and ethnic health 20 care disparities, which shall address concerns relat- 21 ing to the Office for Civil Rights as released by the 22 United States Commission on Civil Rights in the re- 23 port entitled ‘Health Care Challenge: Acknowledging 24 Disparity, Confronting Discrimination, and Ensur- 25 ing Equity’ (September 1999) in conjunction with 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 753 •S 3660 IS the reports by the National Academy of Sciences 1 (formerly known as the Institute of Medicine) enti- 2 tled ‘Unequal Treatment: Confronting Racial and 3 Ethnic Disparities in Health Care’, ‘Crossing the 4 Quality Chasm: A New Health System for the 21st 5 Century’, ‘In the Nation’s Compelling Interest: En- 6 suring Diversity in the Health Care Workforce’, 7 ‘The National Partnership for Action to End Health 8 Disparities’, and ‘The Health of Lesbian, Gay, Bi- 9 sexual, and Transgender People’, and other related 10 reports by the National Academy of Sciences. This 11 plan shall be publicly disclosed for review and com- 12 ment and the final plan shall address any comments 13 or concerns that are received 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, gender iden- 18 tity, sexual orientation, sex, disability status, socio- 19 economic status, and primary language health data 20 collected by Federal health agencies to assess health 21 care disparities related to intentional discrimination 22 and policies and practices that have a disparate im- 23 pact on minorities. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 754 •S 3660 IS ‘‘(4) Outreach and education activities relating 1 to compliance with title VI of the Civil Rights Act. 2 ‘‘(5) The provision of technical assistance for 3 health entities to facilitate compliance with title VI 4 of the Civil Rights Act. 5 ‘‘(6) Coordination and oversight of activities of 6 the civil rights compliance offices established under 7 section 3442. 8 ‘‘(7) Ensuring— 9 ‘‘(A) at a minimum, compliance with the 10 most recent version of the Office of Manage- 11 ment and Budget statistical policy directive en- 12 titled ‘Standards for Maintaining, Collecting, 13 and Presenting Federal Data on Race and Eth- 14 nicity’; and 15 ‘‘(B) consideration of available data and 16 language standards such as— 17 ‘‘(i) the standards for collecting and 18 reporting data under section 3101; and 19 ‘‘(ii) the National Standards on Cul- 20 turally and Linguistically Appropriate 21 Services of the Office of Minority Health. 22 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 23 sure the effectiveness of the Office of Health Disparities 24 by ensuring that the Office is provided with— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 755 •S 3660 IS ‘‘(1) adequate funding to enable the Office to 1 carry out its duties under this section; and 2 ‘‘(2) staff with expertise in— 3 ‘‘(A) epidemiology; 4 ‘‘(B) statistics; 5 ‘‘(C) health quality assurance; 6 ‘‘(D) minority health and health dispari- 7 ties; 8 ‘‘(E) cultural and linguistic competency; 9 ‘‘(F) civil rights; and 10 ‘‘(G) social, behavioral, and economic de- 11 terminants of health. 12 ‘‘(d) REPORT.—Not later than December 31, 2019, 13 and annually thereafter, the Secretary, in collaboration 14 with the Director of the Office for Civil Rights and the 15 Deputy Assistant Secretary for Minority Health, shall 16 submit a report to the Committee on Health, Education, 17 Labor, and Pensions of the Senate and the Committee on 18 Energy and Commerce of the House of Representatives 19 that includes— 20 ‘‘(1) the number of cases filed, broken down by 21 category; 22 ‘‘(2) the number of cases investigated and 23 closed by the office; 24 ‘‘(3) the outcomes of cases investigated; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 756 •S 3660 IS ‘‘(4) the staffing levels of the office including 1 staff credentials; 2 ‘‘(5) the number of other lingering and emerg- 3 ing cases in which civil rights inequities can be dem- 4 onstrated; and 5 ‘‘(6) the number of cases remaining open and 6 an explanation for their open status. 7 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2019 through 2024. 11 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 12 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 13 HEALTH AND HUMAN SERVICES AGENCIES. 14 ‘‘(a) IN GENERAL.—The Secretary shall establish 15 civil rights compliance offices in each agency within the 16 Department of Health and Human Services that admin- 17 isters health programs. 18 ‘‘(b) PURPOSE OF OFFICES.—Each office established 19 under subsection (a) shall ensure that recipients of Fed- 20 eral financial assistance under Federal health programs 21 administer programs, services, and activities in a manner 22 that— 23 ‘‘(1) does not discriminate, either intentionally 24 or in effect, on the basis of race, national origin, lan- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 757 •S 3660 IS guage, ethnicity, sex, age, disability, sexual orienta- 1 tion, and gender identity; and 2 ‘‘(2) promotes the reduction and elimination of 3 disparities in health and health care based on race, 4 national origin, language, ethnicity, sex, age, dis- 5 ability, sexual orientation, and gender identity. 6 ‘‘(c) POWERS AND DUTIES.—The offices established 7 in subsection (a) shall have the following powers and du- 8 ties: 9 ‘‘(1) The establishment of compliance and pro- 10 gram participation standards for recipients of Fed- 11 eral financial assistance under each program admin- 12 istered by the applicable agency, including the estab- 13 lishment of disparity reduction standards to encom- 14 pass disparities in health and health care related to 15 race, national origin, language, ethnicity, sex, age, 16 disability, sexual orientation, and gender identity. 17 ‘‘(2) The development and implementation of 18 program-specific guidelines that interpret and apply 19 Department of Health and Human Services guid- 20 ance under title VI of the Civil Rights Act of 1964 21 and section 1557 of the Patient Protection and Af- 22 fordable Care Act to each Federal health program 23 administered by the agency. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 758 •S 3660 IS ‘‘(3) The development of a disparity-reduction 1 impact analysis methodology that shall be applied to 2 every rule issued by the agency and published as 3 part of the formal rulemaking process under sections 4 555, 556, and 557 of title 5, United States Code. 5 ‘‘(4) Oversight of data collection, analysis, and 6 publication requirements for all recipients of Federal 7 financial assistance under each Federal health pro- 8 gram administered by the agency; compliance with, 9 at a minimum, the most recent version of the Office 10 of Management and Budget statistical policy direc- 11 tive entitled ‘Standards for Maintaining, Collecting, 12 and Presenting Federal Data on Race and Eth- 13 nicity’; and consideration of available data and lan- 14 guage standards such as— 15 ‘‘(A) the standards for collecting and re- 16 porting data under section 3101; and 17 ‘‘(B) the National Standards on Culturally 18 and Linguistically Appropriate Services of the 19 Office of Minority Health. 20 ‘‘(5) The conduct of publicly available studies 21 regarding discrimination within Federal health pro- 22 grams administered by the agency as well as dis- 23 parity reduction initiatives by recipients of Federal 24 financial assistance under Federal health programs. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 759 •S 3660 IS ‘‘(6) Annual reports to the Committee on 1 Health, Education, Labor, and Pensions and the 2 Committee on Finance of the Senate and the Com- 3 mittee on Energy and Commerce and the Committee 4 on Ways and Means of the House of Representatives 5 on the progress in reducing disparities in health and 6 health care through the Federal programs adminis- 7 tered by the agency. 8 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 9 IN THE DEPARTMENT OF JUSTICE.— 10 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 11 SERVICES.—The Office for Civil Rights of the De- 12 partment of Health and Human Services shall pro- 13 vide standard-setting and compliance review inves- 14 tigation support services to the Civil Rights Compli- 15 ance Office for each agency described in subsection 16 (a), subject to paragraph (2). 17 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 18 for Civil Rights of the Department of Justice may, 19 as appropriate, institute formal proceedings when a 20 civil rights compliance office established under sub- 21 section (a) determines that a recipient of Federal fi- 22 nancial assistance is not in compliance with the dis- 23 parity reduction standards of the applicable agency. 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 760 •S 3660 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, including health service 9 programs.’’. 10 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 11 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 12 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 13 TIES.—Section 3(a) of the Civil Rights Commission Act 14 of 1983 (42 U.S.C. 1975a(a)) is amended— 15 (1) in paragraph (1), by striking ‘‘and’’ at the 16 end; 17 (2) in paragraph (2), by striking the period at 18 the end and inserting ‘‘; and’’; and 19 (3) by adding at the end the following: 20 ‘‘(3) shall, with respect to activities carried out 21 in health care and correctional facilities toward the 22 goal of eliminating health disparities between the 23 general population and members of minority groups 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 761 •S 3660 IS based on race or color, promote coordination of such 1 activities of— 2 ‘‘(A) the Office for Civil Rights within the 3 Office of Justice Programs of the Department 4 of Justice; 5 ‘‘(B) the Office of Justice Programs within 6 the Department of Justice; 7 ‘‘(C) the Office for Civil Rights within the 8 Department of Health and Human Services; 9 and 10 ‘‘(D) the Office of Minority Health within 11 the Department of Health and Human Services 12 (headed by the Deputy Assistant Secretary for 13 Minority Health).’’. 14 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 15 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 16 1975c) is amended by striking the first sentence and in- 17 serting the following: ‘‘For the purpose of carrying out 18 this Act, there are authorized to be appropriated 19 $30,000,000 for fiscal year 2019, and such sums as may 20 be necessary for each of the fiscal years 2020 through 21 2024.’’. 22 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 762 •S 3660 IS SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 1 ING OF ACTIVITIES TO ELIMINATE RACIAL 2 AND ETHNIC HEALTH DISPARITIES. 3 (a) FINDINGS.—Congress makes the following find- 4 ings: 5 (1) The health status of the population of the 6 United States is declining and the United States 7 currently ranks below most industrialized nations in 8 health status measured by longevity, sickness, and 9 mortality. 10 (2) Racial and ethnic minority populations tend 11 to have the poorest health status and face substan- 12 tial cultural, social, and economic barriers to obtain- 13 ing quality health care. 14 (3) Lesbian, gay, bisexual, transgender, queer, 15 and questioning populations experience significant 16 personal and structural barriers to obtaining high- 17 quality health care. 18 (4) Efforts to improve minority health have 19 been limited by inadequate resources (funding, staff- 20 ing, and stewardship) and lack of accountability. 21 (b) SENSE OF CONGRESS.—It is the sense of Con- 22 gress that— 23 (1) health disparities negatively impact out- 24 comes for health and human security of the Nation; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 763 •S 3660 IS (2) reducing racial, ethnic, sexual, and gender 1 disparities in prevention and treatment are unique 2 civil and human rights challenges and, as such, Fed- 3 eral agencies and health care entities and systems 4 receiving Federal funds should be accountable for 5 their role in causing disparities and inequity; 6 (3) funding for the National Institute for Mi- 7 nority Health Disparities, the Office of Civil Rights 8 in the Department of Health and Human Services, 9 the National Institute of Nursing Research, and the 10 Office of Minority Health should be doubled by fiscal 11 year 2020; 12 (4) adequate funding by fiscal year 2020, and 13 subsequent funding increases, should be provided for 14 health and human service professions training pro- 15 grams, the Racial and Ethnic Approaches to Com- 16 munity Health Initiative at the Centers for Disease 17 Control and Prevention, the Minority HIV/AIDS 18 Initiative, and the Excellence Centers to Eliminate 19 Ethnic/Racial Disparities Program at the Agency for 20 Healthcare Research and Quality; 21 (5) funding should be fully restored to the Ra- 22 cial and Ethnic Approaches to Community Health 23 Initiative at the Centers for Disease Control and 24 Prevention, which has been a successful program at 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 764 •S 3660 IS the community health level, and efforts should con- 1 tinue to place a strong emphasis on building commu- 2 nity capacity to secure financial resources and tech- 3 nical assistance to eliminate health disparities; 4 (6) adequate funding for fiscal year 2020 and 5 increased funding for future years should be pro- 6 vided for the Racial and Ethnic Approaches to Com- 7 munity Health Initiative’s United States Risk Fac- 8 tor Survey to ensure adequate data collection to 9 track health disparities, and there should be appro- 10 priate avenues provided to disseminate findings to 11 the general public; 12 (7) current and newly created health disparity 13 elimination incentives, programs, agencies, and de- 14 partments under this Act (and the amendments 15 made by this Act) should receive adequate staffing 16 and funding by fiscal year 2020; and 17 (8) stewardship and accountability should be 18 provided to the Congress and the President for 19 measurable and sustainable progress toward health 20 disparity elimination. 21 SEC. 906. GAO AND NIH REPORTS. 22 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 23 NIC DIVERSITY.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 765 •S 3660 IS (1) IN GENERAL.—The Comptroller General of 1 the United States shall conduct a study on the racial 2 and ethnic diversity among the following groups: 3 (A) All applicants for grants, contracts, 4 and cooperative agreements awarded by the Na- 5 tional Institutes of Health during the period be- 6 ginning on January 1, 2006, and ending De- 7 cember 31, 2017. 8 (B) All recipients of such grants, con- 9 tracts, and cooperative agreements during such 10 period. 11 (C) All members of the peer review panels 12 of such applicants and recipients, respectively. 13 (2) REPORT.—Not later than 6 months after 14 the date of the enactment of this Act, the Comp- 15 troller General shall complete the study under para- 16 graph (1) and submit to Congress a report con- 17 taining the results of such study. 18 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 19 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 20 DISPARITIES.—Not later than 6 months after the date of 21 the enactment of this Act, and biennially thereafter, the 22 Director of the National Institutes of Health, in collabora- 23 tion with the Director of the National Institute on Minor- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 766 •S 3660 IS ity Health and Health Disparities, shall submit to Con- 1 gress a report that details and evaluates— 2 (1) the steps taken during the applicable report 3 period by the Director of the National Institutes of 4 Health to enforce the expanded planning, coordina- 5 tion, review, and evaluation authority provided the 6 National Institute on Minority Health and Health 7 Disparities under section 464z–3(h) of the Public 8 Health Service Act (42 U.S.C. 285(h)) over all mi- 9 nority health and health disparity research that is 10 conducted or supported by the Institutes and Cen- 11 ters at the National Institutes of Health; and 12 (2) the outcomes of such steps. 13 (c) GAO REPORT RELATED TO RECIPIENTS OF 14 PPACA FUNDING.—Not later than one year after the 15 date of the enactment of this Act and biennially thereafter 16 until 2022, the Comptroller General of the United States 17 shall submit to Congress a report that identifies— 18 (1) the racial and ethnic diversity of commu- 19 nity-based organizations that applied for Federal en- 20 rollment funding provided pursuant to the Patient 21 Protection and Affordable Care Act (Public Law 22 111–148) (including the amendments made by such 23 Act); 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 767 •S 3660 IS (2) the percentage of such organizations that 1 were awarded such funding; and 2 (3) the impact of such community-based organi- 3 zations’ enrollment efforts on the insurance status of 4 their communities. 5 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 6 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 7 PARITIES.—The Director of the National Institute on Mi- 8 nority Health and Health Disparities shall prepare an an- 9 nual report on the activities carried out or to be carried 10 out by such institute, and shall submit each such report 11 to the Committee on Health, Education, Labor, and Pen- 12 sions of the Senate, the Committee on Energy and Com- 13 merce of the House of Representatives, the Secretary of 14 Health and Human Services, and the Director of the Na- 15 tional Institutes of Health. With respect to the fiscal year 16 involved, the report shall— 17 (1) describe and evaluate the progress made in 18 health disparities research conducted or supported 19 by institutes and centers of the National Institutes 20 of Health; 21 (2) summarize and analyze expenditures made 22 for activities with respect to health disparities re- 23 search conducted or supported by the National Insti- 24 tutes of Health; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 768 •S 3660 IS (3) include a separate statement applying the 1 requirements of paragraphs (1) and (2) specifically 2 to minority health disparities research; and 3 (4) contain such recommendations as the Direc- 4 tor of the Institute considers appropriate. 5 TITLE X—ADDRESSING SOCIAL 6 DETERMINANTS AND IM- 7 PROVING ENVIRONMENTAL 8 JUSTICE 9 Subtitle A—In General 10 SEC. 1001. DEFINITIONS. 11 In this title: 12 (1) DETERMINANTS OF HEALTH.—The term 13 ‘‘determinants of health’’— 14 (A) means the range of personal, social, 15 economic, and environmental factors that influ- 16 ence health status; and 17 (B) includes social determinants of health 18 (which are sometimes referred to as ‘‘social and 19 economic determinants of health’’ or ‘‘socio- 20 economic determinants of health’’), environ- 21 mental determinants of health, and personal de- 22 terminants of health. 23 (2) ENVIRONMENTAL DETERMINANTS OF 24 HEALTH.—The term ‘‘environmental determinants 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 769 •S 3660 IS of health’’ means the broad physical, psychological, 1 social, and aesthetic environment. 2 (3) PERSONAL DETERMINANTS OF HEALTH.— 3 The term ‘‘personal determinants of health’’ means 4 an individual’s behavior, biology, and genetics. 5 (4) SOCIAL DETERMINANTS OF HEALTH.—The 6 term ‘‘social determinants of health’’ means a subset 7 of determinants of the health of individuals and en- 8 vironments (such as communities, neighborhoods, 9 and societies) that describe an individual’s or group 10 of people’s social identity, describe the social and 11 economic resources to which such individual or 12 group has access, and describe the conditions in 13 which an individual or group of people works, lives, 14 and plays. 15 SEC. 1002. FINDINGS. 16 Congress finds as follows: 17 (1) There are more opportunities to improve 18 health for everyone when we understand that health 19 starts, first, not in a medical setting, but in our 20 families, in our schools and workplaces, in our 21 neighborhoods, in the air we breathe, and in the 22 water we drink. 23 (2) The social determinants of health are the 24 largest predictors of health outcomes. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 770 •S 3660 IS (3)(A) Healthy People 2020 identifies health 1 and health care quality as a function of not only ac- 2 cess to health care, but also the social determinants 3 of health, categorized into the following: neighbor- 4 hoods and the built environment; social and commu- 5 nity context; education; and economic stability. 6 (B) The following examples illustrate the nexus 7 between the unequal distribution of the social deter- 8 minants of health and health disparities: 9 (i) The built environment influences resi- 10 dents’ level of physical activity. Neighborhoods 11 with high levels of poverty are significantly less 12 likely to have places where children can be 13 physically active, such as parks, green spaces, 14 and bike paths and lanes. Neighborhoods and 15 communities can provide opportunities for phys- 16 ical activity and support active lifestyles 17 through accessible and safe parks and open 18 spaces and through land use policy, zoning, and 19 healthy community design. 20 (ii) Emotional and physical health and 21 well-being are directly impacted by perceived 22 levels of safety, such as unlit streets at night. 23 Community members have expressed that safety 24 is not only a barrier to accessing programs and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 771 •S 3660 IS services that increase quality of life but they 1 are also not able to access physical activity in 2 their community through the built environment. 3 (iii) In many workplace environments, 4 toxic chemicals have lasting detrimental effects 5 on employees’ health. The hazardous com- 6 pounds found in most nail salon products affect 7 the respiratory system, reproductive system, 8 and central nervous system, and also cause kid- 9 ney and liver damage. Recognizing the impor- 10 tance of addressing occupational hazards as a 11 matter of public health, especially for Viet- 12 namese women who constitute 48 percent of 13 nail salon technicians, the White House Initia- 14 tive on Asian American Pacific Islanders has 15 created an interagency working group to coordi- 16 nate efforts by the Environmental Protection 17 Agency, Occupational and Safety Health Ad- 18 ministration, Food and Drug Administration, 19 and other Federal agencies to create program- 20 ming, draft regulations, and conduct more out- 21 reach on educating workers on health and safe- 22 ty issues. 23 (iv) Historical and institutional discrimina- 24 tion against certain racial groups in the United 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 772 •S 3660 IS States has shaped the way in which social and 1 economic resources and exposure to health pro- 2 moting environments are distributed. Income, 3 education, occupation, neighborhood conditions, 4 schools, workplaces, the use of health and social 5 services, and experiences with the criminal jus- 6 tice system are all highly patterned by race, 7 with non-White racial groups experiencing more 8 that is health harming. Finding ways to uncou- 9 ple the link between race and access to re- 10 sources and healthy environments is a principal 11 means of reducing health disparities. Addition- 12 ally, the anticipation of racism itself causes 13 higher psychological and cardiovascular stress 14 levels that are linked to poor health outcomes. 15 Remedying discriminatory practices at the indi- 16 vidual and systemic levels will likely reduce 17 health disparities caused by this unequal dis- 18 tribution of stress. 19 (v) Poor health among Native Americans 20 has largely been driven by post-colonial oppres- 21 sion and historical trauma. The expropriation of 22 native lands and territories to the American 23 state had severe consequences on Native Amer- 24 ican health. This resulted in the deprivation of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 773 •S 3660 IS traditional food sources—and nutrients—for 1 Native Americans and also the destruction of 2 traditional economies and community organiza- 3 tion. Today, Native Americans have twice the 4 rate of diabetes of non-Hispanic Whites. Rec- 5 ognition of the origins of the diabetes as having 6 a social and community context, rather than 7 just individual responsibility and genetic pre- 8 disposition, will shape better policy to provide 9 food security. 10 (vi) In the context of prisons, overcrowding 11 has led to the deterioration of the physical and 12 mental health of individuals after they leave 13 prison. In particular, the mass incarceration of 14 African-American males as a result of unequal 15 contact with and treatment in the criminal jus- 16 tice system has contributed to an overburdening 17 of certain infectious diseases within the African- 18 American community. As a social institution, 19 incarceration amplifies existing adverse health 20 conditions by concentrating diseases and harm- 21 ful health behaviors such as tobacco use, drug 22 use, and violence. 23 (vii) Educational attainment is the strong- 24 est predictor of adult mortality. It is a basic 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 774 •S 3660 IS component of socioeconomic status that shapes 1 earning potential to access resources that pro- 2 mote health. People with more education are 3 less likely to report that they are in poor health, 4 and are also less likely to have diabetes and 5 other chronic diseases. 6 (viii) Similarly, reading ability is a strong 7 predictor of adult health status and greater 8 reading ability is negatively correlated with 9 other child health issues, such as developmental 10 problems, vision and hearing impairments, and 11 frequent school absence due to illness. 12 (ix) Individuals with lower levels of edu- 13 cational attainment are much more likely to re- 14 port to be current smokers. In 2015, smoking 15 prevalence was 34.1 percent among adults with 16 a GED diploma, 24.2 percent with less than a 17 high school diploma, and 19.8 percent with a 18 high school diploma, while dropping signifi- 19 cantly to 7.4 percent among adults with an un- 20 dergraduate college degree and 3.6 percent with 21 a postgraduate college degree. 22 (x) Social class differences account for a 23 large part of health disparities. For example, 24 children living in poverty experience poorer 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 775 •S 3660 IS housing conditions, increased exposure to in- 1 door allergens and toxins (such as pesticides, 2 lead, mercury, radon, air pollution, and carcino- 3 gens), and more psychological stress. These ex- 4 periences culminate in worse adult health as 5 compared with children with higher socio- 6 economic status. Specifically, children living in 7 socioeconomic neighborhoods have higher rates 8 of asthma due to higher rates of psychological 9 stress resulting from higher rates of violence. 10 (xi) Lesbian, gay, bisexual, transgender, 11 queer, questioning, questioning and intersex 12 (LGBTQIA) individuals face health disparities 13 linked to societal stigma, discrimination, and 14 denial of their civil and human rights. Discrimi- 15 nation against LGBTQIA individuals has been 16 associated with high rates of psychiatric dis- 17 orders, substance abuse, and suicide. Experi- 18 ences of violence and victimization are frequent 19 for LGBTQIA individuals, and have long-last- 20 ing effects on the individual and the commu- 21 nity. Personal, family, and social acceptance of 22 sexual orientation and gender identity affects 23 the mental health and personal safety of 24 LGBTQIA individuals. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 776 •S 3660 IS (xii) Individuals in older and cheaper hous- 1 ing are at higher risks to be exposed to lead, 2 particularly in housing built prior to 1960. The 3 threat of lead poisoning disproportionally af- 4 fects vulnerable populations, with children living 5 in poverty (5.6 percent) and Black children 6 (5.6) experiencing the highest rates. According 7 to the Department of Housing and Urban De- 8 velopment, about 3,600,000 homes nationwide 9 that house young children have lead hazards 10 such as peeling paint, contaminated dust, or 11 toxic soil. The combined cost of medical treat- 12 ment and special education for lead poisoned 13 children averages about $5,600 per child per 14 year, and lead poisoning costs the United 15 States an estimated $50,000,000,000 annually. 16 (4) Laws and regulations that improve opportu- 17 nities to live in safe neighborhoods, with more social 18 cohesion, attain higher education, sustain stable em- 19 ployment, and bridge class differences help foster 20 the health and safety of individuals. 21 (5) The global public health community has 22 reached consensus through the Rio Political Declara- 23 tion of Social Determinants of Health adopted by 24 the World Health Organisation in October 2011 that 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 777 •S 3660 IS ‘‘[c]ollaboration in coordinated and intersectoral pol- 1 icy actions has proven to be effective. Health in All 2 Policies, an initiative of the American Public Health 3 Association, together with intersectoral cooperation 4 and action, is one promising approach to enhance 5 accountability in other sectors of health, as well as 6 the promotion of health equity and more inclusive 7 and productive societies.’’. 8 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 9 (a) FINDINGS.—Congress makes the following find- 10 ings: 11 (1) Health Impact Assessment is a tool to help 12 planners, health officials, decisionmakers, and the 13 public make more informed decisions about the po- 14 tential health effects of proposed plans, policies, pro- 15 grams, and projects in order to maximize health 16 benefits and minimize harms. 17 (2) Health Impact Assessments can be done at 18 a fraction of the cost and time typically required for 19 other planning and permitting reviews. 20 (3) Health Impact Assessments can build com- 21 munity support and reduce opposition to a project or 22 policy, thereby facilitating economic growth by aid- 23 ing the development of consensus regarding new de- 24 velopment proposals. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 778 •S 3660 IS (4) Health Impact Assessments facilitate col- 1 laboration across sectors. 2 (b) PURPOSES.—It is the purpose of this section to— 3 (1) provide more information about the poten- 4 tial human health effects of policy decisions and the 5 distribution of those effects; 6 (2) improve how health is considered in plan- 7 ning and decisionmaking processes; and 8 (3) build stronger, healthier communities 9 through the use of Health Impact Assessment. 10 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 11 III of the Public Health Service Act (42 U.S.C. 280g et 12 seq.), as amended by section 796A, is further amended 13 by adding at the end the following: 14 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 15 ‘‘(a) DEFINITIONS.—In this section: 16 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 17 trator’ means the Administrator of the Environ- 18 mental Protection Agency. 19 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 20 environment’ means the components of the environ- 21 ment, and the location of these components in a geo- 22 graphically defined space, that are created or modi- 23 fied by individuals to form the physical and social 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 779 •S 3660 IS characteristics of a community or enhance quality of 1 human life, including— 2 ‘‘(A) homes, schools, and places of work 3 and worship; 4 ‘‘(B) parks, recreation areas, and green- 5 ways; 6 ‘‘(C) transportation systems; 7 ‘‘(D) business, industry, and agriculture; 8 and 9 ‘‘(E) land-use plans, projects, and policies 10 that impact the physical or social characteris- 11 tics of a community, including access to services 12 and amenities. 13 ‘‘(3) DIRECTOR.—The term ‘Director’ means 14 the Director of the Centers for Disease Control and 15 Prevention. 16 ‘‘(4) HEALTH IMPACT ASSESSMENT.—The term 17 ‘health impact assessment’ means a systematic proc- 18 ess that uses an array of data sources and analytic 19 methods and considers input from stakeholders to 20 determine the potential effects of a proposed policy, 21 plan, program, or project on the health of a popu- 22 lation and the distribution of those effects within the 23 population. Such term includes identifying and rec- 24 ommending appropriate actions on monitoring and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 780 •S 3660 IS maximizing potential benefits and minimizing the 1 potential harms. 2 ‘‘(5) HEALTH DISPARITY.—The term ‘health 3 disparity’ means a particular type of health dif- 4 ference that is closely linked with social, economic, 5 or environmental disadvantage and that adversely 6 affects groups of people who have systematically ex- 7 perienced greater obstacles to health based on their 8 racial or ethnic group; religion; socioeconomic status; 9 gender; age; mental health; cognitive, sensory, or 10 physical disability; sexual orientation or gender iden- 11 tity; geographic location; or other characteristics his- 12 torically linked to discrimination or exclusion. 13 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 14 through the Director and in collaboration with the Admin- 15 istrator, shall— 16 ‘‘(1) in consultation with the Director of the 17 National Center for Chronic Disease Prevention and 18 Health Promotion and relevant offices within the 19 Department of Housing and Urban Development, 20 the Department of Transportation, and the Depart- 21 ment of Agriculture, establish a program at the Na- 22 tional Center for Environmental Health at the Cen- 23 ters for Disease Control and Prevention focused on 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 781 •S 3660 IS advancing the field of health impact assessment that 1 includes— 2 ‘‘(A) collecting and disseminating best 3 practices; 4 ‘‘(B) administering capacity building 5 grants to States to support grantees in initi- 6 ating health impact assessments, in accordance 7 with subsection (d); 8 ‘‘(C) providing technical assistance; 9 ‘‘(D) developing training tools and pro- 10 viding training on conducting health impact as- 11 sessment and the implementation of built envi- 12 ronment and health indicators; 13 ‘‘(E) making information available, as ap- 14 propriate, regarding the existence of other com- 15 munity healthy living tools, checklists, and indi- 16 ces that help connect public health to other sec- 17 tors, and tools to help examine the effect of the 18 indoor built environment and building codes on 19 population health; 20 ‘‘(F) conducting research and evaluations 21 of health impact assessments; and 22 ‘‘(G) awarding competitive extramural re- 23 search grants; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 782 •S 3660 IS ‘‘(2) develop guidance and guidelines to conduct 1 health impact assessments in accordance with sub- 2 section (c); and 3 ‘‘(3) establish a grant program to allow States 4 to fund eligible entities to conduct health impact as- 5 sessments. 6 ‘‘(c) GUIDANCE.— 7 ‘‘(1) IN GENERAL.—Not later than 1 year after 8 the date of enactment of the Health Equity and Ac- 9 countability Act of 2018, the Secretary, acting 10 through the Director, shall issue final guidance for 11 conducting the health impact assessments. In devel- 12 oping such guidance the Secretary shall— 13 ‘‘(A) consult with the Director of the Na- 14 tional Center for Environmental Health and, 15 the Director of the National Center for Chronic 16 Disease Prevention and Health Promotion, and 17 relevant offices within the Department of Hous- 18 ing and Urban Development, the Department of 19 Transportation, and the Department of Agri- 20 culture; and 21 ‘‘(B) consider available international health 22 impact assessment guidance, North American 23 health impact assessment practice standards, 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 783 •S 3660 IS and recommendations from the National Acad- 1 emy of Science. 2 ‘‘(2) CONTENT.—The guidance under this sub- 3 section shall include— 4 ‘‘(A) background on national and inter- 5 national efforts to bridge urban planning and 6 public health institutions and disciplines, in- 7 cluding a review of health impact assessment 8 best practices internationally; 9 ‘‘(B) evidence-based direct and indirect 10 pathways that link land-use planning, transpor- 11 tation, and housing policy and objectives to 12 human health outcomes; 13 ‘‘(C) data resources and quantitative and 14 qualitative forecasting methods to evaluate both 15 the status of health determinants and health ef- 16 fects, including identification of existing pro- 17 grams that can disseminate these resources; 18 ‘‘(D) best practices for inclusive public in- 19 volvement in conducting health impact assess- 20 ments; and 21 ‘‘(E) technical assistance for other agen- 22 cies seeking to develop their own guidelines and 23 procedures for health impact assessment. 24 ‘‘(d) GRANT PROGRAM.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 784 •S 3660 IS ‘‘(1) IN GENERAL.—The Secretary, acting 1 through the Director and in collaboration with the 2 Administrator, shall— 3 ‘‘(A) award grants to States to fund eligi- 4 ble entities for capacity building or to prepare 5 health impact assessments; and 6 ‘‘(B) ensure that States receiving a grant 7 under this subsection further support training 8 and technical assistance for grantees under the 9 program by funding and overseeing appropriate 10 local, State, Tribal, Federal, institution of high- 11 er education, or nonprofit health impact assess- 12 ment experts to provide such technical assist- 13 ance. 14 ‘‘(2) APPLICATIONS.— 15 ‘‘(A) IN GENERAL.—To be eligible to re- 16 ceive a grant under this section, an eligible enti- 17 ty shall— 18 ‘‘(i) be a State, Indian tribe, or tribal 19 organization that includes individuals or 20 populations the health of which are, or will 21 be, affected by an activity or a proposed 22 activity; and 23 ‘‘(ii) submit to the Secretary an appli- 24 cation in accordance with this subsection, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 785 •S 3660 IS at such time, in such manner, and con- 1 taining such additional information as the 2 Secretary may require. 3 ‘‘(B) INCLUSION.—An application under 4 this subsection shall include a list of proposed 5 activities that require or would benefit from 6 conducting a health impact assessment within 7 six months of awarding funds. The list should 8 be accompanied by supporting documentation, 9 including letters of support, from potential con- 10 ductors of health impact assessments for the 11 listed proposed activities. Each application 12 should also include an assessment by the eligi- 13 ble entity of the health of the population of its 14 jurisdiction and describe potential adverse or 15 positive effects on health that the proposed ac- 16 tivities may create. 17 ‘‘(C) PREFERENCE.—Preference in award- 18 ing funds under this section may be given to el- 19 igible entities that demonstrate the potential to 20 significantly improve population health or lower 21 health care costs as a result of potential health 22 impact assessment work. 23 ‘‘(3) USE OF FUNDS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 786 •S 3660 IS ‘‘(A) IN GENERAL.—An entity receiving a 1 grant under this section shall use such grant 2 funds to conduct health impact assessment ca- 3 pacity building or to fund subgrantees in con- 4 ducting a health impact assessment for a pro- 5 posed activity in accordance with this sub- 6 section. 7 ‘‘(B) PURPOSES.—The purposes of a 8 health impact assessment under this subsection 9 are— 10 ‘‘(i) to facilitate the involvement of 11 tribal, State, and local public health offi- 12 cials in community planning, transpor- 13 tation, housing, and land use decisions and 14 other decisions affecting the built environ- 15 ment to identify any potential health con- 16 cern or health benefit relating to an activ- 17 ity or proposed activity; 18 ‘‘(ii) to provide for an investigation of 19 any health-related issue of concern raised 20 in a planning process, an environmental 21 impact assessment process, or policy ap- 22 praisal relating to a proposed activity; 23 ‘‘(iii) to describe and compare alter- 24 natives (including no-action alternatives) to 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 787 •S 3660 IS a proposed activity to provide clarification 1 with respect to the potential health out- 2 comes associated with the proposed activity 3 and, where appropriate, to the related ben- 4 efit-cost or cost-effectiveness of the pro- 5 posed activity and alternatives; 6 ‘‘(iv) to contribute, when applicable, 7 to the findings of a planning process, pol- 8 icy appraisal, or an environmental impact 9 statement with respect to the terms and 10 conditions of implementing a proposed ac- 11 tivity or related mitigation recommenda- 12 tions, as necessary; 13 ‘‘(v) to ensure that the dispropor- 14 tionate distribution of negative impacts 15 among vulnerable populations is minimized 16 as much as possible; 17 ‘‘(vi) to engage affected community 18 members and ensure adequate opportunity 19 for public comment on all stages of the 20 health impact assessment; 21 ‘‘(vii) where appropriate, to consult 22 with local and county health departments 23 and appropriate organizations, including 24 planning, transportation, and housing or- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 788 •S 3660 IS ganizations and providing them with infor- 1 mation and tools regarding how to conduct 2 and integrate health impact assessment 3 into their work; and 4 ‘‘(viii) to inspect homes, water sys- 5 tems, and other elements that pose risks to 6 lead exposure, with an emphasis on areas 7 that pose a higher risk to children. 8 ‘‘(4) ASSESSMENTS.—Health impact assess- 9 ments carried out using grant funds under this sec- 10 tion shall— 11 ‘‘(A) take appropriate health factors into 12 consideration as early as practicable during the 13 planning, review, or decisionmaking processes; 14 ‘‘(B) assess the effect on the health of in- 15 dividuals and populations of proposed policies, 16 projects, or plans that result in modifications to 17 the built environment; and 18 ‘‘(C) assess the distribution of health ef- 19 fects across various factors, such as race, in- 20 come, ethnicity, age, disability status, gender, 21 and geography. 22 ‘‘(5) ELIGIBLE ACTIVITIES.— 23 ‘‘(A) IN GENERAL.—Eligible entities fund- 24 ed under this subsection shall conduct an eval- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 789 •S 3660 IS uation of any proposed activity to determine 1 whether it will have a significant adverse or 2 positive effect on the health of the affected pop- 3 ulation in the jurisdiction of the eligible entity, 4 based on the criteria described in subparagraph 5 (B). 6 ‘‘(B) CRITERIA.—The criteria described in 7 this subparagraph include, as applicable to the 8 proposed activity, the following: 9 ‘‘(i) Any substantial adverse effect or 10 significant health benefit on health out- 11 comes or factors known to influence health, 12 including the following: 13 ‘‘(I) Physical activity. 14 ‘‘(II) Injury. 15 ‘‘(III) Mental health. 16 ‘‘(IV) Accessibility to health-pro- 17 moting goods and services. 18 ‘‘(V) Respiratory health. 19 ‘‘(VI) Chronic disease. 20 ‘‘(VII) Nutrition. 21 ‘‘(VIII) Land use changes that 22 promote local, sustainable food 23 sources. 24 ‘‘(IX) Infectious disease. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 790 •S 3660 IS ‘‘(X) Health disparities. 1 ‘‘(XI) Existing air quality, 2 ground or surface water quality or 3 quantity, or noise levels. 4 ‘‘(XII) Lead exposure. 5 ‘‘(ii) Other factors that may be con- 6 sidered, including— 7 ‘‘(I) the potential for a proposed 8 activity to result in systems failure 9 that leads to a public health emer- 10 gency; 11 ‘‘(II) the probability that the pro- 12 posed activity will result in a signifi- 13 cant increase in tourism, economic de- 14 velopment, or employment in the ju- 15 risdiction of the eligible entity; 16 ‘‘(III) any other significant po- 17 tential hazard or enhancement to 18 human health, as determined by the 19 eligible entity; or 20 ‘‘(IV) whether the evaluation of a 21 proposed activity would duplicate an- 22 other analysis or study being under- 23 taken in conjunction with the pro- 24 posed activity. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 791 •S 3660 IS ‘‘(C) FACTORS FOR CONSIDERATION.—In 1 evaluating a proposed activity under subpara- 2 graph (A), an eligible entity may take into con- 3 sideration any reasonable, direct, indirect, or 4 cumulative effect that can be clearly related to 5 potential health effects and that is related to 6 the proposed activity, including the effect of 7 any action that is— 8 ‘‘(i) included in the long-range plan 9 relating to the proposed activity; 10 ‘‘(ii) likely to be carried out in coordi- 11 nation with the proposed activity; 12 ‘‘(iii) dependent on the occurrence of 13 the proposed activity; or 14 ‘‘(iv) likely to have a disproportionate 15 impact on high-risk or vulnerable popu- 16 lations. 17 ‘‘(6) REQUIREMENTS.—A health impact assess- 18 ment prepared with funds awarded under this sub- 19 section shall incorporate the following, after con- 20 ducting the screening phase (identifying projects or 21 policies for which a health impact assessment would 22 be valuable and feasible) through the application 23 process: 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 792 •S 3660 IS ‘‘(A) SCOPING.—Identifying which health 1 effects to consider and the research methods to 2 be utilized. 3 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 4 Assessing the baseline health status and factors 5 known to influence the health status in the af- 6 fected community, which may include aggre- 7 gating and synthesizing existing health assess- 8 ment evidence and data from the community. 9 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 10 Suggesting changes to proposals to promote 11 positive or mitigate adverse health effects. 12 ‘‘(D) REPORTING.—Synthesizing the as- 13 sessment and recommendations and commu- 14 nicating the results to decisionmakers. 15 ‘‘(E) MONITORING AND EVALUATING.— 16 Tracking the decision and implementation effect 17 on health determinants and health status. 18 ‘‘(7) PLAN.—An eligible entity that is awarded 19 a grant under this section shall develop and imple- 20 ment a plan, to be approved by the Director, for 21 meaningful and inclusive stakeholder involvement in 22 all phases of the health impact assessment. Stake- 23 holders may include community-based organizations, 24 youth-serving organizations, planners, public health 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 793 •S 3660 IS experts, State and local public health departments 1 and officials, health care experts or officials, housing 2 experts or officials, and transportation experts or of- 3 ficials. 4 ‘‘(8) SUBMISSION OF FINDINGS.—An eligible 5 entity that is awarded a grant under this section 6 shall submit the findings of any funded health im- 7 pact assessment activities to the Secretary and make 8 these findings publicly available. 9 ‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en- 10 tity that is awarded a grant under this section shall 11 ensure the assessment of the distribution of health 12 impacts (related to the proposed activity) across 13 race, ethnicity, income, age, gender, disability status, 14 and geography. 15 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 16 greatest extent feasible, a health impact assessment 17 shall be conducted under this section in a manner 18 that respects the needs and timing of the decision- 19 making process it evaluates. 20 ‘‘(11) METHODOLOGY.—In preparing a health 21 impact assessment under this subsection, an eligible 22 entity or partner shall follow the guidance published 23 under subsection (c). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 794 •S 3660 IS ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 1 The Secretary, acting through the Director and in collabo- 2 ration with the Administrator, shall establish, maintain, 3 and make publicly available a health impact assessment 4 database, including— 5 ‘‘(1) a catalog of health impact assessments re- 6 ceived under this section; 7 ‘‘(2) an inventory of tools used by eligible enti- 8 ties to conduct health impact assessments; and 9 ‘‘(3) guidance for eligible entities with respect 10 to the selection of appropriate tools described in 11 paragraph (2). 12 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 13 Secretary shall award competitive grants to Prevention 14 Research Centers, or nonprofit organizations or academic 15 institutions with expertise in health impact assessments 16 to— 17 ‘‘(1) assist grantees with the provision of train- 18 ing and technical assistance in the conducting of 19 health impact assessments; 20 ‘‘(2) evaluate the activities carried out with 21 grants under subsection (d); and 22 ‘‘(3) assist the Secretary in disseminating evi- 23 dence, best practices, and lessons learned from 24 grantees. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 795 •S 3660 IS ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 1 after the date of enactment of the Health Equity and Ac- 2 countability Act of 2018, the Secretary shall submit to 3 Congress a report concerning the evaluation of the pro- 4 grams under this section, including recommendations as 5 to how lessons learned from such programs can be incor- 6 porated into future guidance documents developed and 7 provided by the Secretary and other Federal agencies, as 8 appropriate. 9 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary. 12 ‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 13 TO IMPROVE HEALTH OUTCOMES THROUGH 14 THE BUILT ENVIRONMENT. 15 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 16 in collaboration with the Administrator of the Environ- 17 mental Protection Agency (referred to in this section as 18 the ‘Administrator’), shall award grants to public agencies 19 or private nonprofit institutions to implement evidence- 20 based programming to improve human health through im- 21 provements to the built environment and subsequently 22 human health, by addressing— 23 ‘‘(1) levels of physical activity; 24 ‘‘(2) consumption of nutritional foods; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 796 •S 3660 IS ‘‘(3) rates of crime; 1 ‘‘(4) air, water, and soil quality; 2 ‘‘(5) risk or rate of injury; 3 ‘‘(6) accessibility to health-promoting goods and 4 services; 5 ‘‘(7) chronic disease rates; 6 ‘‘(8) community design; 7 ‘‘(9) housing; or 8 ‘‘(10) other factors, as the Secretary determines 9 appropriate. 10 ‘‘(b) APPLICATIONS.—A public agency or private 11 nonprofit institution desiring a grant under this section 12 shall submit to the Secretary an application at such time, 13 in such manner, and containing such agreements, assur- 14 ances, and information as the Secretary, in consultation 15 with the Administrator, may require. 16 ‘‘(c) RESEARCH.—The Secretary, in consultation 17 with the Administrator, shall support, through grants 18 awarded under this section, research that— 19 ‘‘(1) uses evidence-based research to improve 20 the built environment and human health; 21 ‘‘(2) examines— 22 ‘‘(A) the scope and intensity of the impact 23 that the built environment (including the var- 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 797 •S 3660 IS ious characteristics of the built environment) 1 has on the human health; or 2 ‘‘(B) the distribution of such impacts by— 3 ‘‘(i) location; and 4 ‘‘(ii) population subgroup; 5 ‘‘(3) is used to develop— 6 ‘‘(A) measures and indicators to address 7 health impacts and the connection of health to 8 the built environment; 9 ‘‘(B) efforts to link the measures to trans- 10 portation, land use, and health databases; and 11 ‘‘(C) efforts to enhance the collection of 12 built environment surveillance data; 13 ‘‘(4) distinguishes carefully between personal 14 attitudes and choices and external influences on be- 15 havior to determine how much the association be- 16 tween the built environment and the health of resi- 17 dents, versus the lifestyle preferences of the people 18 that choose to live in the neighborhood, reflects the 19 physical characteristics of the neighborhood; and 20 ‘‘(5)(A) identifies or develops effective interven- 21 tion strategies focusing on enhancements to the built 22 environment that promote increased use physical ac- 23 tivity, access to nutritious foods, or other health-pro- 24 moting activities by residents; and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 798 •S 3660 IS ‘‘(B) in developing the intervention strategies 1 under subparagraph (A), ensures that the interven- 2 tion strategies will reach out to high-risk or vulner- 3 able populations, including low-income urban and 4 rural communities and aging populations, in addi- 5 tion to the general population. 6 ‘‘(d) SURVEYS.—The Secretary may allow recipients 7 of grants under this section to use such grant funds to 8 support the expansion of national surveys and data track- 9 ing systems to provide more detailed information about 10 the connection between the built environment and health. 11 ‘‘(e) PRIORITY.—In awarding grants under this sec- 12 tion, the Secretary and the Administrator shall give pri- 13 ority to entities with programming that incorporates— 14 ‘‘(1) interdisciplinary approaches; or 15 ‘‘(2) the expertise of the public health, physical 16 activity, urban planning, land use, and transpor- 17 tation research communities in the United States 18 and abroad. 19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated such sums as may be 21 necessary to carry out this section. The Secretary may al- 22 locate not more than 20 percent of the amount so appro- 23 priated for a fiscal year for purposes of conducting re- 24 search under subsection (c).’’. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 799 •S 3660 IS SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 1 ENVIRONMENTAL PROTECTION AGENCY. 2 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 3 Administrator of the Environmental Protection Agency 4 (referred to in this section as the ‘‘Administrator’’) shall, 5 as promptly as practicable, carry out each of the following 6 recommendations of the Inspector General of the Environ- 7 mental Protection Agency as described in the report enti- 8 tled ‘‘EPA needs to conduct environmental justice reviews 9 of its programs, policies and activities’’ (Report No. 2006– 10 P–00034): 11 (1) The recommendation that the program and 12 regional offices of the Environmental Protection 13 Agency identify which programs, policies, and activi- 14 ties need environmental justice reviews and the Ad- 15 ministrator require those offices to establish a plan 16 to complete the necessary reviews. 17 (2) The recommendation that the Administrator 18 ensure that the reviews described in paragraph (1) 19 determine whether the programs, policies, and activi- 20 ties may have a disproportionately high and adverse 21 health or environmental impact on minority and low- 22 income populations. 23 (3) The recommendation that each program 24 and regional office of the Environmental Protection 25 Agency develop specific environmental justice review 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 800 •S 3660 IS guidance for conducting environmental justice re- 1 views. 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 promulgating reg- 7 ulations of the Environmental Protection Agency, the Ad- 8 ministrator shall, as promptly as practicable, carry out 9 each of the following recommendations of the Comptroller 10 General of the United States as described in the report 11 entitled ‘‘EPA Should Devote More Attention to Environ- 12 mental Justice when Developing Clean Air Rules’’ (GAO– 13 05–289): 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 the workgroups described in 20 paragraph (1) to identify potential environmental 21 justice issues through steps such as— 22 (A) providing workgroup members with 23 guidance and training to help those members 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 801 •S 3660 IS identify potential environmental justice prob- 1 lems; and 2 (B) involving environmental justice coordi- 3 nators in the workgroups if appropriate. 4 (3) The recommendation that the Administrator 5 improve assessments of potential environmental jus- 6 tice impacts in economic reviews by identifying the 7 data and developing the modeling techniques needed 8 to assess those impacts. 9 (4) The recommendation that the Administrator 10 direct appropriate officers and employees of the En- 11 vironmental Protection Agency, if feasible, to re- 12 spond fully to public comments on environmental 13 justice, including by— 14 (A) improving the explanation by the Ad- 15 ministrator of the basis for any conclusions re- 16 lating to environmental justice; and 17 (B) including in an explanation under sub- 18 paragraph (A) supporting data. 19 (c) 2004 INSPECTOR GENERAL REPORT.— 20 (1) IN GENERAL.—The Administrator shall, as 21 promptly as practicable, carry out each of the fol- 22 lowing recommendations of the Inspector General of 23 the Environmental Protection Agency as described 24 in the report entitled ‘‘EPA Needs to Consistently 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 802 •S 3660 IS Implement the Intent of the Executive Order on En- 1 vironmental Justice’’ (Report No. 2004–P–00007): 2 (A) The recommendation that the Admin- 3 istrator clearly define the mission of the Office 4 of Environmental Justice and provide Environ- 5 mental Protection Agency staff with an under- 6 standing of the roles and responsibilities of that 7 Office. 8 (B) The recommendation that the Admin- 9 istrator— 10 (i) establish, through the issuance of 11 guidance or a policy statement, specific 12 timeframes for the development of defini- 13 tions, goals, and measurements regarding 14 environmental justice; and 15 (ii) provide the regions and program 16 offices a standard and consistent definition 17 for a minority and low-income community, 18 with instructions on how the Environ- 19 mental Protection Agency will implement 20 and put into operation environmental jus- 21 tice in the daily activities of the Environ- 22 mental Protection Agency. 23 (C) The recommendation that the Adminis- 24 trator ensure that the comprehensive training 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 803 •S 3660 IS program under development (as of the date of 1 enactment of this Act) includes standard and 2 consistent definitions of the key environmental 3 justice concepts, such as ‘‘low-income’’, ‘‘minor- 4 ity’’, and ‘‘disproportionately impacted’’, and 5 instructions for implementation of those con- 6 cepts. 7 (2) REPORTS.— 8 (A) INITIAL REPORT.—Not later than 180 9 days after the date of enactment of this Act, 10 the Administrator shall submit to Congress an 11 initial report on the strategy of the Adminis- 12 trator for implementing the recommendations 13 described in subparagraphs (A), (B), and (C) of 14 paragraph (1). 15 (B) SUBSEQUENT REPORTS.—After sub- 16 mitting the initial report under subparagraph 17 (A), the Administrator shall submit to Congress 18 semiannual reports on the progress of the Ad- 19 ministrator in— 20 (i) implementing the recommendations 21 referred to in subparagraph (A); and 22 (ii) modifying the emergency manage- 23 ment procedures of the Administrator to 24 incorporate environmental justice in the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 804 •S 3660 IS Incident Command Structure of the Envi- 1 ronmental Protection Agency, in accord- 2 ance with the December 18, 2006, letter 3 from the Deputy Administrator to the Act- 4 ing Inspector General of the Environ- 5 mental Protection Agency. 6 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 7 PROTECTING PEOPLE AND THEIR FAMILIES FROM 8 RADON.— 9 (1) FINDINGS.—Congress finds that radon is a 10 naturally occurring radioactive gas that is— 11 (A) recognized as the leading cause of lung 12 cancer among nonsmokers; and 13 (B) a particular environmental threat for 14 low-income and minority individuals because of 15 the lack of information about radon levels in 16 the homes of those individuals. 17 (2) IMPLEMENTATION.—Not later than 180 18 days after the date of the enactment of this Act, the 19 Administrator shall implement the action plan enti- 20 tled ‘‘Protecting People and Families from Radon: A 21 Federal Action Plan for Saving Lives’’ (June 20, 22 2011), in consultation with the Director of the Cen- 23 ters for Disease Control and Prevention and any 24 other Federal agencies referred to in the action plan. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 805 •S 3660 IS (3) SPECIFIC STEPS.—In carrying out para- 1 graph (2), the Administrator shall ensure that— 2 (A) the workgroup comprised of the Fed- 3 eral agencies participating in the development 4 of the action plan referred to in paragraph (2) 5 implements specific steps within the existing 6 authority and activities of each Federal agency 7 to reduce exposure to radon; and 8 (B) not later than the date that is 1 year 9 after the date on which the Administrator be- 10 gins implementation of the action plan de- 11 scribed in paragraph (2), the workgroup de- 12 scribed in subparagraph (A) meets to assess 13 and recognize achievements of the plan. 14 (4) REPORT.—After the progress meeting of 15 the workgroup under paragraph (3)(B), the Admin- 16 istrator shall submit to Congress a report on the im- 17 plementation of the action plan described in para- 18 graph (2), including the challenges remaining and 19 the progress in reducing radon exposure, particularly 20 for low-income and minority families. 21 (e) FEDERAL ACTION PLAN FOR PREVENTING 22 CHILDHOOD LEAD POISONING.— 23 (1) FINDINGS.—Congress finds that— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 806 •S 3660 IS (A) the effects of lead poisoning are irre- 1 versible and cost the United States millions an- 2 nually in medical and education costs; 3 (B) the cognitive effects suffered by chil- 4 dren exposed to lead result in a lifetime of 5 health and behavioral problems, which makes 6 prevention efforts more critical; and 7 (C) the risk is especially high for vulner- 8 able minority populations who are more likely 9 to live in older homes, where lead-based paint 10 is more likely to be present. 11 (2) ACTION PLAN.—Not later than 180 days 12 after the date of enactment of this Act, the Adminis- 13 trator, in consultation with the Director of the Cen- 14 ters for Disease Control and Prevention and other 15 relevant Federal agencies, shall develop an action 16 plan to reduce exposure to lead. 17 (3) SPECIFIC STEPS.—In carrying out para- 18 graph (2), the Administrator shall— 19 (A) establish a working group, comprised 20 of representatives of the Federal agencies par- 21 ticipating in the development of the action plan 22 described in paragraph (2), to make rec- 23 ommendations for the implementation of spe- 24 cific steps within the existing authority and ac- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 807 •S 3660 IS tivities of each Federal agency to reduce expo- 1 sure to lead; and 2 (B) assist other Federal agencies in the de- 3 velopment of materials on the hazards of lead- 4 based paint for the purpose of educating ten- 5 ants and landlords, how to recognize potential 6 sources of exposure, and how to remediate those 7 sources. 8 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 9 MENTAL HEALTH IMPROVEMENT ACTIVITIES 10 AND TO IMPROVE SOCIAL DETERMINANTS OF 11 HEALTH. 12 (a) DEFINITIONS.—In this section: 13 (1) DIRECTOR.—The term ‘‘Director’’ means 14 the Director of the Centers for Disease Control and 15 Prevention, acting in collaboration with the Adminis- 16 trator of the Environmental Protection Agency and 17 the Director of the National Institute of Environ- 18 mental Health Sciences. 19 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 20 ty’’ means a State or local community that— 21 (A) bears a disproportionate burden of ex- 22 posure to environmental health hazards; 23 (B) bears a disproportionate burden of ex- 24 posure to unhealthy living conditions, low 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 808 •S 3660 IS standard housing conditions, low socioeconomic 1 status, poor nutrition, less opportunity for edu- 2 cational attainment, disproportionately high un- 3 employment rates, or lower literacy levels; 4 (C) has established a coalition— 5 (i) with not less than 1 community- 6 based organization or demonstration pro- 7 gram; and 8 (ii) with not less than 1— 9 (I) public health entity; 10 (II) health care provider organi- 11 zation; 12 (III) academic institution, includ- 13 ing any minority-serving institution 14 (including a Hispanic-serving institu- 15 tion, a historically black college or 16 university, or a tribal college or uni- 17 versity); 18 (IV) child-serving institution; or 19 (V) landlord or housing provider 20 working on lead remediation; 21 (D) ensures planned activities and funding 22 streams are coordinated to improve community 23 health; and 24 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 809 •S 3660 IS (E) submits an application in accordance 1 with subsection (c). 2 (b) ESTABLISHMENT.—The Director shall establish a 3 grant program under which eligible entities shall receive 4 grants to conduct environmental health improvement ac- 5 tivities and to improve social determinants of health. 6 (c) APPLICATION.—To receive a grant under this sec- 7 tion, an eligible entity shall submit an application to the 8 Director at such time, in such manner, and accompanied 9 by such information as the Director may require. 10 (d) USE OF GRANT FUNDS.—An eligible entity may 11 use a grant under this section— 12 (1) to promote environmental health; 13 (2) to address environmental health disparities 14 among all populations, including children; and 15 (3) to address racial and ethnic disparities in 16 social determinants of health. 17 (e) AMOUNT OF COOPERATIVE AGREEMENT.—The 18 Director shall award grants to eligible entities at the fol- 19 lowing 3 funding levels: 20 (1) LEVEL 1 COOPERATIVE AGREEMENTS.— 21 (A) IN GENERAL.—An eligible entity 22 awarded a grant under this paragraph shall use 23 the funds to identify environmental health prob- 24 lems and solutions by— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 810 •S 3660 IS (i) establishing a planning and 1 prioritizing council in accordance with sub- 2 paragraph (B); and 3 (ii) conducting an environmental 4 health assessment in accordance with sub- 5 paragraph (C). 6 (B) PLANNING AND PRIORITIZING COUN- 7 CIL.— 8 (i) IN GENERAL.—A prioritizing and 9 planning council established under sub- 10 paragraph (A)(i) (referred to in this para- 11 graph as a ‘‘PPC’’) shall assist the envi- 12 ronmental health assessment process and 13 environmental health promotion activities 14 of the eligible entity. 15 (ii) MEMBERSHIP.—Membership of a 16 PPC shall consist of representatives from 17 various organizations within public health, 18 planning, development, and environmental 19 services and shall include stakeholders 20 from vulnerable groups such as children, 21 the elderly, disabled, and minority ethnic 22 groups that are often not actively involved 23 in democratic or decisionmaking processes. 24 (iii) DUTIES.—A PPC shall— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 811 •S 3660 IS (I) identify key stakeholders and 1 engage and coordinate potential part- 2 ners in the planning process; 3 (II) establish a formal advisory 4 group to plan for the establishment of 5 services; 6 (III) conduct an in-depth review 7 of the nature and extent of the need 8 for an environmental health assess- 9 ment, including a local epidemiological 10 profile, an evaluation of the service 11 provider capacity of the community, 12 and a profile of any target popu- 13 lations; and 14 (IV) define the components of 15 care and form essential programmatic 16 linkages with related providers in the 17 community. 18 (C) ENVIRONMENTAL HEALTH ASSESS- 19 MENT.— 20 (i) IN GENERAL.—A PPC shall carry 21 out an environmental health assessment to 22 identify environmental health concerns. 23 (ii) ASSESSMENT PROCESS.—The 24 PPC shall— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 812 •S 3660 IS (I) define the goals of the assess- 1 ment; 2 (II) generate the environmental 3 health issue list; 4 (III) analyze issues with a sys- 5 tems framework; 6 (IV) develop appropriate commu- 7 nity environmental health indicators; 8 (V) rank the environmental 9 health issues; 10 (VI) set priorities for action; 11 (VII) develop an action plan; 12 (VIII) implement the plan; and 13 (IX) evaluate progress and plan- 14 ning for the future. 15 (D) EVALUATION.—Each eligible entity 16 that receives a grant under this paragraph shall 17 evaluate, report, and disseminate program find- 18 ings and outcomes. 19 (E) TECHNICAL ASSISTANCE.—The Direc- 20 tor may provide such technical and other non- 21 financial assistance to eligible entities as the 22 Director determines to be necessary. 23 (2) LEVEL 2 COOPERATIVE AGREEMENTS.— 24 (A) ELIGIBILITY.— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 813 •S 3660 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 (1)). 13 (B) USE OF GRANT FUNDS.—An eligible 14 entity awarded a grant under this paragraph 15 shall use the funds to further activities to carry 16 out environmental health improvement activi- 17 ties, including— 18 (i) addressing community environ- 19 mental health priorities in accordance with 20 paragraph (1)(C)(ii), including— 21 (I) geography; 22 (II) the built environment; 23 (III) air quality; 24 (IV) water quality; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 814 •S 3660 IS (V) land use; 1 (VI) solid waste; 2 (VII) housing; 3 (VIII) crime; 4 (IX) socioeconomic status; 5 (X) ethnicity, social construct 6 and language preference; 7 (XI) educational attainment; 8 (XII) employment; 9 (XIII) food safety; 10 (XIV) nutrition; 11 (XV) health care services; and 12 (XVI) injuries; 13 (ii) building partnerships between 14 planning, public health, and other sectors, 15 including child-serving institutions, to ad- 16 dress how the built environment impacts 17 food availability and access and physical 18 activity to promote healthy behaviors and 19 lifestyles and reduce overweight and obe- 20 sity, musculoskeletal diseases, respiratory 21 conditions, dental, oral and mental health 22 conditions, poverty, and related co- 23 morbidities; 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 815 •S 3660 IS (iii) establishing programs to ad- 1 dress— 2 (I) how environmental and social 3 conditions of work and living choices 4 influence physical activity and dietary 5 intake; or 6 (II) how the conditions described 7 in subclause (I) influence the concerns 8 and needs of people who have im- 9 paired mobility and use assistance de- 10 vices, including wheelchairs, lower 11 limb prostheses, and hip, knee, and 12 other joint replacements; and 13 (iv) convening intervention and dem- 14 onstration programs that examine the role 15 of the social environment in connection 16 with the physical and chemical environ- 17 ment in— 18 (I) determining access to nutri- 19 tional food; 20 (II) improving physical activity to 21 reduce overweight, obesity, and co- 22 morbidities and increase quality of 23 life; and 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 816 •S 3660 IS (III) location and access to med- 1 ical facilities. 2 (3) LEVEL 3 COOPERATIVE AGREEMENTS.— 3 (A) IN GENERAL.—An eligible entity 4 awarded a grant under this paragraph shall use 5 the funds to identify and address racial and 6 ethnic disparities in social determinants of 7 health by creating demonstration programs that 8 assess the feasibility of establishing a federally 9 funded comprehensive program and describe 10 key outcomes that address racial and ethnic dis- 11 parities in social determinants of health. 12 (B) PROGRAM DESIGN.— 13 (i) EVALUATION.—No later than 1 14 year after enactment of this Act, the Di- 15 rector shall evaluate the best practices of 16 existing programs from the private, public, 17 community based, and academically sup- 18 ported initiatives focused on reducing dis- 19 parities in the social determinants of 20 health for racial and ethnic populations. 21 (ii) DEMONSTRATION PROJECTS.— 22 Not later than two years after the date of 23 enactment of this Act, the Director shall 24 implement at least ten demonstration 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 817 •S 3660 IS projects including at least one project for 1 each major racial and ethnic minority 2 group, each of which is unique to the cul- 3 tural and linguistic needs of each of the 4 following groups: 5 (I) Native Americans and Alaska 6 Natives. 7 (II) Asian Americans. 8 (III) African Americans/Blacks. 9 (IV) Hispanic/Latino-Americans. 10 (V) Native Hawaiians and Pacific 11 Islanders. 12 (iii) REPORT TO CONGRESS.—No later 13 than 2 years after the implementation of 14 the initial demonstration projects, the Di- 15 rector shall submit to Congress a report 16 which includes— 17 (I) a description of each dem- 18 onstration project and design; 19 (II) an evaluation of the cost-ef- 20 fectiveness of each project’s preven- 21 tion and treatment efforts; 22 (III) an evaluation of the cultural 23 and linguistic appropriateness of each 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 818 •S 3660 IS project by racial and ethnic group; 1 and 2 (IV) an evaluation of the bene- 3 ficiary’s health status improvement 4 under the demonstration project. 5 (iv) ANY OTHER INFORMATION 6 DEEMED APPROPRIATE BY THE DIREC- 7 TOR.—The Director shall require eligible 8 entities awarded a grant under this para- 9 graph to report any other information the 10 Director determines appropriate to be 11 shared by or developed by such entity, in- 12 cluding the following: 13 (I) Developing models and evalu- 14 ating methods that improve the cul- 15 tural and linguistically appropriate 16 services provided through the Centers 17 for Disease Control and Prevention to 18 target individuals impacted by health 19 disparities based on their race, eth- 20 nicity, and gender. 21 (II) Promoting the collaboration 22 between primary and specialty care 23 health care providers and patients, to 24 ensure patients impacted by health 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 819 •S 3660 IS disparities based on race, ethnicity, 1 and gender are receiving comprehen- 2 sive and organized treatment and 3 care. 4 (III) Educating health care pro- 5 fessionals on the causes and effects of 6 disparities in the social determinants 7 of health as it relates to minority and 8 racial and ethnic communities and the 9 need for culturally and linguistically 10 appropriate care in the prevention and 11 treatment of high-impact diseases. 12 (IV) Encouraging collaboration 13 among community and patient-based 14 organizations which work to address 15 disparities in the social determinants 16 of health as it relates to high-impact 17 diseases in minority and racial and 18 ethnic populations. 19 (f) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this sec- 21 tion— 22 (1) $25,000,000 for fiscal year 2019; and 23 (2) such sums as may be necessary for fiscal 24 years 2020 through 2022. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 820 •S 3660 IS SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 1 BETWEEN THE BUILT ENVIRONMENT AND 2 THE HEALTH OF COMMUNITY RESIDENTS. 3 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 4 section, the term ‘‘eligible institution’’ means a public or 5 private nonprofit institution that submits to the Secretary 6 of Health and Human Services (in this section referred 7 to as the ‘‘Secretary’’) and the Administrator of the Envi- 8 ronmental Protection Agency (in this section referred to 9 as the ‘‘Administrator’’) an application for a grant under 10 the grant program authorized under subsection (b)(2) at 11 such time, in such manner, and containing such agree- 12 ments, assurances, and information as the Secretary and 13 Administrator may require. 14 (b) RESEARCH GRANT PROGRAM.— 15 (1) DEFINITION OF HEALTH.—In this section, 16 the term ‘‘health’’ includes— 17 (A) levels of physical activity; 18 (B) degree of mobility due to factors such 19 as musculoskeletal diseases, arthritis, and obe- 20 sity; 21 (C) consumption of nutritional foods; 22 (D) rates of crime; 23 (E) air, water, and soil quality; 24 (F) risk of injury; 25 (G) accessibility to health care services; 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 821 •S 3660 IS (H) levels of educational attainment; and 1 (I) other indicators as determined appro- 2 priate by the Secretary. 3 (2) GRANTS.—The Secretary, in collaboration 4 with the Administrator, shall provide grants to eligi- 5 ble institutions to conduct and coordinate research 6 on the built environment and its influence on indi- 7 vidual and population-based health. 8 (3) RESEARCH.—The Secretary shall support 9 research that— 10 (A) investigates and defines the causal 11 links between all aspects of the built environ- 12 ment and the health of residents; 13 (B) examines— 14 (i) the extent of the impact of the 15 built environment (including the various 16 characteristics of the built environment) on 17 the health of residents; 18 (ii) the variance in the health of resi- 19 dents by— 20 (I) location (such as inner cities, 21 inner suburbs, and outer suburbs); 22 and 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 822 •S 3660 IS (II) population subgroup (includ- 1 ing children, the elderly, the disadvan- 2 taged); or 3 (iii) the importance of the built envi- 4 ronment to the total health of residents, 5 which is the primary variable of interest 6 from a public health perspective; 7 (C) is used to develop— 8 (i) measures to address health and the 9 connection of health to the built environ- 10 ment; and 11 (ii) efforts to link the measures to 12 travel and health databases; 13 (D) distinguishes carefully between per- 14 sonal attitudes and choices and external influ- 15 ences on observed behavior to determine how 16 much an observed association between the built 17 environment and the health of residents, versus 18 the lifestyle preferences of the people that 19 choose to live in the neighborhood, reflects the 20 physical characteristics of the neighborhood; 21 and 22 (E)(i) identifies or develops effective inter- 23 vention strategies to promote better health 24 among residents with a focus on behavioral 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 823 •S 3660 IS interventions and enhancements of the built en- 1 vironment that promote increased use by resi- 2 dents; and 3 (ii) in developing the intervention strate- 4 gies under clause (i), ensures that the interven- 5 tion strategies will reach out to high-risk popu- 6 lations, including racial and ethnic minorities, 7 low-income urban and rural communities, and 8 children. 9 (4) PRIORITY.—In providing assistance under 10 the grant program authorized under paragraph (2), 11 the Secretary and the Administrator shall give pri- 12 ority to research that incorporates— 13 (A) minority-serving institutions as grant- 14 ees; 15 (B) interdisciplinary approaches; or 16 (C) the expertise of the public health, 17 physical activity, nutrition and health care (in- 18 cluding child health), urban planning, and 19 transportation research communities in the 20 United States and abroad. 21 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 22 TION. 23 (a) FINDINGS.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 824 •S 3660 IS (1) GENERAL FINDINGS.—Congress finds 1 that— 2 (A) humans share an environment with a 3 wide variety of habitats and ecosystems that 4 nurture and sustain a diversity of species; 5 (B) the abundance of natural resources in 6 the environment forms the basis for the econ- 7 omy and has greatly contributed to human de- 8 velopment throughout history; 9 (C) the accelerated pace of human develop- 10 ment over the last several hundred years has 11 significantly impacted— 12 (i) the natural environment and its re- 13 sources; 14 (ii) the health and diversity of plant 15 and animal life; 16 (iii) the availability of critical habi- 17 tats; 18 (iv) the quality of the air and water; 19 and 20 (v) the global climate; 21 (D) the intervention of the Federal Gov- 22 ernment is necessary to minimize and mitigate 23 human impact on the environment— 24 (i) for the benefit of public health; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 825 •S 3660 IS (ii) to maintain air quality and water 1 quality; 2 (iii) to sustain the diversity of plants 3 and animals; 4 (iv) to combat global climate change; 5 and 6 (v) to protect the environment; 7 (E) laws and regulations in the United 8 States have been enacted and promulgated to 9 minimize and mitigate human impact on the en- 10 vironment for the benefit of public health, to 11 maintain air quality and water quality, to sus- 12 tain wildlife, and to protect the environment, in- 13 cluding— 14 (i) chapter 3203 of title 54, United 15 States Code (commonly known as the ‘‘An- 16 tiquities Act of 1906’’), which was initiated 17 by President Theodore Roosevelt to create 18 the National Park System; 19 (ii) the National Environmental Policy 20 Act of 1969 (42 U.S.C. 4321 et seq.); 21 (iii) the Clean Air Act (42 U.S.C. 22 7401 et seq.); 23 (iv) the Federal Water Pollution Con- 24 trol Act (33 U.S.C. 1251 et seq.); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 826 •S 3660 IS (v) the Comprehensive Environmental 1 Response, Compensation, and Liability Act 2 of 1980 (42 U.S.C. 9601 et seq.); 3 (vi) the Endangered Species Act of 4 1973 (16 U.S.C. 1531 et seq.); and 5 (vii) the National Forest Management 6 Act of 1976 (Public Law 94–588; 90 Stat. 7 2949) and the amendments made by that 8 Act; and 9 (F) attempts to repeal or weaken key envi- 10 ronmental safeguards pose dangers to the pub- 11 lic health, air quality, water quality, wildlife, 12 and the environment. 13 (2) FINDINGS ON CHANGES AND PROPOSED 14 CHANGES IN LAW.—Congress finds that, since 2001, 15 the following changes and proposed changes to exist- 16 ing law or regulations have negatively impacted or 17 will negatively impact the environment and public 18 health: 19 (A) CLEAN WATER.— 20 (i) FILL MATERIAL.— 21 (I) On May 9, 2002, the Envi- 22 ronmental Protection Agency and the 23 Corps of Engineers issued a final rule, 24 entitled ‘‘Final Revisions to the Clean 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 827 •S 3660 IS Water Act Regulatory Definitions of 1 ‘Fill Material’ and ‘Discharge of Fill 2 Material’ ’’ (67 Fed. Reg. 31129), 3 that reconciled regulations imple- 4 menting section 404 of the Federal 5 Water Pollution Control Act (33 6 U.S.C. 1344) by redefining the term 7 ‘‘fill material’’ and amending the defi- 8 nition of the term ‘‘discharge of fill 9 material’’, reversing a 25-year-old reg- 10 ulation. 11 (II) The rule described in sub- 12 clause (I)— 13 (aa) fails to restrict the 14 dumping of hardrock mining 15 waste, construction debris, and 16 other industrial wastes into riv- 17 ers, streams, lakes, and wetlands; 18 and 19 (bb) allows destructive 20 mountaintop removal coal mining 21 companies to dump waste into 22 streams and lakes, polluting the 23 surrounding natural habitat and 24 poisoning plants and animals 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 828 •S 3660 IS that depend on those water 1 sources. 2 (ii) LIVESTOCK WASTE REGULA- 3 TIONS.— 4 (I) On February 12, 2003, the 5 Environmental Protection Agency 6 published the rule entitled ‘‘National 7 Pollutant Discharge Elimination Sys- 8 tem Permit Regulation and Effluent 9 Limitation Guidelines and Standards 10 for Concentrated Animal Feeding Op- 11 erations (CAFOs)’’ (68 Fed. Reg. 12 7176), new livestock waste regulations 13 that aimed to control factory farm 14 pollution but which would severely un- 15 dermine then-existing protections 16 under the Federal Water Pollution 17 Control Act (33 U.S.C. 1251 et seq.). 18 (II) The regulation described in 19 subclause (I) allows large-scale animal 20 factories to foul waters in the United 21 States with animal waste, allows live- 22 stock owners to draft their own pollu- 23 tion-management plans and avoid 24 ground water monitoring, legalizes the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 829 •S 3660 IS discharge of contaminated runoff 1 water rich in nitrogen, phosphorus, 2 bacteria, and metals, and ensures that 3 large factory farms are not held liable 4 for the environmental damage they 5 cause. 6 (III) In a 2005 Federal court de- 7 cision, Waterkeeper Alliance, et al. v. 8 Environmental Protection Agency, 9 399 F.3d 486 (2nd Cir. 2005), major 10 parts of the rule were upheld, others 11 vacated, and still others remanded 12 back to the Environmental Protection 13 Agency. 14 (IV) On November 20, 2008, the 15 Environmental Protection Agency 16 published a revised final rule, entitled 17 ‘‘Revised National Pollutant Dis- 18 charge Elimination System Permit 19 Regulation and Effluent Limitations 20 Guidelines for Concentrated Animal 21 Feeding Operations in Response to 22 the Waterkeeper Decision’’ (73 Fed. 23 Reg. 70418), that undermines envi- 24 ronmental protection provisions by re- 25 VerDate Sep 11 2014 20:47 Dec 03, 2018 Jkt 089200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 830 •S 3660 IS moving mandatory permitting require- 1 ments and allowing large animal 2 farms to self-certify the absence of 3 pollutant discharge activity. 4 (iii) TOTAL MAXIMUM DAILY LOAD.— 5 (I) On March 19, 2003, the En- 6 vironmental Protection Agency pub- 7 lished a new rule regarding the total 8 maximum daily load program under 9 section 303(d) of the Federal Water 10 Pollution Control Act (33 U.S.C. 11 1313(d)), entitled ‘‘Withdrawal of Re- 12 visions to the Water Quality Planning 13 and Management Regulation and Re- 14 visions to the National Pollutant Dis- 15 charge Elimination System Program 16 in Support of Revisions to the Water 17 Quality Planning and Management 18 Regulation’’ (68 Fed. Reg. 13608), 19 that regulates the maximum amount 20 of a particular pollutant that can be 21 present in a body of water and still 22 meet water quality standards. 23 (II) The new rule described in 24 subclause (I) withdrew the then-exist- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 831 •S 3660 IS ing regulation issued on July 13, 1 2000, and entitled ‘‘Revisions to the 2 Water Quality Planning and Manage- 3 ment Regulation and Revisions to the 4 National Pollutant Discharge Elimi- 5 nation System Program in Support of 6 Revisions to the Water Quality Plan- 7 ning and Management Regulation’’ 8 (65 Fed. Reg. 43586) and halted mo- 9 mentum in cleaning up polluted wa- 10 terways throughout the United States. 11 (III) By abandoning the then-ex- 12 isting rule, the Environmental Protec- 13 tion Agency is undermining the effec- 14 tiveness of cleanup plans and is allow- 15 ing States to avoid cleaning polluted 16 waters entirely by dropping them from 17 their cleanup lists. 18 (IV) Waterways play a crucial 19 role in the lives of the people of the 20 United States and are critical to the 21 livelihood of fish and wildlife. 22 (V) The result of dropping the 23 rule described in subclause (II) is that 24 the restoration of polluted rivers, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 832 •S 3660 IS shorelines, and lakes will be delayed, 1 harming more fish and wildlife and 2 worsening the quality of drinking 3 water. 4 (iv) WATERS OF THE UNITED 5 STATES.— 6 (I) On December 2, 2008, the 7 Environmental Protection Agency and 8 the Corps of Engineers jointly issued 9 a guidance document, entitled ‘‘Clean 10 Water Act Jurisdiction Following the 11 U.S. Supreme Court’s Decision in 12 Rapanos v. United States & Carabell 13 v. United States’’. 14 (II) The guidance described in 15 subclause (I) dictates enforcement ac- 16 tions under the Federal Water Pollu- 17 tion Control Act (33 U.S.C. 1251 et 18 seq.) and calls for a complicated 19 ‘‘case-by-case’’ analysis to determine 20 jurisdiction for waterways that do not 21 flow all year. 22 (III) Enforcement actions de- 23 scribed in subclause (II) endanger 24 small streams and wetlands that serve 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 833 •S 3660 IS as important habitats for aquatic life, 1 which play a fundamental role in safe- 2 guarding sources of clean drinking 3 water and mitigate the risks and ef- 4 fects of floods and droughts. 5 (IV) The definition provided in 6 the guidance described in subclause 7 (I) for ‘‘waters of the United States’’ 8 is applicable to the Federal Water 9 Pollution Control Act (33 U.S.C. 10 1251 et seq.) as a whole, potentially 11 affecting programs that control indus- 12 trial pollution and sewage levels, pre- 13 vent oil spills, and set water quality 14 standards for all waters in the United 15 States protected under that Act. 16 (B) FORESTS AND LAND MANAGEMENT.— 17 (i) HEALTHY FORESTS RESTORATION 18 ACT OF 2003.— 19 (I) On December 3, 2003, the 20 President signed into law the Healthy 21 Forests Restoration Act of 2003 (16 22 U.S.C. 6501 et seq.) (referred to in 23 this clause as the ‘‘law’’). 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 834 •S 3660 IS (II) Although the law attempts to 1 reduce the risk of catastrophic forest 2 fires, the law provides a boon to tim- 3 ber companies by accelerating the ag- 4 gressive thinning of backcountry for- 5 ests that are located far from at-risk 6 communities. 7 (III) The law allows for increased 8 logging of large, fire-resistant trees 9 that are not in close proximity to 10 homes and communities. 11 (IV) The law undermines critical 12 protections for endangered species by 13 exempting Federal land management 14 agencies from consulting with the 15 United States Fish and Wildlife Serv- 16 ice before approving any action that 17 could harm endangered plants or wild- 18 life. 19 (V) The law limits public partici- 20 pation by reducing the number of en- 21 vironmental reviews for projects car- 22 ried out under the law. 23 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 835 •S 3660 IS (ii) NFS LAND MANAGEMENT PLAN- 1 NING FINAL PLANNING RULE AND RECORD 2 OF DECISION.— 3 (I) On April 21, 2008, the Sec- 4 retary of Agriculture issued a final 5 rule entitled ‘‘National Forest System 6 Land Management Planning’’ (73 7 Fed. Reg. 21486 (April 21, 2008)) 8 (referred to in this clause as the ‘‘re- 9 vised rule’’). 10 (II) The revised rule is a revision 11 of a similar final rule entitled ‘‘Na- 12 tional Forest System Land Manage- 13 ment Planning’’ (70 Fed Reg. 1022 14 (January 5, 2005)), which the United 15 States District Court for the Northern 16 District of California remanded to the 17 Secretary of Agriculture in the case 18 styled Citizens for Better Forestry v. 19 United States Department of Agri- 20 culture (481 F. Supp. 2d 1059 (N.D. 21 Cal. 2007)) for violating— 22 (aa) the National Environ- 23 mental Policy Act of 1969 (42 24 U.S.C. 4321 et seq.); 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 836 •S 3660 IS (bb) the Endangered Species 1 Act of 1973 (16 U.S.C. 1531 et 2 seq.); and 3 (cc) subchapter II of chapter 4 5, and chapter 7, of title 5, 5 United States Code (commonly 6 known as the ‘‘Administrative 7 Procedure Act’’). 8 (III) The revised rule eliminates 9 strict forest planning standards estab- 10 lished in 1982. 11 (IV) The revised rule opens mil- 12 lions of acres of public land to dam- 13 aging and invasive logging, mining, 14 and drilling operations. 15 (V) The revised rule would re- 16 verse more than 20 years of protec- 17 tions for wildlife and national forests 18 by— 19 (aa) removing the overall 20 goal of ensuring ecological sus- 21 tainability in managing the Na- 22 tional Forest System; 23 (bb) weakening the effect of 24 the National Forest Management 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 837 •S 3660 IS Act of 1976 (Public Law 94–588; 1 90 Stat. 2949) and the amend- 2 ments made by that Act; and 3 (cc) effectively ending the 4 review of forest management 5 plans under the National Envi- 6 ronmental Policy Act of 1969 (42 7 U.S.C. 4321 et seq.). 8 (iii) INVENTORIED ROADLESS AREA 9 RULES.— 10 (I) On September 20, 2006, the 11 United States District Court for the 12 Northern District of California va- 13 cated the final rule entitled ‘‘Special 14 Areas; State Petitions for Inventoried 15 Roadless Area Management’’ (70 Fed. 16 Reg. 25654 (May 13, 2005)) (referred 17 to in this clause as the ‘‘2005 rule’’), 18 which gave each Governor of a State 19 18 months to petition the Federal 20 Government— 21 (aa) to restore the inven- 22 toried roadless area rules applica- 23 ble to the State of the Governor 24 before the effective date of the 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 838 •S 3660 IS final rule entitled ‘‘Special Areas; 1 Roadless Area Conservation’’ (66 2 Fed. Reg. 3244 (January 12, 3 2001)) (referred to in this clause 4 as the ‘‘2001 rule’’); or 5 (bb) to submit a new man- 6 agement and development plan 7 for National Forest System 8 inventoried roadless areas within 9 the State. 10 (II) Despite the enjoinment of 11 the 2005 rule and the subsequent res- 12 toration of the 2001 rule, the Forest 13 Service has continued to allow States 14 to petition for a special rule under the 15 authority of section 553(e) of title 5, 16 United States Code, and has issued a 17 final rule entitled ‘‘Special Areas; 18 Roadless Area Conservation; Applica- 19 bility to the National Forests in 20 Idaho’’ (73 Fed. Reg. 61456 (October 21 16, 2008)). 22 (III) As a result, 58,500,000 23 acres of wild National Forest System 24 land are still vulnerable to logging, 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 839 •S 3660 IS road building, and other developments 1 that may fragment natural habitats 2 and negatively impact fish and wild- 3 life. 4 (iv) BLM RESOURCE MANAGEMENT 5 PLANS.— 6 (I) On November 28, 2008, the 7 Bureau of Land Management an- 8 nounced the record of decision entitled 9 ‘‘Record of Decision for Oil Shale and 10 Tar Sands Resources to Address 11 Land Use Allocations in Colorado, 12 Utah, and Wyoming’’ (73 Fed. Reg. 13 72519 (November 28, 2008)), which 14 amended 12 resource management 15 plans in the States of Colorado, Utah, 16 and Wyoming, opening 2,000,000 17 acres of public land to commercial tar 18 sands and oil shale exploration and 19 development. 20 (II) On November 18, 2008, the 21 Bureau of Land Management issued 22 the final rule entitled ‘‘Oil Shale Man- 23 agement—General’’ (73 Fed. Reg. 24 69414 (November 18, 2008)), setting 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 840 •S 3660 IS the policies and procedures for a com- 1 mercial leasing program for the man- 2 agement of federally owned oil shale 3 in the States referred to in subclause 4 (I). 5 (III) Previously barred by a con- 6 gressional moratorium on the com- 7 mercial leasing regulations for oil 8 shale until September 30, 2008, the 9 development of oil shale on public 10 land poses a serious threat to land 11 conservation, endangered and threat- 12 ened species, and critical habitat. 13 (IV) Domestic shale oil produc- 14 tion authorized by the final rules de- 15 scribed in subclauses (I) and (II)— 16 (aa) is water- and energy-in- 17 tensive; and 18 (bb) will intensify existing 19 water scarcity in the arid West- 20 ern United States and potentially 21 degrade air and water quality for 22 surrounding populations. 23 (C) SCIENTIFIC REVIEW.— 24 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 841 •S 3660 IS (i) On December 16, 2008, the United 1 States Fish and Wildlife Service and the 2 National Marine Fisheries Service jointly 3 issued a new rule, entitled ‘‘Interagency 4 Cooperation Under the Endangered Spe- 5 cies Act’’ (73 Fed. Reg. 76272) amending 6 regulations governing interagency coopera- 7 tion under section 7 of the Endangered 8 Species Act of 1973 (16 U.S.C. 1536). 9 (ii) The rule described in clause (i) 10 undermines the intention of the Endan- 11 gered Species Act (16 U.S.C. 1531 et seq.) 12 to protect species and the ecosystems on 13 which those species depend by allowing 14 Federal agencies to carry out, permit, or 15 fund an action without proper environ- 16 mental review and expert third-party con- 17 sultation from Federal wildlife experts. 18 (iii) Under the rule described in 19 clause (i), Federal agencies can unilaterally 20 circumvent the formal review process, 21 eliminating longstanding and scientifically 22 grounded safeguards that serve to protect 23 the biodiversity of ecosystems in the 24 United States and avert harm to thou- 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00841 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 842 •S 3660 IS sands of endangered and threatened spe- 1 cies. 2 (b) STATEMENT OF POLICY.—It is the policy of the 3 Federal Government to work in conjunction with States, 4 territories, Tribal governments, international organiza- 5 tions, and foreign governments as a steward of the envi- 6 ronment for the benefit of public health, to maintain air 7 quality and water quality, to sustain the diversity of plant 8 and animal species, to combat global climate change, and 9 to protect the environment for future generations. 10 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 11 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 12 TIONS, LAWS, OR PROPOSED LAWS.— 13 (1) STUDY.—Not later than 30 days after the 14 date of enactment of this Act, the President shall 15 enter into an arrangement under which the National 16 Academy of Sciences shall conduct a study to deter- 17 mine the impact on public health, air quality, water 18 quality, wildlife, and the environment of the fol- 19 lowing regulations, laws, and proposed laws: 20 (A) CLEAN WATER.— 21 (i) The final rule of the Environ- 22 mental Protection Agency and the Corps of 23 Engineers entitled ‘‘Final Revisions to the 24 Clean Water Act Regulatory Definitions of 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 843 •S 3660 IS ‘Fill Material’ and ‘Discharge of Fill Mate- 1 rial’ ’’ (67 Fed. Reg. 31129 (May 9, 2 2002)). 3 (ii) The final rule of the Environ- 4 mental Protection Agency entitled ‘‘Re- 5 vised National Pollutant Discharge Elimi- 6 nation System Permit Regulation and Ef- 7 fluent Limitations Guidelines for Con- 8 centrated Animal Feeding Operations in 9 Response to the Waterkeeper Decision’’ 10 (73 Fed. Reg. 70418 (November 20, 11 2008)). 12 (iii) The final rule entitled ‘‘With- 13 drawal of Revisions to the Water Quality 14 Planning and Management Regulation and 15 Revisions to the National Pollutant Dis- 16 charge Elimination System Program in 17 Support of Revisions to the Water Quality 18 Planning and Management Regulation’’ 19 (68 Fed. Reg. 13608 (March 19, 2003)). 20 (iv) The guidance document of the 21 Environmental Protection Agency and the 22 Corps of Engineers entitled ‘‘Clean Water 23 Act Jurisdiction Following the U.S. Su- 24 preme Court’s Decision in Rapanos v. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 844 •S 3660 IS United States & Carabell v. United States’’ 1 (December 2, 2008). 2 (B) FORESTS AND LAND MANAGEMENT.— 3 (i) The Healthy Forests Restoration 4 Act of 2003 (16 U.S.C. 6501 et seq.). 5 (ii) The application of section 553(e) 6 of title 5, United States Code, such that a 7 State may petition for a special rule for 8 the National Forest System inventoried 9 roadless areas within the State. 10 (iii) The final rule entitled ‘‘National 11 Forest System Land Management Plan- 12 ning’’ (73 Fed. Reg. 21486 (April 21, 13 2008)). 14 (iv) The final rule entitled ‘‘Oil Shale 15 Management—General’’ (73 Fed. Reg. 16 69414 (November 18, 2008)). 17 (v) The record of decision entitled 18 ‘‘Record of Decision for Oil Shale and Tar 19 Sands Resources To Address Land Use Al- 20 locations in Colorado, Utah, and Wyo- 21 ming’’ (73 Fed. Reg. 72519 (November 22 28, 2008)). 23 (C) SCIENTIFIC REVIEW.—The final rule 24 of the United States Fish and Wildlife Service 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00844 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 845 •S 3660 IS and the National Marine Fisheries Service enti- 1 tled ‘‘Interagency Cooperation Under the En- 2 dangered Species Act’’ (73 Fed. Reg. 76272 3 (December 16, 2008)). 4 (2) METHOD.—In conducting the study under 5 paragraph (1), the National Academy of Sciences 6 may use and compare existing scientific studies re- 7 garding the regulations, laws, and proposed laws de- 8 scribed in paragraph (1). 9 (3) REPORT.—Not later than 270 days after 10 the date on which the President enters into the ar- 11 rangement under paragraph (1), the National Acad- 12 emy of Sciences shall make publicly available and 13 shall submit to the Congress and to the head of each 14 department and agency of the Federal Government 15 that issued, implements, or would implement a regu- 16 lation, law, or proposed law described in paragraph 17 (1), a report that includes— 18 (A) a description of the impact of each 19 regulation, law, or proposed law described in 20 paragraph (1) on public health, air quality, 21 water quality, wildlife, and the environment, 22 compared to the impact of preexisting regula- 23 tions, or laws in effect, as applicable, includ- 24 ing— 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00845 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 846 •S 3660 IS (i) any negative impacts to air quality 1 or water quality; 2 (ii) any negative impacts to wildlife; 3 (iii) any delays in hazardous waste 4 cleanup that are projected to be hazardous 5 to public health; and 6 (iv) any other negative impact on pub- 7 lic health or the environment; and 8 (B) any recommendations that the Na- 9 tional Academy of Sciences considers appro- 10 priate to maintain, restore, or improve in whole 11 or in part protections for public health, air 12 quality, water quality, wildlife, and the environ- 13 ment for each of the regulations, laws, and pro- 14 posed laws described in paragraph (1), which 15 may include recommendations for the adoption 16 of any regulation or law in place or proposed 17 prior to January 1, 2001. 18 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 19 ING RULES, REGULATIONS, OR LAWS.—Not later than 20 180 days after the date on which the report is submitted 21 pursuant to subsection (c)(3), the head of each depart- 22 ment or agency that has issued or implemented a regula- 23 tion or law described in subsection (c)(1) shall submit to 24 Congress a plan describing the steps the department or 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00846 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 847 •S 3660 IS agency will take, or has taken, to restore or improve pro- 1 tections for public health and the environment in whole 2 or in part that were in existence prior to the issuance of 3 the applicable regulation or law. 4 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 5 WATER HORIZON OIL RIG EXPLOSION IN THE 6 GULF COAST. 7 (a) STUDY.—The Comptroller General of the United 8 States (referred to in this section as the ‘‘Comptroller 9 General’’) shall conduct a study on the type and scope of 10 health care services administered through the Department 11 of Health and Human Services addressing the provision 12 of health care to racial and ethnic minorities, including 13 residents, cleanup workers, and volunteers, affected by the 14 blowout and explosion of the mobile offshore drilling unit 15 Deepwater Horizon that occurred on April 20, 2010, and 16 resulting hydrocarbon releases into the environment. 17 (b) SPECIFIC COMPONENTS.—In carrying out sub- 18 section (a), the Comptroller General shall— 19 (1) assess the type, size, and scope of programs 20 administered by the Secretary of Health and Human 21 Services that focus on the provision of health care 22 to communities on the Gulf Coast; 23 (2) identify the merits and disadvantages asso- 24 ciated with each of the programs; 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00847 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 848 •S 3660 IS (3) perform an analysis of the costs and bene- 1 fits of the programs; and 2 (4) determine whether there is any duplication 3 of programs. 4 (c) REPORT.—Not later than 180 days after the date 5 of enactment of this Act, the Comptroller General shall 6 submit to Congress a report that includes— 7 (1) the findings of the study conducted under 8 subsection (a); and 9 (2) recommendations for improving access to 10 health care for racial and ethnic minorities. 11 Subtitle B—Gun Violence 12 SEC. 1011. FINDINGS. 13 Congress finds as follows: 14 (1) On average, 86 Americans are killed by 15 guns each day. 16 (2) An estimated 15,549 people were killed by 17 guns in 2017, not including suicides. 18 (3) Gun violence disproportionately affects com- 19 munities of color, especially African Americans (who 20 comprise around 14 percent of the United States 21 population but account for more than half the coun- 22 try’s gun homicide victims). 23 (4) On average, there is more than one mass 24 shooting each day in the United States. 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00848 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 849 •S 3660 IS SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE 1 CENTERS FOR DISEASE CONTROL AND PRE- 2 VENTION. 3 (a) IN GENERAL.—Section 391 of the Public Health 4 Service Act (42 U.S.C. 280b) is amended— 5 (1) in subsection (a)(1), by striking ‘‘research 6 relating to the causes, mechanisms, prevention, diag- 7 nosis, treatment of injuries, and rehabilitation from 8 injuries;’’ and inserting ‘‘research, including data 9 collection, relating to— 10 ‘‘(A) the causes, mechanisms, prevention, 11 diagnosis, and treatment of injuries, including 12 with respect to gun violence; and 13 ‘‘(B) rehabilitation from such injuries;’’; 14 and 15 (2) by adding at the end the following new sub- 16 section: 17 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON- 18 TROL.—Nothing in this section shall be construed to— 19 ‘‘(1) authorize the Secretary to give assistance, 20 make grants, or enter into cooperative agreements or 21 contracts for the purpose of advocating or promoting 22 gun control; or 23 ‘‘(2) permit a recipient of any assistance, grant, 24 cooperative agreement, or contract under this section 25 to use such assistance, grant, agreement, or contract 26 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00849 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 850 •S 3660 IS for the purpose of advocating or promoting gun con- 1 trol.’’. 2 SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 3 The Secretary of Health and Human Services, acting 4 through the Director of the Centers for Disease Control 5 and Prevention, shall improve, particularly through the in- 6 clusion of additional States, the National Violent Death 7 Reporting System, as authorized by sections 301(a) and 8 391(a) of the Public Service Health Act (42 U.S.C. 9 241(a), 280(b)). Participation in the system by the States 10 shall be voluntary. 11 SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON 12 PUBLIC HEALTH. 13 Not later than one year after the date of the enact- 14 ment of this Act, and annually thereafter, the Surgeon 15 General shall submit to Congress a report on the effects 16 on public health, including mental health, of gun violence 17 in the United States during the preceding year, and the 18 status of actions taken to address such effects. 19 SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON 20 MENTAL HEALTH IN MINORITY COMMU- 21 NITIES. 22 Not later than one year after the date of the enact- 23 ment of this Act, the Deputy Assistant Secretary for Mi- 24 nority Health in the Office of the Secretary of Health and 25 VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00850 Fmt 6652 Sfmt 6201 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS 851 •S 3660 IS Human Services shall submit to the Congress a report on 1 the effects of gun violence on public health, including men- 2 tal health, in minority communities in the United States, 3 and the status of actions taken to address such effects. 4 Æ VerDate Sep 11 2014 04:01 Nov 28, 2018 Jkt 089200 PO 00000 Frm 00851 Fmt 6652 Sfmt 6301 E:\BILLS\S3660.IS S3660 dlhill on DSK3GLQ082PROD with BILLS